When a couple is not successful at achieving pregnancy after a full year of unprotected intercourse, both partners should undergo a thorough physical and medical assessment with a fertility specialist. Using clues from this comprehensive evaluation the physician can suggest appropriate tests to diagnosis the fertility problem. Seeing a physician who specializes in fertility can pinpoint the problem more quickly and will often avoid unnecessary tests and save money. Over Three million couples in the U.S. are evaluated for infertility yearly, by fertility specialists.
At this first comprehensive appointment with the fertility specialist, the physician will review the patient’s menstrual history, pregnancy history, past birth control measures, past fertility treatments, current and past sexual history, surgical history, medications, and general health. In addition, the fertility specialist will inquire about lifestyle habits such as smoking, alcohol and illicit drug use. The male partner will need to provide a list of medications currently used, a general health history, surgical history, a history of any past fertility treatments.
The second step of the workup involves a physical exam. The doctor will examine the female partner. In addition, a pelvic ultrasound is performed to check for uterine and ovarian problems.
After the initial visit, the fertility specialist will schedule the initial testing to evaluate the sperm, egg quality, ovulation, tubal patency, and uterine shape.
One of the first things the fertility specialist will want to know is about the egg quality. Evaluation of the number and quality of your eggs is referred to as ovarian reserve testing. Ovarian reserve testing is done to assess a women’s ability to produce eggs that will ultimately produce a healthy baby. The 3 most common blood tests obtained to figure out about egg quality are FSH (measures follicle-stimulating hormone), estradiol (measures estrogen), and AMH (Anti-mullerian Hormone). These tests are typically drawn on Day 2, 3 or 4 of the menstrual cycle. The AMH level is the most important of these three tests, and is the best predictor of success with fertility therapy.
Often an ultrasound is also performed to assess ovarian reserve. The antral follicle count is performed with a transvaginal ultrasound to count the number of eggs currently visible by ultrasound. When an average to high number of antral follicles (10 or more) are visible on the ultrasound, fertility specialists expect better success with fertility therapy.
Next, tests to assess the uterus shape and fallopian tubes are performed. A Hysterosalpingogram (HSG) is a special imaging procedure of the uterus and fallopian tubes. X-ray dye or saline is injected into the uterus and tubes from a catheter placed on the cervix. While the dye or saline is injected, the doctor takes pictures and assesses for blockages. This test can be done with X-rays or by ultrasound.
For men, a semen analysis is the most important test. The semen analysis requires abstinence from intercourse for two to five days before collecting a sample into a sterile specimen container. After collection, the semen sample is examined in a laboratory for the sperm count, motility and percentage of sperm with a normal shape. Men are advised to avoid smoking, excessive drinking, illegal drugs, maintain a healthy weight, and stay out of sources of excessive heat (like tubs and saunas) that can reduce the sperm count. If the semen analysis is abnormal, pregnancy may still be possible through intrauterine insemination or in vitro fertilization. It is important to note, if sperm abnormalities are detected, the semen analysis will be repeated in four weeks, to help determine if the abnormalities are permanent or temporary.