Your TTC Strategy 11: Know Your Options--Infertility Evaluation and Treatments

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What Does a Fertility Evaluation Entail?

The first step in evaluating infertility is to perform a detailed medical and personal history. This includes information from the couple about past medical and surgical history, current health status, occupational risks, history of sexual development, previous use of birth control, past gynecological and obstetric history, and current sexual practices.

The basic questions that are answered with an infertility evaluation are:

Are there enough high quality sperm? The semen analysis is the single most important test in the evaluation of the male. It provides information about a number of factors related to fertility such as volume of semen, number of live sperm, sperm movement, shape, and structure. In order to perform the test, a semen sample is collected by masturbation into a sterile container provided by the physician.

Is an egg produced each month?Regular menstrual cycles, a biphasic BBT chart, and detection of luteinizing hormone LH in the urine all are reassuring that ovulation is occurring. However, if there is a concern, an ultrasound may be performed to examine the ovary or blood tests may be performed to determine the reason why ovulation is not occurring.

Are there any barriers that prevent the sperm and egg from getting together? Common barriers include blockage of the fallopian tubes, hostile cervical mucus, and the presence of endometriosis or adhesions. The most common tests include a hysterosalpingogram (HSG), which determines if the fallopian tubes are open, and laparoscopy, a procedure performed under general anesthesia to assess the reproductive organs and repair structural infertility problems that may be present.

Is the uterine lining receptive? Factors that interfere with implantation include inadequate production of progesterone (determined by a blood test), lack of proteins (beta 3-integrins) that allow the embryo to stick to the uterine lining, congenital uterine deformities, and irregularities of the uterine lining such as polyps or fibroids.

Sometimes the factors affecting your fertility are easy to detect and treat, but in many cases a specific reason for infertility may be difficult to identify. Forty percent of infertility can be attributed to male factors and the remainder to female or couple factors. There are two different treatment philosophies that are used by physicians who treat infertility: (1) find out what's wrong and fix it or (2) nonspecifically enhance fertility by increasing the chances that the sperm and egg will get together. Thanks to the many options existing today, including advanced reproductive technologies and adoption, most infertile couples will be able to experience the joy of parenthood.

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