Preliminary Investigations into Infertility
A good first step for an OB-GYN to implement in an infertility evaluation is the basal body temperature (BBT) chart. This is a simple method wherein a woman takes and records her temperature every morning so that she can look for the subtle rise that indicates ovulation has taken place. Her OB-GYN can supply her with the chart and instructions needed to begin doing this. A few months of basal body temperature recordings can clearly indicate whether a woman's cycles are abnormal.
Once a normal cycle has been established, a simple sampling of the lining of the uterus in the physician's office or some blood tests to verify adequate hormonal levels can determine whether these "normal" menses are in fact adequate for fertilization and implantation of a fertilized egg. Perhaps the ovulated egg wasn't healthy; or the site of the ovulation—the remaining tissue bed necessary to provide progesterone—may not yield enough of this hormone to thicken the implantation site. If this happens, a fertilized egg may slough off with the menstrual flow, a microscopic miscarriage lost in the shuffle of what seems like just another month without having achieved pregnancy.
At any point along the way there may be trouble indicating a need for therapy. For instance, irregular cycles can be manipulated with ovulation enhancers, and inadequate uterine tissue for implantation of a fertilized egg can be nurtured further with the hormone (progesterone) that may be lacking. These can be among the most straightforward problems in infertility.
As much as half of all infertility problems begin with the male, however. Decreased sperm counts from surgically correctable problems or medically correctable infections can be dealt with, but low counts for unknown reasons pose particular problems for the urologist.