Have you and your partner been talking about starting a family? Do you have concerns about fertility? As you go through the process of evaluating your fertility there will be tests, but not all of those tests will be “pass/fail.” Most couples land somewhere on a spectrum of fertility, meaning that getting pregnant could be more difficult for some, but not necessarily impossible. Some tests will evaluate your and your partner’s counts while others will focus on your anatomy. To explain the various tests that could be recommended, we spoke with Sohaib Kayani, MD, an obstetrician and gynecologist at Banner Health in Arizona.
Beginning the journey
Dr. Kayani explained that every fertility evaluation begins with a detailed interview and physical examination of the female and male partners. The interview is discreet, respectful and will include questions covering sexual patterns, length of time attempting pregnancy, occupational exposures, habits with alcohol, nicotine and recreational drugs, and more. Additionally, the man and woman could be asked questions regarding their own experiences with painful menstruation, infections, erectile dysfunction, sexually transmitted diseases, past medical procedures and prescribed medications. Gathering an honest and comprehensive history is vital to determining which tests should be prescribed.
Common tests for men
“Women commonly feel the weight of fertility rests solely on them, but men contribute to one-third of infertility cases,” said Dr. Kayani. It is very important for men to be included in conversations regarding infertility. For men, a semen analysis is typically the first step following the interview. This simple exam measures the sperm count, shape of the sperm and movement of the sperm. Following the results, the man may be directed to his primary care physician or urologist for further examination of his anatomy.
Common tests for women
There are various tests that can be recommended following the interview, Dr. Kayani explained a few of the most common:
- Basic lab workup – It’s important to get a baseline for hormone and thyroid levels. This helps to rule out any hormonal abnormality which may interfere with the release of an egg each month, called ovulation, and for assessment of ovarian reserve.
- Pelvic ultrasound – This evaluates anatomic problems such as polycystic ovary syndrome (PCOS). A special x-ray (hysterosalpingogram) may also be recommended.
- Hysteroscopy – This evaluation allows doctors to see the cervix and inside the uterus by means of a thin lighted tube, inserted into the vagina.
- Ultrasound egg count – You have a finite number of eggs. Knowing that number could help determine your fertility. Your doctor could obtain an ultrasound to help count the remaining eggs. A well-timed test could also inform the doctor about how many eggs could be frozen during one cycle.
- Hormone egg count – This may be included in your basic lab workup. Bloodwork to evaluate your hormone levels is another way that doctors can get an accurate egg count.
What comes after testing?
Once your lab work and imaging tests are completed, you may be referred to a reproductive endocrinologist and infertility specialist (REI). An REI referral typically accompanies cases such as:
- Abnormalities found in the uterus or fallopian tubes
- History of repeat miscarriages
- Same sex couples
- Conservation of eggs/sperm for future fertility
Ovulation induction is another option and can be performed by an OBGYN. “Since infertility treatment is generally not covered by most insurances and the costs of treatment can be prohibitive, most patients hesitate to see an REI immediately and prefer a trial of induction with their general OBGYN and seek referral only if unsuccessful,” Dr. Kayani explained.
Ovulation induction is a closely monitored process which begins with taking medication for a few days at the start of the menstrual cycle. You will be counselled regarding proper timing of intercourse often using either home monitoring ovulation kits, confirmation of ovulation with imaging or day-21 progesterone levels. Labs are drawn during the cycles to confirm if ovulation occurred. “If ovulation induction is unsuccessful after 3 cycles, we generally refer the patient to a reproductive infertility expert,” said Dr. Kayani.
For more information about fertility testing, speak with your healthcare provider. To find a qualified and experienced OBGYN, visit bannerhealth.com to find a provider near you.
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