This is it, today is the day. Over the past year, you have hopefully stared down at all the negative pregnancy tests you can stand to look at. You are going to schedule an appointment with your OB/Gyn or better yet, ask for a referral to a fertility specialist. Be proud of yourself for taking control of your reproductive health! This is a big, bold step towards seeking the answers to those “why am I not getting pregnant” questions you are having.
Once your appointment is scheduled, what should you expect during a fertility workup? Not surprisingly fertility workups differ for both men and women. Let us walk you through all of the different components.
What should I expect when I visit my doctor?
You should probably anticipate answering a lot of questions. In order for your doctor to get the full story of why you may be having trouble conceiving, it begins with a bit of a Q&A session. Here are some of the topics that may be covered:
- Menstrual history
- Pregnancy history
- Birth control history
- History of STD’s (sexually transmitted diseases)
- Current sexual patterns
- Surgical history
- Other significant health problems
- Work environment
The Physical Exam
Typically this is a basic fertility exam that commonly performed by your OB/Gyn. During this exam your doctor is looking for some of the more outward physical indications of potential fertility problems. You can likely expect:
- Thyroid Exam – looking for abnormalities in size
- Hair distribution/ patterns on the face and body – indicating a possible increase in male hormones which could affect your fertility
- Breast examination – the doctor will examine the size and shape of your breasts and squeeze them to see if any liquid comes out, which may indicate the presence of increased prolactin, a hormone that prevents ovulation
- Pelvic examination – to inspect the cervix, looking for signs of unusual growths, sores, discharge, or infection.
- Pap smear – is done to check for cervical cancer and cervical mucus is examined for possible infections.
If these tests do not explain your difficulty conceiving, it is very likely additional tests may be ordered or you will be referred to a fertility specialist/Reproductive Endocrinologist (RE).
Other possible testing
There are many causes of infertility and many tests that help determine the cause. In some cases there is no immediate cause indicating an unexplained infertility problem. Before any diagnosis can be made your doctor will be interested in performing a number of tests to determine if you ovulate, when you will ovulate next, evaluate ovarian function and the ability to produce eggs, if you currently ovulated and measure your uterus’s receptivity to pregnancy on the second half of your cycle. These tests are broken into 5 categories: ovulation, ovarian function, luteal phase, cervical mucus and reproductive organ testing.
Basel Body Temperature (BBT) Charts: This is an easy way to “DIY” track your ovulation at home. It is relatively easy, just track your BBT every morning when you first wake up and document over the course of a cycle or prolonged period when you ovulated. This is indicted by a spike in your normal body temperature.
Ovulation Predictor Kits (OPKs): These are designed to help you predict the time you will ovulate, they measure the LH level in your urine.
Blood Tests and Ultrasound: Blood tests measure levels of estrogen and LH, while frequent ultrasounds track follicular growth.
Ovarian Function Tests
Day 3 FSH: This is a blood test taken on day 3 of your period. It measures the level of the hormone FSH. An increase in FSH may indicate the decrease in the production of good quality eggs and embryos.
Day 3 Estradiol Tests: This blood test measures the amount of estrogen in your blood. A high level of estradiol may indicate poor egg quality.
Inhibin B levels: A blood test to determine if inhibin B is being produced at too low a level is conducted.
Ultrasound: A transvaginal ultrasound may be performed several days after the LH surge to determine if ovulation has occurred.
Luteal Phase Testing
Plasma progesterone level: A blood test in the last part of your cycle, high levels of progesterone indicate that ovulation has occurred.
Hormone tests: Your physician may take a blood test to measure the amount of prolactin, androgen and thyroid stimulating hormone.
Endometrial biopsy: Performed after day 21, the test involves taking a small piece of tissue from the uterine lining. This test determines if the lining is thick enough for a fertilized embryo to implant. The results will indicate endometrial development.
Evaluate the Cervical Mucus
Postcoital test (PCT): Performed mid-cycle, shortly after intercourse, this tests evaluates the quality and quantity of cervical mucus and documents the presence of live, motile sperm in the mucus.
Reproductive Organ function tests
Hysterosalpingogram (HSG): An HSG is an x-ray procedure performed in the first half of the cycle, using water or oil based dye to identify any structural abnormalities in your uterus or fallopian tubes.
Hysteroscopy: A hysteroscope is a tiny telescope mounted with a fiber optic light, it is used to examine uterine abnormalities (if your HSG indicated uterine abnormality).
Laparoscopy: A surgical procedure, performed under general anesthesia, it is performed around or before ovulation. This procedure allows the doctor to get a clear view of your pelvic cavity including; ovaries, outsides of fallopian tubes and the uterus. In addition, if endometriosis or adhesions are found, a laser can be used to remove them.
Sonohystogram: A ultrasound using saline to inflate the uterine cavity to allow for careful examination of the uterus.
Ultrasound: Either abdominal or vaginal ultrasound can be used to visualize the uterus and ovaries. Vaginal ultrasound is more sensitive. Ultrasound is often used to monitor the growth of follicles on the ovary during a cycle or to detect fibroids or ovarian cysts.