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Infertility affects approximately 6.1 million Americans, or 10 percent of the reproductive age population, according to the American Society for Reproductive Medicine. Commonly, couples experiencing infertility don’t recognize it as such and may delay seeking treatment for the condition. In general, if you are under 35 and have been having well-timed, unprotected intercourse for one year without a pregnancy, it is time to see a physician. If you are over 35 and have been having well-timed, unprotected intercourse without success or if you have other medical conditions that may impair your fertility, you should consult with your physician after six months. In most cases the first physician consulted will be an OB-Gyn. You can expect the physician to take a detailed and thorough family medical history on both you and your partner. It is important to be truthful when answering the questions even though some of them may seem personal or be embarrassing to you. For example, do you have a history of untreated sexually transmitted infections like gonorrhea or chlamydia that can impair fertility by causing scarring in the fallopian tubes? You should also expect questions about your lifestyle such as dietary habits, exercise, use of tobacco or recreational drugs, prescription medications and any exposure to chemicals. And finally, your physician will want to know if you have ever been pregnant or terminated a pregnancy; about the regularity of your menstrual cycle; and about your sexual habits.  For the female partner a physical exam is the first of many tests your OB-Gyn can perform. This will include a breast exam, pelvic exam and perhaps a transvaginal ultrasound scan to rule out cysts, polyps or fibroids in the uterus. They will also check for abnormal patterns of hair growth which, along with irregular menstrual cycles and obesity, may indicate a condition called Polycystic Ovarian Syndrome. (See Current Trends April 2007). Vaginal cultures for gonorrhea and chlamydia along with a Pap smear may also be done at this time. You can expect your physician to do a number of blood tests including:
The doctor should also be doing blood tests to check your ovarian function, also known as ovarian reserve. Age can have a significant impact on ovarian reserve. This typically starts with a blood test on the second or third day of your menstrual cycle that checks three hormones: Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), and Estradiol (E2). The functions of these hormones are as follows: Your OB-Gyn will likely suggest a hysterosalpingogram. In this test a special oil or water-based dye is injected through the cervix and into the uterus and fallopian tubes. X-ray fluoroscopic equipment is used to monitor the movement of the liquid as it progresses from the uterus to the tubes; this helps to show the shape and structure of the uterine cavity and also if the fallopian tubes are open or blocked. Several x-ray films are taken; many times the normal result is called a ‘fill and spill’ – the dye filled the cavity and tubes and spilled out the end of the fallopian tubes indicating they are open.  The basic female work-up may take a couple of menstrual cycles to complete. Most women starting an infertility work-up are anxious to start treatment and may be impatient. This testing is very important and will give your OB-Gyn the information he/she needs to determine your best treatment options. The male infertility work-up is less involved. A physical exam along with a semen analysis is usually all that is required. The semen test will be checking the sperm count (the number of live sperm), the sperm motility (how well they move) and sperm morphology (the shape of the sperm). Once the test results are back it is a good idea to schedule another consultation with your OB-Gyn to determine your next steps. This is the ideal time to ask your physician if a referral to a Reproductive Endocrinologist (a physician with special training in reproductive medicine), or a urologist (a physician with special training in male reproductive medicine) is recommended. A special podcast entitled, “Trouble Getting Pregnant? How Your Doctor Can Help.” is available with Dr. David Granger, a fertility specialist, at the following website: http://www.fertilityjourney.com/support/podcasts/ For more information on this topic you can also visit these websites: American Society for Reproductive Medicine: http://www.asrm.org/Patients/patientbooklets/infertility_overview.pdf Diagnosing Infertiltiy: http://infertility.about.com/od/infertility101/p/dxinfertility.htm Resolve: http://www.resolve.org/site/PageServer?pagename=lrn_wdigfh_tiwu American Fertility Association: http://www.afafamilymatters.com/library/index.html References: ASRM Practice Committee Report: Optimal Evaluation of the Infertile Female. Fertil Steril 2006; 86 (Suppl 4): S264-7. |
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Seeking a second medical opinion is your right and you shouldn’t hesitate to get one. Doctors even get second opinions from colleagues.