Having trouble getting pregnant can be one of the most frustrating problems for couples. It can be a challenge to keep a positive attitude when people all around you seem to be getting pregnant. You are not alone! It is estimated that about 15% of couples have trouble with infertility.
Infertility is defined as an inability to achieve pregnancy after one year of regular, unprotected intercourse. It is at this point that we recommend couples be evaluated. However, if you are 35 years of age or older, we recommend evaluation after 6 months.
We also recommend earlier evaluation for:
- Women who have very irregular periods (suggesting the absence of ovulation)
- If there is a known fertility problem with you or your partner
About the Evaluation
Your initial fertility evaluation will include the following components:
A thorough medical and pregnancy history for you and your partner. The provider will ask questions about:
- Your periods
- If your periods are irregular and you have a “menstrual calendar” indicating the days of your cycle over the last few months, please bring it.
- Any abnormal bleeding, discharge, or pelvic pain you have
- Frequency of sexual intercourse
- If you have records from previous infertility evaluation, it is very helpful if you have those available at this visit.
After a thorough history is taken, you may undergo a physical exam. This depends on when the last one was performed by our office and if you have any concerns at the time of that visit.
Evaluations for Different Causes of Infertility
Below is a quick overview of the different causes of infertility and how they are evaluated.
Irregular or absent ovulation accounts for about 25% of all infertility. If you have regular monthly menses every 24-34 days, then you are likely ovulating
- There some methods you can use to help evaluate if you are ovulating
- Cervical mucus monitoring
- Clear, wet, and stretchy (“egg white”) discharge from your cervix and vagina occurs for 3-4 days just before and during ovulation.
- If you track your cervical secretions over a month, you’ll notice no secretions for 3-4 days after your period, followed by scant and cloudy secretions for the next 3-5 days, then the clear and stretchy discharge of ovulation for 3-4 days, and lastly no notable secretions for the following 11-14 days until next period begins.
- Body temperature
- Take your temperature FIRST thing in the morning for a month. This may be charted online or recorded in your menstrual diary. The progesterone that increases after ovulation causes your body temperature to rise 0.5-1 degree Fahrenheit.
- Not everyone who ovulates gets an increase in body temperature.
- Ovulation predictor kits (OPKs)
- These are designed to alert when you ovulate, thus allowing you to have intercourse at the correct time each month.
- Cervical mucus monitoring
- The best test to determine ovulation is a laboratory test to check the progesterone level in your blood during the second half of the menstrual cycle. This is usually done around day 21 of your cycle if you have 28-day cycles (day #1 is the first day of bleeding). However, if your cycle length is typically longer or shorter than 28 days, your provider may recommend checking a progesterone level on another day.
Abnormal fallopian tubes or inflammation in the abdomen around the fallopian tubes account for 35% of infertility.
- Risk factors for tubal factor infertility include:
- Gonorrhea or Chlamydia or pelvic inflammatory disease
- Severe endometriosis
- Prior ectopic pregnancy in the fallopian tube
- Multiple pelvic surgeries
- Prior tubal surgery
- To assess if the tubes are open and if the uterine cavity is of normal shape, we refer you to get a special x-ray called a hysterosalpingogram (HSG). This can be done in most infertility specialty clinics and radiology offices.
Male Factor Infertility
Infertility is not just a female problem. This is why we like your partner to be an active participant in this evaluation. Abnormal sperm accounts for 40% of infertility and thus a semen analysis is a very important part of the work-up.
- Your partner will be given a referral to a physician that does this test. This is usually a urology office or an infertility specialty clinic.
- The semen analysis looks at the amount of sperm, the movement of the sperm, and the shape of the sperm.
Fertility begins to decline more rapidly in your later 30’s because fewer eggs remain in the ovaries. Of the eggs that remain, fewer are of the same quality as they were when you were younger.
- There are blood tests that help us determine your fertility potential by examining the amount of ovarian function you have remaining.
This is rarely the sole cause of infertility.
- The uterine cavity will be assessed at the time of the HSG but can also be assessed with a special ultrasound called a saline-infusion sonogram or sonohysterogram.
15% of infertile couples who undergo the full evaluation have all normal results.
Schedule a Consult
If you would like to discuss infertility with your provider in Raleigh, NC, it is best to schedule your visit as a CONSULT visit. This allows you to be booked into the last slot in the morning or afternoon, which affords you the most time with your provider. Discussion of infertility at your annual exam may be less comprehensive given time constraints. Call us at (919) 781-6200 to schedule your consult.