If you and your partner are one of the 7.3 million U.S. couples who are having difficulty conceiving, a fertility specialist may be able to help you. For many people, visiting a fertility specialist is the first step toward an eventual successful pregnancy, but in between it can be a lengthy and sometimes frustrating journey. Knowing what to expect can help you navigate the tests and procedures more easily.

Many fertility sources recommend waiting until you have attempted to get pregnant for one year without success. But according to Resolve, a national infertility association, for many couples, a year is too long. The couple should consult a specialist if they're having trouble conceiving for 6 months or more and she is over 35, or if she is over 30 and has had any of the following: irregular menstrual cycles, miscarriage, or a history of pelvic infection.

Trouble with conception doesn't necessarily mean the woman has a fertility problem -- her partner may have a low sperm count or other difficulty -- but for women, the above factors can be red flags to fertility specialists. Resolve recommends that you ask your primary care doctor or ob-gyn for a referral to a board-certified reproductive endocrinologist. This specialist is an ob-gyn with two or three additional years of schooling in fertility problems.

Both you and your partner should attend the initial visit. The doctor will take a complete medical history from both of you.

For women, questions will likely cover these areas:

•A detailed menstrual history (to help determine whether and how often you are ovulating)

•Any previous pregnancies you've had

•What kinds of birth control you've used

•Any history of sexually transmitted diseases

•Your current sexual patterns

•Medications (including over-the-counter drugs and herbs) that you're taking

•Your surgical history

•Any health problems

•Your lifestyle and work environment, to gauge any exposure you may have had to toxic materials

•Your history of drug and alcohol use, smoking, and any other lifestyle factors that may influence your ability to get pregnant.

For men, your doctor will want to know about these potential factors:

•Any past medical problems that could affect your fertility, such as mumps after puberty, hernia repairs, injuries to the groin, or a history of undescended testicles

•Any history of sexually transmitted diseases

•Whether you've had urinary tract infections

•Any history of prostatitis

•Whether you are impotent or have ejaculatory problems

•What medications you're taking

•Personal habits that may affect sperm quality, such as smoking, drinking, or drug use.

Next comes a physical examination to help your doctor spot any obvious signs of problems that could affect your fertility.

The woman's exam will probably include the following:

•Thyroid exam. The doctor will palpate your neck, feeling for any abnormalities.

•Hair patterns. Unusually heavy hair growth on your face and body could indicate an increase in male hormones, which can affect fertility. The growth pattern of a woman's pubic hair, for example, can be an indicator of an overabundance of male hormones.

•Breast exam. Your doctor will check for abnormal breast secretions by gently squeezing behind the nipples. Such secretions may indicate you have a higher than normal level of prolactin, a hormone that stimulates milk production in nursing mothers but interferes with ovulation.

•Pelvic exam. In addition to looking for abnormalities, your doctor will probably do a Pap smear to rule out cervical cancer and a cervical culture to look for chlamydia and other bacterial infections.

The man's physical exam will include a check for any abnormalities in the penis and scrotum and a prostate examination; the lab work will include a semen analysis. The semen analysis is the single most important indicator of male fertility. It's usually done from a sample produced in private at the doctor's office or lab. From the semen analysis, your doctor can tell whether you are producing sperm, whether you have enough, and if they are well-formed and sufficiently active.

If your doctor doesn't find something through the initial exam, he or she may suggest further studies. Some common tests for women are listed below. You may already be using a variety of methods to test your ovulation.

These tests will let your doctor know whether you have been ovulating and when to expect your next ovulation. Blood tests are used to measure hormone levels and ultrasound to see whether an egg is developing and likely to be released, among other things. Your doctor may also use one or more of these additional testing methods:

•Basal body temperature charts. Your basal body temperature (also called basal metabolic temperature) is the temperature of your body in the morning when you are at rest. A woman's basal body temperature rises slightly when she ovulates, so keeping accurate records for a few cycles can help you and your doctor chart the most likely time for you to conceive.

•Checking cervical mucus. It also helps to know how to gauge the consistency of your cervical mucus. Just before you ovulate, this normal discharge changes from sticky and milky to slippery, clear, and very stretchy.

•Testing with ovulation predictor kits. These work by measuring the level of an important hormone called luteinizing hormone (LH) in your urine. LH stimulates the release of the egg and causes changes in the uterus and cervical mucus that support conception. With these kits, a woman can test herself and figure out the best time to try to get pregnant.

A number of tests measure whether your ovaries are able to produce healthy eggs. Here are some your doctor may use:

•Day 3 FSH. This blood test performed on the third day of your menstrual cycle measures your level of Follicle Stimulating Hormone (FSH), which is responsible for stimulating the growth of the sacs, or follicles, that house developing eggs. Too much FSH may mean a decrease in the production of good quality eggs.

•Day 3 Estradiol Tests. Also a blood test, this one measures the level of one kind of estrogen. Too much estradiol may indicate poor quality eggs.

•Ultrasound. Performed a few days following a rise in your LH levels, an ultrasound can determine if you have ovulated.

Tests performed after ovulation (luteal phase testing). Your luteal phase is the time between ovulation and the start of your next period, usually from 12 to 16 days. These are some of the tests that may be performed during this phase:

•Plasma progesterone level. This blood test taken toward the end of your cycle indicates whether ovulation has occurred.

•Hormone tests. You may have blood tests to determine your levels of the hormones that play a role in fertility, such as progesterone, prolactin, androgen, and thyroid-stimulating hormone.

•Endometrial biopsy. Your doctor may take a small tissue sample from your uterine lining to see if it is thick enough to support a fertilized embryo.

•Cervical mucus testing. Your doctor may want you to take a sample of your cervical mucus shortly after intercourse in the middle of your cycle, so it can be checked for the presence of live, active sperm.

To make sure your reproductive organs are in good shape, your doctor may perform any of the following procedures:

•Hysterosalpingogram (HSG). This x-ray, performed in the first part of your cycle, involves putting radiographic dye in your uterus and watching its course through your fallopian tubes. The test is to determine whether you have blockages, either from scar tissue or some other cause, as well as to find out if your uterus is properly shaped. Some gynecologists believe that having an HSG test can help a woman get pregnant -- even if her tubes aren't blocked -- possibly because it flushes out the reproductive plumbing.

•Hysteroscopy. If an HSG finds uterine abnormalities, your doctor may take a closer look with a hysteroscope, a tiny telescope with a fiber optic light attached.

•Laparoscopy. This surgical procedure may be performed if previous tests haven't found the source of the problem. It allows your doctor to examine your ovaries, uterus, and the exterior of the fallopian tubes, and to use a laser to remove any problematic tissue obstructing the tube.

•Sonohystogram. During this ultrasound procedure, your uterine cavity is inflated with saline to allow your doctor to get a clearer picture of your uterus.

The number and variety of tests can seem daunting. It's natural that at times you may feel invaded or embarrassed. Be sure to talk to your doctor about your feelings and to ask questions when you don't understand a procedure. You, your partner and your doctor are on the same team, and by working together you may be able to achieve your goal -- a healthy pregnancy.

-- Nancy Montgomery is an associate editor at Consumer Health Interactive.

Further Resources

Resolve: The National Infertility Association

References

Last updated September 22, 2009
Copyright © 2002 Consumer Health Interactive

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