The First Step

 

The first step in overcoming infertility is a correct diagnosis of the cause of your infertility. Many couples will have more than one cause, so a thorough evaluation is essential.

 

• Are you ovulating normally?

• Are your fallopian tubes functioning?

• Is your uterine cavity normal and functional?

• Are your partner's sperms normal and functional?

 

These are just a few of the questions that must be answered before we can recommend which treatment option is best suited for your specific problem. Current statistics show there is a female problem in about 40% of the cases, a male problem in 40% of the cases and a combined problem in approximately 20% of cases.

 

In order to obtain a precise diagnosis, an in-depth study of each partner's medical history and medical records is initiated at a consultation with one of our reproductive endocrinologists. You will also have the opportunity to meet with a nurse and financial counselor during your initial consultation. This allows you to meet directly with the staff that will be assisting you in your fertility journey. A detailed physical exam may also be conducted for the female and additional diagnostic testing ordered based on your initial evaluation. Our personal approach to your work-up means that particular care will be taken, so only the appropriate tests are conducted, saving both time and expense.

 

Using the results from the diagnostic tests your physician will make appropriate recommendations for the next steps. In cases where male infertility is suspected, additional testing and a urological exam may be recommended. Other specialized testing or procedures may also be ordered at this time. In most cases, the evaluation can be completed within one menstrual cycle.

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Female Screening Tests

 

For most couples, several tests may be needed prior to initiating treatment. These are designed to look for problems that could have an adverse impact on your treatment or subsequent pregnancy. The testing is based on guidelines from the American College of Obstetrics and Gynecology and the American Society for Reproductive Medicine. If you have had any of the Female Screening Tests listed below within the last 6-12 months, please make the results available to us. Depending upon the test, you may not need to have the test repeated immediately prior to treatment. Depending upon the type of therapy planned, some tests may not need to be done.

 

Examples of Female Screening Tests

 

1. Mammogram

 

A mammogram is a screening test for breast cancer. The baseline mammogram for most women should be done at age 35, with a follow-up mammogram at 40. Current recommendations suggest screening every 1-2 years after that until age 50, then yearly mammograms after that.

 

2. Pap smear

 

A pap smear screens for cervical cancer and human papilloma virus infections. Currently, screening for most women is recommended to be done on a yearly basis.

 

3. Blood Tests

 

FSH / LH / Estradiol -This combination of FSH (follicle stimulating hormone), LH (luteinizing hormone) and estradiol drawn on day 2, 3 or 4 of the cycle is a reflection of the female partner's ovarian reserve, or how well we expect her ovaries to respond to stimulation. This is done because women may have "normal" cycles, but not be able to become pregnant for about 6 years before menopause (average age 50-51). We will generally test all women regardless of age because of the wide range of variation in the onset of menopause and of ovarian function in infertility patients. These tests will help us determine which procedures and protocols are most appropriate.

 

Infectious Screen (chlamydia, hepatitis, syphilis, HIV, Mycoplasma, gonorrhea) - Having one of these organisms could adversely affect the outcome of your treatment or your pregnancy should you become pregnant. All of these infections (except gonorrhea) have one thing in common: you may be infected, but not have symptoms for long periods of time. Thus, it is imperative that these be completed prior to initiation of therapy.

 

Pre-Pregnancy Screen (blood type and Rh Factor, Rubella titer, complete blood count) - Determining blood type can be helpful if there are problems with a pregnancy. Rubella is an infection that can cause serious birth defects if it occurs while you are pregnant. Most of us have been immunized against it. However, some people have not been immunized or their immunization is no longer working. This test determines if immunization is needed. A complete blood count screens for anemia and other blood disorders, as well as tip us off about certain inherited disorders.

 

Prolactin, TSH - These hormonal tests screen for subtle abnormalities that could affect your treatment or your pregnancy. Both hormones are made by the pituitary gland in the brain. Prolactin is a hormone that helps to stimulate milk production during breast-feeding. Some women will secrete too much prolactin when not breast-feeding. TSH (thyroid-stimulating hormone) is the most sensitive test of thyroid function. It can detect either over activity or under activity of the thyroid gland.

 

Other - If you're medical history, family history or testing suggests that you may be at risk for genetic or autoimmune diseases, or other medical problems, appropriate tests will be ordered prior to initiating the cycle.

 

4. Uterine Testing

 

Hysterosalpingogram (HSG) or Sonohysterography (saline sono) An HSG or a saline sono will be done to evaluate the inside of the uterine cavity. The HSG can also provide information regarding the fallopian tubes.

 

* Our physicians perform HSG testing onsite at our facility, which makes it much more convenient and timely for our patients.

 

Baseline ultrasound - A baseline ultrasound allows us to look at the muscle of the uterus and assess the ovaries and can be done on your initial visit or pre-IVF visit.

 

Trial Transfer - A special catheter is inserted into your uterus to determine the direction and length of the uterine cavity. This measurement may also be done by ultrasound. This is done so that when an insemination is done or the actual embryo transfer is done at IVF, it will occur in the smoothest possible fashion.

 

5. Physical Examination

 

Our physicians perform a complete physical examination on each patient.

 

6. Pelvic Ultrasound

 

A pelvic ultrasound takes a picture of the organs and structures in the lower belly (pelvis). It looks at the bladder, ovaries, uterus, cervix and fallopian tubes.

 

7. Ovarian Reserve Testing

 

It has been recognized for quite some time that a woman's chances of conception decrease with age.

 

With aging there is an accumulation of damage within cells. Over time as cellular damage accumulates, organs and tissues work less effectively and eventually may cease to function altogether. Compared with other organ systems, the female reproductive system fails at a relatively early age (the average age of menopause is 51 years). However, changes that limit a woman's chances to reproduce start many years before that. This appears to be due to a decrease in number of oocytes, as well as an increased proportion of oocytes that have abnormal chromosomes. Treatment options for infertility become more limited as ovarian function wanes, as there is no treatment that can restore eggs or improve their quality.

 

Ovarian reserve – The ovarian reserve is the term that we use to describe the reproductive potential of a woman's ovaries during the aging process. While age itself is an important determinant of ovarian reserve, not all women of the same age have the same reproductive potential. The medical evaluation of ovarian reserve is accomplished by tests that measure important components of the reproductive system.