Pinpointing a fertility problem
We've made an appointment with a fertility specialist. What happens next?
You, your partner, and your doctor are now a team, working together to unlock the clues to your fertility problems. The male and female reproductive systems are extremely complex, and today's fertility specialists are high-tech super sleuths trained to uncover and, with luck, repair any glitches in this amazing machinery.
Since fertility problems are a shared concern, you and your partner should go to the first appointment together. Bring copies of your health records to your visit and have copies sent to your doctor ahead of time to avoid the hassle and expense of duplicating medical tests. Expect to be asked about your sexual history, when you first menstruated, whether you've ever had any sexually transmitted diseases, miscarriages, or abortions, how often you make love, whether you use lubricants, and more. Not much about your private life will be private anymore, so you'll want to feel comfortable with your doctor.
What tests will we be taking?
After looking over your medical history, your doctor will want to do a complete workup on you and your partner. This initial assessment will probably include most or all of the tests described below. Bear in mind that you may need to rearrange your schedules to make time for some of these procedures.
For women:
Blood tests: You'll have several blood tests so your doctor can check your hormone production, including your levels of thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, prolactin, and sometimes androgen and progesterone.
Clomiphene challenge test: This test may give your doctor more information about your ovarian function than some of the other hormone tests. You'll have a blood test on the third day of your cycle to check your follicle stimulating hormone (FSH) level. Then, you'll begin taking a five-day cycle of Clomiphene, a fertility drug, on the fifth day of your cycle. Afterward, your doctor will measure your FSH level on the tenth day of your cycle. The results will give him some insight into how well therapy may work for you, and how aggressive it should be.
Charting basal body temperature (BBT): Your doctor may ask you to track your basal body temperature so you can tell whether you're ovulating. You'll take your temperature every morning upon waking for at least a month and record it on a BBT chart. When your body releases progesterone following ovulation your temperature rises slightly. (You can also use over-the-counter ovulation predictor kits for this purpose. The kits detect the telltale surge of luteinizing hormone (LH) in your urine just before you ovulate. Click here to buy a kit from our Store.)
Endometrial biopsy: Your doctor may perform this quick in-office procedure to assess the quality of your uterine lining and also determine whether you're ovulating. It has to be done at a certain point in your cycle, can be uncomfortable, and sometimes needs to be repeated.
Hysterosalpingogram (HSG): This X-ray procedure will allow your doctor to see whether your Fallopian tubes are open. It also helps determine whether the contour and inside of your uterus is normal or you have polyps, fibroids, scar tissue, or other uterine abnormalities that could affect your fertility. Your doctor will inject a dye through your cervix and into your uterus and Fallopian tubes and trace its movement by X-ray.
Laparoscopy: This outpatient surgery performed under general anesthesia will provide your doctor with a view of your pelvic organs so she can check for signs of scarring or endometriosis.
Pelvic ultrasound: Your doctor will use this painless procedure to determine whether your follicles are growing in order to anticipate ovulation, and also to identify any problems in your pelvis and ovaries such as ovarian cysts or fibroids.
Post-coital test: Your doctor will use this procedure to evaluate the interaction between your cervical mucus and your partner's sperm. You'll be asked to have intercourse on a certain day of your menstrual cycle. Then, within 24 hours, your doctor will collect a sample of your mucus for testing. He'll look at the quality of the cervical mucus, and at how vigorously the sperm are moving. The movement of the sperm may indicate that antibodies in your mucus are impeding the sperm's progress.
Hysteroscopy: During this procedure, your doctor will place a tiny scope (a thin tube with a camera at the end) through your cervix and into your uterus to see whether you have fibroids, polyps, or other abnormalities in your uterine cavity that could impair your fertility. The procedure doesn't allow your doctor to evaluate your Fallopian tubes, but it does provide him with a clear picture of your uterus — and sometimes the opportunity to correct the problem at the time of the procedure.
For men:
Semen analysis: You'll be asked to provide a semen sample, usually by *********ing and ejaculating into a specimen jar. Your doctor will examine your sperm under a microscope for count, shape, appearance, and movement.
Post-coital test: Your doctor will use this procedure to evaluate the interaction between your sperm and your partner's cervical mucus. You'll be asked to have intercourse on a certain day of her menstrual cycle. Then, within 24 hours, your doctor will collect a sample of her mucus for testing. He'll look at the quality of the cervical mucus, and at how vigorously the sperm are moving. The movement of the sperm may indicate that antibodies in the mucus are impeding your sperm's progress.
What are our chances of pinpointing the problem?
In many cases, more than one factor causes fertility problems, and some causes are harder to detect than others, so a clear diagnosis isn't always possible. (See our articles on the most common causes of fertility problems in men and women.) In 10 to 15 percent of cases, testing reveals no abnormalities at all; doctors characterize those patients as having 'unexplained' fertility problems.
Fortunately, even unexplained problems can be treated.
