Posted on:January 1, 2018
Infertility is defined as the failure to achieve pregnancy after 12 months of attempting conception, 6 months if the female partner is over the age of 35 years. If couples have been having unprotected intercourse for this length of time and are not pregnant, then it is time to see a fertility specialist. However, at Austin Fertility Institute, we support women who are interesting in understanding their fertility potential at any time.
The basic fertility evaluation includes:
1. Ovarian reserve testing – All women have a decrease in egg number as they get older and ovarian reserve tests attempt to quantify this decline. A blood test, named Antimullerian hormone (AMH) can help compare a woman’s ovarian reserve to that of her peers. In addition, an evaluation or the reproductive hormones early in the menstrual cycle (FSH, LH, and Estradiol) and a pelvic ultrasound to determine an antral follicle count (AFC) is also a part of this evaluation.
2. Evaluation of ovulation – The strongest measure of ovulation is regular, reliable cycles. Other markets such as positive ovulation predictor tests, cervical mucus changes, and basal body temperature shifts support this. Spotting at a time other than after the menses can be concerning and may warrant a further evaluation. We also evaluate thyroid and pituitary hormones as subtle abnormalities in these hormones can impact ovulation.
3. Anatomical evaluation – Female reproductive anatomy should be evaluated to make sure there are no barriers to fertilization or implantation. The most common means of evaluating reproductive anatomy include either a hysterosalpingogram (HSG) or surgical evaluation. The HSG is an x-ray dye test in which dye is injected into the uterine cavity to show the inside of the uterus and can determine patency of the fallopian tubes. Surgical evaluation is sometimes warranted based on history and risk factors for more advanced disease and often include both laparoscopy and hysteroscopy.
4. Semen analysis – a semen sample will be evaluated to determine sperm count, motility, and morphology (shape).
5. Preconception evaluation – other testing includes determination of generalized health measures (such as Vitamin D levels) and genetic carrier screening. The American Society for Reproductive Medicine (ASRM) currently recommends testing at least one partner in a coupole to see if they are a carrier for any autosomal recessive conditions. The disease present as “silent carriers.” If both partners are carriers for the same disease, then they are at risk for having an affected child and IVF with preimplantation genetic diagnosis (PGD) should be considered. Examples of such diseases include cystic fibrosis and spinal muscular atrophy.
Some couples should seek an evaluation sooner than the above mentioned time intervals. Examples of when to see a fertility specialist sooner include:
1. Menstrual cycles are not regular or have spotting during the cycle
2. Severe pain with menses or intercourse
3. Difficulty achieving erection or ejaculation
4. Frequent miscarriages
5. Known history of fertility impacting conditions, such as endometriosis, chlamydia, uterine fibroids, or multiple abdominal surgeries
6. Male partner with current/recent use of anabolic steroids such as testosterone
You can receive additional information under our Patient Education tab on the AFI website, or by scheduling a visit with one of our physicians today!