The frustration that comes with trying but failing to get pregnant is real. On top of this, you likely feel helpless to correct your own body. At a certain point, it’s time to set aside your pride and ask for help. An infertility evaluation from the professionals at Aurora OB-GYN in San Antonio, TX, can pinpoint the cause for concern and pave the path to an individualized treatment plan.
What Tests Are Usually in an Infertility Evaluation?
If you’re under age 35 and have been trying for one consecutive year to get pregnant, an infertility evaluation should be performed to understand your reproductive health. An evaluation should be performed at six months for women over age 35.
The best place to start is with a full review of your medical history. You can expect a series of questions about previous obstetric, gynecological, and medical conditions as well as surgeries. We’ll also want to know about your current lifestyle, such as whether or not you smoke and drink alcohol.
A Physical Exam
Records from past fertility doctors you’ve met with can likewise help fill in the missing pieces. We want a complete picture of your overall health because reproduction involves the entire body. With that in mind, a physical exam that includes a pelvic ultrasound may also be performed.
The ultrasound will focus on your uterus, fallopian tubes, and ovaries to easily identify abnormalities. For instance, pelvic scarring like that caused by an ovary stuck to the uterus will show during an ultrasound. We can also see the uterine shape in more detail and determine if the fallopian tubes are open or blocked.
Identifying the Ovarian Reserve
Infertility is often caused by a lack of high-quality eggs, a factor that becomes even more common as a woman ages. While egg quality deteriorates at different rates for all women, it’s an important place to start in any infertility evaluation.
A woman is born with her lifetime supply of eggs already present in the ovaries. These are continually lost with menstruation until a woman reaches menopause – a time marked by an empty ovarian reserve. Women who have undergone ovarian surgery or are over the age of 37 are more likely to grapple with infertility because of a smaller ovarian reserve.
Time to Explain
The term ovarian reserve is used to identify a woman’s remaining egg supply. A woman’s fertility largely depends on her eggs’ quality and quantity. When all other fertility factors have been examined, ovarian reserve counts as the most important signal of a woman’s likelihood of getting pregnant. Generally speaking, consistent menstruation points to normal ovulation.
On the other hand, regularly missed or altogether absent periods mean a woman is only occasionally ovulating. Human reproduction is much less efficient than you might think; even healthy couples have only a 20% chance of conceiving during a menstrual cycle. Inconsistent ovulation therefore means even fewer opportunities to become pregnant and more difficulty in appropriately timing intercourse.
The Testing Methods
Hormone levels can be measured to determine ovarian reserve, the main ones being follicle-stimulating hormone, anti-Mullerian hormone, and estradiol. We test the blood on the second or third day of menstrual flow to gain the most accurate measurement possible.
A vaginal ultrasound can also be used to find, measure, and count antral follicles. Small in size, these follicles each contain an egg with the potential to be released during ovulation. If only a few antral follicles are detected with the ultrasound, it’s reasonable to believe corresponding egg numbers are similarly low.
One of the most important aspects of infertility evaluation is finding whether or not you ovulate. This can be done in a variety of ways, such as by recording and examining basal body temperature. The process is simple:
- You use an oral thermometer to take your temperature before leaving bed each morning
- We’ll review this information after you’ve charted your temperature over a given time period
- A dip in temperature often occurs just before your ovary releases an egg
- Your temperature then rises and stays up for several days after the egg’s release
You can use this information to track your cycle and identify ovulation. Because the changes in temperature are slight, using a basal thermometer that measures to tenths of a degree is helpful. This variety is also faster and more exact than traditional thermometers.
These kits are quite simple to use. They detect luteinizing hormone (LH) in the urine that commonly occurs 12 to 24 hours before ovulation. Conversely, these kits can also be used to detect a problem with ovulation; when the test persistently fails to show LH, a different course of action is likely needed.
Measuring Serum Progesterone
The ovaries secrete high quantities of serum progesterone after ovulation. A laboratory test can confirm the presence of this serum and, in turn, identify ovulation.
During a healthy menstrual cycle, the lining of the uterus (endometrium) grows thicker in preparation for embryo implantation and growth. This effect is the result of estrogen and progesterone released by the ovaries throughout the ovulatory cycle.
An endometrial biopsy can help evaluate the endometrium’s ability to respond to progesterone. If this ability is found lacking, we know the uterus does not properly prepare for implantation. To ensure the biopsy’s success, a specimen is obtained on roughly day 26 of your cycle and sent to a pathologist for review. The goal is to determine if the ovary and uterine lining are in sync.
Throughout this conversation, we’ve focused on evaluating women for causes of infertility. But a semen analysis is a critical component of this overall study and should be done before prescribing any treatments. One-third of infertility cases relate to the male partner, another one-third involve the female partner, and the remaining third is either inexplicable or involves both partners.
Even when a fertility concern is identified in a female partner, the male should still undergo a semen analysis. This is commonly referred to as a sperm count but involves much more. If a defect is found in any of the following categories, therapy can be immediately administered to help resolve infertility:
- Semen ejaculate volume
- Total sperm number
- Sperm concentration and motility
- Viability (percentage of live sperm)
- Morphology (shape of sperm cells)
- Semen pH
Various blood tests can also be run on men and women to measure testosterone, progesterone, and estrogen – among other hormones. Women who have experienced two or more miscarriages may need additional tests to look for a lupus anticoagulant and/or anti-cardiolipin antibody.
Finally, a laparoscopy can help identify possible causes of infertility. This surgical procedure is usually performed as the last step in an infertility evaluation and involves inserting a fiber-optic tube attached to a light and video camera through incisions in the belly button. The process takes between 30 and 45 minutes and, as the surgeon sees the interior of your pelvic cavity on a video screen, he or she looks for signs of :
- Ovarian and uterine abnormalities
- Scar tissue
- Blocked fallopian tubes
- Fibroid tumors
The Potential for Correction
In some cases, any concerns detected can be corrected during the procedure. For instance, the surgeon can instantly remove fibroids, scar tissue, or endometrial tissue implanted incorrectly outside the uterus. Once the procedure is complete, incisions are closed with a few stitches and a re-evaluation is scheduled for a later date.
It’s important to remember infertility is not a disease. Nor is it a hopeless situation. People in nearly all cultures and societies experience infertility, a concern that affects up to 15% of couples of reproductive age. The number of couples seeking treatment for infertility has risen dramatically in recent years because of factors like:
- Waiting until later in life to have children
- Development of new treatment techniques
- Increased awareness of available services
We’ve also gathered more information on the psychological impacts of infertility, which include social isolation, sexual dysfunction, marital issues, anxiety, depression, and anger. While many people associate these emotions with women, they’re experienced equally by men. Both also undergo a lost sense of identity and actually feel incompetent because, as everyone around them seemingly becomes pregnant, they cannot.
Thanks to technology, hormone imbalances, a lack of ovulation, and low sperm counts are no longer the end of the story. Fertility treatments are numerous and diverse, allowing you and a member of our staff to choose the one that best meets your needs. Sometimes, only the male or female needs treatment, while other cases require both partners to use a combination of treatments together.
It’s true that medications can be administered to correct hormone imbalances and encourage ovulation. When needed, these can be combined with minor surgical procedures. Intrauterine insemination (IUI) and in vitro fertilization (IVF) are additional options that can be explored.
IUI essentially gives sperm a head start by placing them directly inside a woman’s uterus. This eases the processes of fertilization and increases the number of sperm that make it to the fallopian tubes. A sperm must still, however, fertilize an egg on its own. IUI works well with:
- Decreased sperm mobility or low sperm counts
- Unexplained infertility
- Ejaculation dysfunction
- A hostile cervical condition
- Cervical scar tissue
In Vitro Fertilization
IVF, like IUI, is a component of assisted reproductive technology (ART). With this treatment, eggs are extracted and a sperm sample retrieved; an egg and sperm are then manually combined in a laboratory dish. The resulting embryo is transferred to the uterus for implantation. With refined techniques and more experienced providers, IVF is becoming increasingly successful in helping couples become pregnant.
Once more, IVF can be a great option in cases of unexplained infertility. It can also help overcome:
- Blocked or damaged fallopian tubes
- Ovulation disorders or failure
- Uterine fibroids
- Male infertility
- Genetic disorders
Donor sperm and donor eggs can also be used, especially for same-sex couples or single people who want a baby. Gestational carriers and cryopreservation (freezing eggs, sperm, or embryos) provide additional options. The best way to explore infertility treatments is by speaking to a member of our staff. We’ll need to first conduct the infertility evaluation, but from there, we’ll explore ways to help you realize your dreams of becoming parents.
A Caring and Gentle Environment
We understand that having a family is a priority for you and your partner. That’s why we’ve created a caring, gentle environment in which you can freely discuss concerns and ask questions. A number of tests exist to help us pinpoint infertility causes, and treatment options have only become more sophisticated with time. Schedule your consultation today by calling Aurora OB-GYN in San Antonio, TX.