Thursday, May 23, 2013

What do we do if we can't get pregnant on our own?

The official definition of infertility is one year of regular unprotected intercourse without a conception.  That means if you conceive but miscarry, you are not actually infertile.  There are many aspects of the process of conception that cannot be studied or tested, and if a couple who has not yet started trying to conceive comes in asking me how they know whether or not they're fertile, I tell them we won't know until they try.  Clearly there are greater concerns in older (especially >34 year old) moms,  in women who have a history of pelvic inflammatory disease/sexually transmitted infections and in women who have had a number of abdominal surgeries.  Also, those women who menstruate infrequently are also likely to be having problems with ovulation, and may require evaluation before a full 12 months has passed.  For men with a history of mumps, genital injury, or age greater than 56 there may also be concerns.  For couples that have problems having regular intercourse, ovulation predictor kits can help them know when to try to create time for sex when it is most likely to result in conception.  Basal body temperature testing can be helpful, but is more cumbersome and vulnerable to inaccuracies with illness, etc.

The basic set of tests we order are a semen analysis or "sperm count", a tubal dye study ("hysterosalpingogram" or HSG), and a measure of "ovarian reserve" with a test called FSH (follicle stimulating hormone)as well as thyroid hormone and prolactin hormone levels.  The semen analysis is best performed at the laboratory after about 48--72 hours of abstinence.  The bloodwork is done on the 3rd day of the menstrual period in order to be accurate.  The  HSG is done after the period is over but before ovulation, about day 9 of the menstrual cycle.  If all the test results are normal, we will then usually refer on to the specialists in infertility called Reproductive Endocrinologists (REI).  They will oftentimes offer a plan that may include ovulation moniotoring and intrauterine insemination (with or without medications).  If that is unsuccessful, IVF or in-vitro fertilization may be discussed.  Fortunately many insurance companies have expanded their benefits regarding both testing and treatment over the years.  It's always a good idea to consult with your carrier ahead of time to get a general idea of what your coverage is for such interventions.

Infertility can be stressful for a couple and it is important to take good care of yourself and your relationship during evaluation and treatment for the problem.  The website  is a great resource for information and support for individuals and couples. 

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