AN ESSENTIAL BEGINNING
It’s always surprising to us when we do our initial infertility evaluation with a new patient who has seen one or more fertility specialists and they have no idea why they’re infertile. Many have no or only a vague idea, while others have been told they have unexplained infertility.
Yes, there are some patients with true “unexplained infertility,” but they are relatively rare. We estimate that with a proper infertility evaluation only about 5% of patients fall into that mysterious category.
Understanding the reason for infertility is not essential for successfully treating it, but it is very helpful. Our advice? Make sure you ask and make sure that you receive an answer for why that fertility specialist thinks you’re infertile.
Below are some of the many procedures in our infertility evaluation that we do to determine the cause(s) for infertility. There are several other more advanced tests that we do to assess more difficult cases. If you need one or more of them, we will discuss them with you in detail.
For some patients, the journey ends soon after completing diagnostics. Many find themselves pregnant after relatively simple medication or surgical treatments that restore fertility. For those requiring more advanced treatments, we offer the full range of advanced reproductive technology options.
Here, you provide answers to basic medical questions. This gives us detailed information about your general and reproductive health, as well as the health of your relatives. To get the most out of your initial consult appointment, your history information should be provided/uploaded before your first appointment.
The history you provide gives us a chance to see if there are any health problems or inherited traits that might contribute to infertility or miscarriage.
Your physical will generally be a focused exam (by ultrasound), as well as some blood tests.
The physical tell us if your general health is appropriate to permit fertility treatment safely. If a health concern is identified during the physical, it alerts us to potential risks you might be facing during your treatment or pregnancy.
Male Fertility Evaluation
A semen sample is provided to our office for a semen analysis. Sperm are analyzed under a microscope for basic testing. If sperm DNA fragmentation is suspected, more detailed testing will be performed by our research colleagues off site.
A basic semen analysis gives information on sperm count, motility, and cell shape. With a more advanced analysis (SCSA), the percentage of sperm that might have fragmented nuclear DNA can be measured.
A series of blood tests are performed at our office (sometimes these need to be done on specific days of the menstrual cycle).
Hormone assessments can identify abnormalities in pituitary, thyroid or adrenal function, as well as give indications of any disturbance in ovarian activity.
Ovarian Reserve Test
A blood test performed at our office to measure anti-Müllerian hormone (AMH) levels. Because these levels remain relatively constant throughout your cycle, AMH can be checked on any day of the month.
AMH is a substance produced by the granulosa cells within the ovaries. AMH blood levels reflect the size of your remaining egg supply. This test can help estimate “ovarian age,” which is the most important factor affecting the chance to achieve pregnancy.
This is a special kind of x-ray “dye test” that is performed by a radiologist to gain information about the uterus and Fallopian tubes.
The HSG provides information about anatomical problems that might contribute to infertility
Using transvaginal ultrasound, we monitor the appearance of your ovaries and uterus on successive days throughout your menstrual cycle.
The purpose of ultrasound monitoring is to see that your ovaries and uterus are functioning properly. On day 2 or 3, a baseline scan can confirm that ovaries are “quiet” and do not have any cysts. Later at mid-cycle, the scan can be repeated to verify that ovulation is likely. A follow-up ultrasound can be performed to reassess the ovaries after ovulation. At each ultrasound examination, we can measure the endometrium (uterine lining) to make sure that your uterus is thickening appropriately—in preparation of implantation (pregnancy).
On the morning after intercourse, we can perform a test, similar to a pap test, where we collect a small sample of your cervical mucous to examine under a microscope.
Rarely performed in the modern era, the post coital test can tell us how the sperm and cervical mucous interact.
A hysteroscopy is a minor surgical procedure that is performed under light sedation in an operating room setting. A thin, lighted tube with a camera, called a hysteroscope, is inserted into the vagina and enables the doctor to examine the cervical canal and the uterine interior.
A hysteroscopy can tell us if uterine problems are causing your infertility, or why you might be suffering from recurrent miscarriages. During the procedure, small fibroids and polyps can be removed and sometimes fallopian tubes can be opened, often times increasing the likelihood that you can soon become pregnant naturally.
A laparoscopy is a procedure that is performed under general anesthesia in a surgical setting. Very small incisions are made where instruments can be inserted to help diagnose (or repair) problems.
Laparoscopy can assist in making a diagnosis (endometriosis), or actually fix problems that cause pain and/or infertility (ovarian cysts, fibroids).
An endometrial biopsy is a procedure (which can be done in the office) where a small sample of uterine tissue is removed and analyzed under a microscope.
An endometrial biopsy gives important information about the uterus lining, which is the surface that the embryo must “land on” to implant properly.