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Should You Be Evaluated for Infertility?

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More than 7.3 million Americans are infertile, according to the Centers for Disease Control and Prevention (CDC). If you and your partner have had difficulties getting pregnant for a specific length of time, and/or you meet other criteria, your doctor may recommend that you be evaluated for infertility. Here, we give you general guidelines for who should be evaluated, and we tell you what to expect at your initial infertility consultation. We'll also offer detailed information on how infertility testing differs for men and women.

More than 7.3 million Americans are infertile. In many cases, an ob-gyn or family physician will recommend that a couple seek an infertility evaluation if:

  • They've been having regular, unprotected intercourse for one year (or six months if the female partner is over 35) and they're still not pregnant.
  • The woman has had irregular or painful periods, a history of abdominal or pelvic surgery or miscarriage, or exposure to DES (diethylstilbestrol, a synthetic hormone taken by women prior to 1971).
  • The man has a history of low sperm count, poor motility (the sperm doesn't swim or move quickly), or abnormal morphology (the shape of his sperm cells are irregular).

If you or your partner fall into one of these categories, or if you've been recommended for further testing, here's what you can expect.

About 40 percent of infertile couples have more than one cause of infertility, or the cause of the infertility cannot be explained. (The remaining 60 percent is due to a problem in one partner.) A complete evaluation may require several visits, by both partners, to one or more infertility specialists. Before beginning any testing, a fertility doctor will schedule an initial appointment to obtain a complete medical history from both you and your partner.

The appointment can take about an hour, during which time the doctor will ask questions about previous surgeries, chronic illnesses, and hospitalizations, and will inquire about any previous testing or treatment you've had for fertility-related disorders. (Bring medical records with you to the appointment, or have them sent ahead.) The doctor will also ask you about your lifestyle and stress, whether you use tobacco, alcohol, drugs, or any medications; you may also be asked if you've been exposed to certain toxins at home or in the workplace.

In addition, you and your partner will be asked to provide a detailed account of your reproductive history, which might include information about previous pregnancies, miscarriages, elective abortions, and sexually transmitted diseases (STDs). You'll be asked about your current sexual practices, such as the frequency and timing of intercourse.

Many couples, understandably, find these questions intrusive and embarrassing. But it's vital that you be completely honest with your doctor so you can get to the root of the problem as quickly as possible.

Because the cause of infertility can result from a female factor, a male factor, or both, it's important that both partners undergo some basic testing. Thirty percent of infertility is due to a male problem, such as structural abnormalities, sperm production disorders, ejaculatory disturbances, and immunologic issues. The male evaluation could involve:

  • A thorough physical exam, including an examination of the external genitals and rectal area to identify any structural abnormalities.
  • Blood tests to rule out certain diseases and STDs, and to determine the level of testosterone and other hormones in the blood.
  • Urine tests to rule out problems such as diabetes and kidney infection.
  • A semen analysis to check for sperm count, motility, and morphology, as well as other factors.
  • A small biopsy of the testicles, in case a semen analysis shows that no sperm is present.

If the doctor suspects that a man has varicocele (a varicose vein in the testicle), he may perform a Doppler ultrasound or venography (an X-ray of the testicular veins) to evaluate blood flow and locate the problem. Varicoceles are a common structural problem in men and account for at least 40 percent of all male infertility

The female workup can often be complicated and invasive, and many of the tests require that a woman be at a certain phase of her menstrual cycle. As a result, a woman's infertility evaluation can take three to four cycles to complete. Here are some of the tests it may include:

  • A full physical, including a pelvic exam, screening for STDs (such as chlamydia), blood tests, and urine tests.
  • An ovulation evaluation, which involves one to two months of charting with an ovulation-detection kit (the test uses daily urine samples to predict ovulation).
  • A series of blood tests at varying points in the menstrual cycle to evaluate hormones.
  • Pelvic ultrasounds to monitor follicle growth and the release of healthy eggs.
  • Pelvic ultrasounds, to monitor follicle growth and the release of healthy eggs
  • A hysterosalpingogram (an X-ray of the uterus and fallopian tubes after they've been injected with dye) to show the shape of the uterus and determine whether the tubes are open.
  • An endometrial biopsy (an evaluation of the uterine lining) to investigate hormonal imbalances that can cause irregular cycles, repeated miscarriages, or irregular uterine bleeding.

In some cases, a doctor will perform a laparoscopy to either confirm or rule out the presence of endometriosis, a disorder in which the endometrial tissue is found outside of the uterine cavity. During this procedure, which is done in an outpatient clinic under general anesthesia, a long, thin tube called a laparoscope is inserted into the abdominal cavity. The laparoscope is used to look at the internal pelvic area and outside the uterus, the fallopian tubes, and the ovaries for the presence of endometriosis.

The postcoital test (PCT) is also sometimes done to test the quality of a woman's cervical mucus and to see how well a man's sperm interacts with it. At the time of ovulation, a couple is instructed to have intercourse a specified number of hours before coming into the office. The doctor will then collect a swab of the woman's mucus, assess its quality and viscosity, and examine it for the presence of active sperm. The test allows a doctor to see how well a man's sperm can penetrate and survive in the woman's mucus.

An infertility evaluation can often be time consuming, emotionally draining, and expensive. Basic testing can cost up to $2,000; more advanced tests--involving a laparoscopy, for instance--can climb to more than $5,000. (Check with your insurance company to see which tests are covered.)

You'll want to get the most out of your evaluation so you can make informed decisions about your future. Here are some tips to help you through the process:

  • Get test results. Once you've begun the evaluation, get the results of each test as it is completed. If test results are abnormal, ask your doctor for a full and clear explanation. Also ask whether you can schedule periodic consultations to discuss your case and review your options.
  • Ask questions. At each step of the evaluation, make sure you understand which tests are needed--and why. If your doctor is unresponsive, evasive, or unavailable to answer your questions, consider changing practices.
  • Communicate with your partner. Talk about your fear, anger, anxiety, and frustrations as you go along. These reactions are completely normal. If you're having trouble dealing with your emotions, you and your spouse may want to consult a therapist or counselor (together or separately), or attend an infertility support group in your area. (RESOLVE, the National Infertility Association, www.resolve.org, can connect you with a support group).
  • Manage stress in a positive way. Fertility issues can wreak havoc on every aspect of your life, including your relationships. To minimize the stress, find ways to nurture yourself and your relationship with your partner on a regular basis. Go out to dinner and a movie, head out of town for a romantic weekend together, or pamper yourself at a local spa.
  • Remember your goals. When all the tests and doctor visits become overwhelming, remember why you're putting yourselves through all of this: to have a baby together. Remember, too, that many couples weather the strain of infertility testing and treatment--no matter what the outcome--and form a stronger, closer relationship.

Copyright © 2011 Meredith Corporation.