Let’s start by recapping on what infertility is.
Infertility is a disease of the reproductive system that impairs one of the body’s most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm’s ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman’s uterus; and sufficient embryo quality. Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman’s hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.
How do you know it’s time to see someone?
Only after one full year of intercourse without protection can you be considered for an infertility diagnosis. Only 25% of couples conceive in the first months of trying, so the majority of couples can expect conception to take much longer. If you haven’t conceived after one year of intercourse with no protection during peak fertility times, it’s time to see a professional.
Once we begin to see you as a patient, we aren’t looking for a diagnosis of infertility – we’re looking for the cause. Every step of the way, you’ll be working with the same clinician to prevent details from slipping through the cracks.
Taking a detailed history may tailor the fertility evaluation in both the male and the female.
Specifically certain parts of history might point us in certain direction in terms of:
- Is it hormonal?
- Is it linked to ovulation?
- Is it linked to people just not having adequate coital frequency?
- Is it more going to be anatomic based on prior infections or surgical history?
In our evaluation stage, we will go through a full menstrual cycle collecting information and trying to differentiate the causes of infertility in that patient.
Testing Performed to Diagnose Infertility
After your consultation, your doctor will conduct a physical examination on both of you to determine your general state of health and to evaluate any physical disorders that may be causing infertility. Usually, both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception.
Infertility Tests for Women
Once we begin testing, we will typically start with blood work. This is done on the second through fourth day of your cycle, which is the optimal window of time to start the fertility evaluation.
We will also do an internal vaginal ultrasound to specifically look at the ovaries and make sure they’re of the appropriate size. While performing the internal vaginal ultrasound, we make sure that the patient has minimal discomfort. During this ultrasound, we’ll also be checking to make sure there’s no obvious scar tissue or ovarian cysts.
However, these evaluations may not give us all the information necessary to find the cause of your infertility. Here are some additional tests your doctor may conduct:
- Blood tests and urine analysis to check hormone levels
- Semen analysis to check count and motility
- Pap smear to check the health of the cervix
- Basal body temperature test, which checks whether the woman is releasing eggs from her ovaries. A woman’s temperature rises slightly during the days she ovulates, so you will be charting your basal body temperature every day for a few months on a graph. This means taking your temperature orally or vaginally with a special, ultra-sensitive thermometer available at most drugstores.
- Endometrial biopsy, in which the doctor removes a piece of tissue in the uterine lining. Examining this tissue will tell the physician whether eggs have been released and whether the corpeus luteum is producing enough progesterone. This test is often done if the results from the woman’s basal body temperature chart are unclear.
- Ultrasound to look for fibroids and cysts in the uterus and ovaries. This test uses sound waves to picture the uterus and ovaries causes little discomfort and is very effective.
- Post-coital testing, in which the doctor takes a sample of mucous from the woman’s vagina. She must have the test during her fertile days and within 12 hours after she and her partner have sex. The test will tell the doctor if the man’s sperm can survive in the woman’s cervical mucus.
Viewing the Antral Follicles
There are small little cysts on the ovaries called antral follicles, and we make sure to take a look at your antral follicles to evaluate overall ovarian function. Based on the number of antral follicle we see on the second, third, or fourth day of your cycle, we can understand how your ovaries are functioning.
During that same visit, we’ll look at the uterus, making sure there’s no obvious concerns with the uterus. We make sure that the uterine lining has been shut appropriately. We make sure that there’s no obvious benign structures involving the uterus. We draw up blood that day, looking at the communication between the brain and the ovaries.
Ovarian Function Testing (AMH)
We draw tests that are used to assess a patient’s ovarian function, specifically a test called AMH, which takes a look at the Anti-Mullerian hormones. AMH is a hormone secreted by the cells that surround a woman’s eggs that this hormone level correlates with egg quantity.
Though the AMH testing does not predict egg quality or pregnancy, we often follow the rule that the higher the number, the “better ovarian function.” It’s a very useful tool in terms of assessing a woman’s ovarian function.
Scar Tissue Screening
Our overall screening includes testing that specifically looks at the anatomy. One of these tests specifically evaluates the uterus and looks for scar tissue or benign growths, like uterine polyps or uterine fibroids. These growths are benign, but could affect the ability for the fertilized egg to implant.
Fallopian Tube Evaluation
As a part of our anatomy testing, we’ll look at the fallopian tubes to make sure they’re open. Historically, this test was performed in radiology using dye and x-ray machines. At Park Avenue Fertility, we prioritize making our patients comfortable, so this test is now performed in the office using ultrasound and water. This is an improvement from the old method that was performed in radiology because we can prevent any unnecessary exposure to radiation and the viscous dye often caused cramping, which can be avoided when you use water versus dye.
Though we have each patient monitor their temperature throughout the month, we want to look at everything to get the full picture. Before your cycle begins, we’ll perform an internal ultrasound to at the ovaries to see if we can see the cyst developing that houses the patient’ egg. This is a chance to also evaluate the uterine lining, making sure that the uterine lining is growing and differentiating as the egg grows.
And we’ll also draw blood after the patient ovulates to confirm that she is in fact ovulating.
Infertility Tests for Men
Many people often think of infertility as a problem that rests within the female partner. However, while we are testing the woman, we will be running tests on the man to review his reproductive health as well though an exam and semen analysis.
To keep things comfortable, the semen collection can happen in the office or at home. The semen analysis is performed in our office, so you can produce a specimen at home after two to five days of abstinence. If you do choose to produce the semen specimen at home, we’ll need it within an hour and carried to us at body temperature.
Once we accept the specimen, we’ll go under the microscope to look at the sperm count and morphology. During the sperm count, we evaluate the total motile sperm count, which is the number of sperm that are moving in the cup.
A normal analysis will typically contain approximately 40 million moving sperm, which is reliant upon the concentration of the sperm, which is how many million sperms there are per CC per milliliter. We’ll also evaluate the volume of the specimen itself and what percentage of the sperm are moving. Put together, that is called a total motile sperm count.
When looking at the morphology of the specimen, the head, the body, and the tail of the sperm are evaluated. The goal of this test is to see at least 4 percent of the sperm looking anatomically normal. If this test gives us abnormal results, you’ll come in for a repeat test on a new specimen in about three weeks. The man may be referred to a urologist to see if there’s anything that can be done to enhance the semen parameters.
Semen analysis allows us to look at the male factors of infertility because that may change our treatment algorithm based on the quantity or quality of the sperm.
Why Is My Evaluation Being Delayed?
Typically, we like to stick to that 3-4 week schedule of evaluation so that we can get an accurate plan as soon as possible. However, if the woman has a prior history of a sexually transmitted disease or pelvic inflammatory disease, we want be very careful about evaluating her uterus and tubes because we wouldn’t want to spread any occult infection. In these cases, we would collect infectious disease cultures before starting to make sure we can proceed safely.
Similarly, with people with a history of any infectious sexually transmitted diseases, we might prescribe a preventative antibiotic prior to doing diagnostic testing to minimize any risk of infection throughout the fertility process.
Results – How Soon Will I Know?
One of the most difficult parts of your fertility journey is the waiting. Waiting for results, waiting to grow your family… That’s why we do things differently. In addition to working with the same clinician for your entire journey, we like real-time results whenever possible. Though some testing may take longer, we like to have information and a plan ready as soon as we can.
At Park Avenue Fertility, this means that our process takes about three to four weeks. Bloodwork, for example, takes about a week to get results from, while semen analysis only takes 72 hours. Other tests, such as the ultrasounds to take a look at the uterus and tubes can give us real-time answers.
Types of Infertility Diagnosis
When giving you a diagnosis, there are a few conclusions that we may come to:
- Male Factor Infertility
- Tubal Factor Infertility
- Cervical Factor Infertility
- Ovulatory Disorder Infertility
- Diminished Ovarian Function Infertility
- Unexplained Infertility
In the case of unexplained infertility, there simply isn’t the technology to understand why yet. However, we very rarely stop the fertility journey at that diagnosis. Instead, we work with you to find treatments that can result in pregnancy.
Although this may sound overwhelming at first, you’ll feel better knowing the cause of your infertility. Ready to move forward with your family planning? Our team is here to help; visit us today!