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The Infertility Evaluation
Infertility Evaluation. What to Expect at Your First Visit
Infertility has many causes. It can result from the following:
- Inadequate production of viable sperm
- Lack of ovulation
- Abnormal anatomy of the uterus by tumors such as fibroids or polyps
The basics of an infertility evaluation involves several simple tests.
Early in the evaluation a simple semen analysis should be performed. The parameters evaluated are sperm concentration, sperm motility, and sperm morphology (shape). A contributing cause of infertility can be found in 20 to 40% of couples. The remainder of the infertility testing will typically involve the female partner if this test is normal.
An ultrasound is frequently done at the first visit. This will allow visualization on the uterus and ovaries looking specifically for the presence of any uterine tumors or ovarian cysts that could affect the ability to conceive or miscarriage rates. Fertility specialists will also be very interested in the size of the ovaries and the number of immature eggs that can be seen within the ovaries. Frequently, ultrasounds done outside this office will not provide this very valuable information as part of the findings.
Testing for ovulation typically occurs next. Ovulation predictor kits (OPK's) obtained from the drugstore or basal body temperature charts can be done at home, but they unfortunately are not accurate enough to adequately predict ovulation.
We recommend that a serum progesterone be performed approximately one week after suspected ovulation. For most people, a more practical way is to perform the blood work approximately one week before the next anticipated menses.
Lastly, testing the tubes for their patency can be most efficiently and accurately done in an outpatient setting by a hysterosalpingogram (HSG). It also provides valuable information about architecture of the internal cavity of the uterus in ways that an ultrasound cannot. Therefore, the HSG is good for finding tumors within the uterus and confirming that the tubes are open to allow the sperm and eggs to fertilize within the tube.
A last significant benefit is the improvement in pregnancy rates seen in the months immediately following an HSG. This is felt to be a result of a “flush effect” from the dye passing through the tubes which makes it easier for the sperm to get to the egg.
An obvious beneficial result of this is that these improvements in pregnancy rates can even be seen in couples who are attempting to conceive at home without the necessity of doing inseminations or other procedures in the office.
If the above fertility testing could be considered the “low-tech” options the “high-tech” testing is typically confined to the following two tests.
First, some men will have a severely abnormal semen analysis and will need more sophisticated sperm testing called a semen profile. This will need to be performed at RMCRM as no other local commercial or hospital laboratory can provide this specialized testing. The tests done in a semen profile allow us to better understand what type of assisted reproductive technology is best.
Couples where moderately abnormal results are found can still reasonably anticipate pregnancies from simple treatment techniques such as intrauterine inseminations. The more severely effected sperm, however, will likely need techniques such as in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) to achieve a pregnancy.
Conditions such as endometriosis or pelvic adhesions (scar tissue) will need to have a laparoscopy in order to diagnose and treat these conditions. This is typically a minor outpatient procedure with small incisions of about a 1/2 inch with quick recovery times of two or three days. This procedure can also have the benefit of treating a couple’s infertility allowing natural conception and can also help alleviate the pain that often accompanies endometriosis.
We provide services for the diagnosis and treatment of infertility.
Our services include an outstanding IVF and donor egg program.
We offer all levels of treatment including infertility testing intrauterine insemination (IUI), medical treatment, and advanced laparoscopic surgery. Most of our patients become pregnant without requiring IVF.
Monday-Thursday 8AM - 5PM
Friday 8AM - 1PM
Our patients can reach us for emergencies 24 hours a day by calling our main number, and selecting choice #1, which pages our medical or nursing staff.
If your situation is life threatening, dial 911 or go directly to your local ER.