If you and your partner are trying to have a child and you have not gotten pregnant, you may want to see your doctor and have an infertility workup. Based on the results of these tests, various treatment options may be employed to cause a pregnancy to occur.
CONCEPTION
Becoming pregnant starts with ovulation, which is the release of an egg from the ovary. In an average 28-day menstrual cycle, ovulation occurs about 14 days after the first day of the last period. When the man ejaculates in the vagina during intercourse, sperm is released into the vagina. Sperm travel up through the cervix and into the fallopian tubes. If a sperm and egg meet, fertilization occurs. The fertilized egg then moves through the fallopian tube and into the uterus. It attaches to the lining of the uterus and begins to grow. All these events must take place for pregnancy to occur. If there is a problem in any of these events, infertility may result.
CAUSES
Infertility may be caused by more than one factor. Some are easy to find and treat, while others are not. The factor may relate to the woman or the man. In some cases, no cause can be found in either partner.
The couple’s age can be a factor. For healthy, young couples, the odds are about 20% that a woman will conceive in any one menstrual cycle. This figure starts to decline more so after age 35 years. A man’s fertility also declines with age, but much later. For this reason, older couples may not want to wait 6–12 months to seek care if they are having problems conceiving.
Male factors most often involve problems with the amount or vitality of the sperm. Infection or scarring from a sexually transmitted infections (STIs) also may be a cause. Female factors may involve abnormal hormone levels. The ovaries may not produce eggs at the right time. Scarring or blockages in the cervix or tubes also may be a cause. Other health problems also can play a role.
INFERTILITY TESTING
The decision to begin testing depends upon a number of factors. These may include your age and your partner’s age, as well as how long you have been trying to get pregnant. You and your partner will receive care as a couple.
A semen analysis is a key part of the basic workup for a man. It may need to be done more than once. The semen sample is obtained by masturbation. The sample may be obtained at home, or at the lab. Your doctor will give you instructions. The semen sample then is studied in a lab.
The man may be referred to a urologist (a doctor trained in treating problems of the urinary tract). The urologist will perform an exam and tests may be done.
The workup for women begins with a physical exam and medical history. They include information about your menstrual cycle, previous pregnancies if any, along with other medical information. Pap test and blood tests also may be done
In the assessment of a woman for infertility several procedures may be done to look at a woman’s reproductive organs. These include tests to check if check if the uterus is normal and if the fallopian tubes are open.
Transvaginal ultrasound. This is an ultrasound test that checks the ovaries and uterus.
Hysterosalpingography (HSG). This test is an X-ray test that shows the inside of the uterus and fallopian tubes. In most cases, it is done after a menstrual period. A small amount of dye is placed in the uterus through a thin tube inserted through the cervix. An X-ray is then taken. The dye outlines the inside of the uterus and fallopian tubes. If it spills from the tubes, it shows that the tubes are open.
Hysteroscopy. This procedure uses a thin telescope-like device, called a hysteroscope, which is placed through the cervix, into the uterus. The cervix and the uterine cavity is examined and any problems found in the uterus can also be corrected at the same time.
Laparoscopy. This procedure lets the doctor view the tubes, ovaries, and the outside of the uterus from within the abdomen. A small telescope-like device, called a laparoscope, is inserted through a small cut in the abdomen. Pelvic diseases may be identified, such as endometriosis, scar tissue or other abnormalities can be corrected through the laparoscope as well.
If you have not been able to conceive after 6–12 months of having sex without using birth control, you may want to think about having an infertility evaluation by an infertility specialist. Certain tests may help find the cause of the infertility. If a problem is found, steps can be taken to treat it.