Infertility is a term generally defined as a failure to achieve pregnancy within 6-12 months of trying to conceive, though the strict definition can vary somewhat depending on each individual patient. For women age 35 and older, or with other medical problems, this window is shortened to 6 months. Infertility affects about 15% of couples due to a variety of reasons including decreased or impaired ovarian function, blocked fallopian tubes, history of pelvic infections, abnormal uterine anatomy, or abnormal sperm in one’s reproductive partner. Many times, however, it is unexplained.
If you have been trying to conceive for 6-12 months and have not yet become pregnant, an evaluation by an OB/GYN is warranted. This typically begins with a complete history, physical examination, and laboratory tests. We will also review your menstrual calendar to ensure that you’ve been having intercourse at the right time each month to increase the chances of getting pregnant. We can then will recommend a variety of tests as well as a referral to a Reproductive Endocrinologist and Infertility specialist (REI). Here is what to expect from testing:
Male factor infertility is typically related to problems with sperm, such as a low count, slow movement, or abnormal appearance. All of these issues can be evaluated with a test called a semen analysis, where a semen sample is viewed under a microscope. We generally refer you to an REI for this, as they perform this test directly in their own laboratory.
Female causes of infertility are much broader. We order blood tests to check hormone levels, as well as thyroid function. A specialized imaging test called a hysterosalpingogram, or HSG, may also be done. During this test, a radiologist puts dye through the cervix into the uterus and fallopian tubes, which lets us see that the fallopian tubes are open. During this test, the doctor may also see that the shape of the womb is abnormal. For insurance reasons, you may need this test ordered by an REI.
Based on all of these findings, your REI will make recommendations and provide treatments for pregnancy. Once you are pregnant, they will have you make an appointment with us to establish care for your pregnancy.
Pending the results of your initial workup, additional testing or procedures may be recommended. Alternatively, certain medications can sometimes be prescribed to help optimize your chances of achieving pregnancy. Ultimately, you may be referred to a specialist in the field for further management. REIs are trained in special methods of achieving pregnancy, including the use of hormonal medications, intrauterine insemination, or in vitro fertilization. Each of these topics can be discussed with your primary OB/GYN, and the need for a consultation with an REI can be determined jointly.
For more information regarding concerns about or difficulties getting pregnant, call and schedule an appointment with one of our general OB/GYNs at Maternal Fetal Medicine Associates. We are here to help!