If you are under the age of 35 and you and your partner have been trying to to conceive naturally for over a year with no success, your OBGYN will most likely advise you to see a fertility specialist. Same for women who are 40 years plus, only they should consider consultation after 3 to 6 months of trying to conceive.
Many people automatically think that infertility specialists will opt to treat you with in vitro fertilization, but there are other options available to you depending on the state of your health and what you may require. In vitro fertilization is an excellent option and has proven to be very successful for many couples, but you and your partner may not need such treatment.
If this is the case, it does not mean that you should give up hope, it only means exploring the other avenues that make more sense for you and/or your partner’s condition. Make sure that you are consulting a fertility specialist you feel that you can trust and take the necessary steps to make sure that the clinic’s location and financial requirements are doable for you. From there, your doctor will examine both you and your partner to see what they can discover about your health.
During this time, it is very important to listen to your gut instinct about what you are comfortable with and exactly what you desire. Do your research and make sure your specialist is taking the proper steps to help you.
Below, we will discuss what you should expect from your evaluation, the different treatments that are available, and the best way to move forward once you have begun your exploration.
Your Evaluation And What To Expect
About 60% of infertility within a couple is a due to only one partner, but 40% includes issues in both people’s reproductive systems. In order to completely assess both partners, this may require more than one visit. In the beginning, you both will have to provide the doctor with a complete medical history.
This usually takes about an hour, and your doctor will ask about:
- previous surgeries
- chronic illnesses
- previous testing or treatments you have had for infertility
- any other important factors about your health
They will ask you about any habits or lifestyle influences, such as:
- tobacco use
- alcohol use
- any medications you have used or are using
- any toxins you may have been exposed to at home or at work
You will be required to give a detailed explanation of your sexual history as well, including:
- previous pregnancies
- sexually transmitted diseases
This information may feel uncomfortable to disclose to a stranger, but it is absolutely necessary in order to get to the root of the problem. This is one of the reasons you should feel completely comfortable and safe with the doctor that you choose.
30% of infertility is due to a male problem, some common examples of these are:
- structural abnormalities
- disorders in sperm production
- difficulty with ejaculation
- immune disorders
When the male partner is evaluated, tests may include, but not be limited to:
- a complete physical exam of the eternal genital area, rectal area, structural expectations and overall health
- blood tests that will check for certain diseases or STDS, the level of testosterone, and other existing hormones in the blood
- urine tests to check for problems like diabetes or kidney infection
- semen analysis to check the sperm count, mobility, and morphology
- biopsy of the testicles
Examining possible issues in a woman’s fertility can be a bit more complicated and take more time. To get a proper diagnosis, it sometimes takes up to 3 or 4 period cycles because evaluating such things is most successful during ovulation.
Some of the necessary tests may include, but are not limited to:
- a full physical exam of the pelvic area, blood tests, urine tests, and overall health
- ovulation evaluation, which involves using urine samples to predict ovulation over a 1 to 2 month period
- blood tests throughout different points of the menstrual cycle to assess hormones
- pelvic ultrasounds that monitor follicle growth
- a hysterosalpingogram (x-ray of the uterus and fallopian tubes) which shows the shape of the uterus and the accessibility of the tubes
- an endometrial biopsy, which evaluates the uterine lining for any hormonal imbalances
- a laparoscopy is sometimes performed to check for endometriosis
- a postcoital test can also be performed to test the woman’s cervical mucus and how her partner’s sperm interacts with it
Ovulatory Function. Ovulatory dysfunction is the reason for up to 40% of female infertility and is found in about 15% of couples. A woman’s ovulation can be tested by an ovulation predictor kit, measuring the basal body temperature, or doing an ultrasound mid-cycle. If the female partner doesn't have regular menstrual cycles that occur every 21-35 days, she will require further ovulatory assessment.
Ovarian Reserve. A woman’s ovarian reserve and the quality of her eggs decreases as she ages and cannot regenerate. In order to determine her fertility potential and treatment options, the doctor must examine her ovarian reserve. This can be done by measuring basal follicle stimulating hormone, estradiol, and anti-Mullerian hormone levels.
Tubal Patency. Another common cause of infertility in women is impaired tubal patency. If tubal disease is suspected due to the patient’s health history, this is when a doctor may perform a hysterosalpingograms. HSG can discover tubal patency or uterine abnormalities.
After you and your partner have gone through all of the necessary testing, your doctor will give you their opinion on the best fertility treatment plan available for you. Which technique you may need largely depends on the cause of infertility. Some of the options that will be made available to you include:
Fertility drugs. These are typically injected or taken in pill form to release hormones into the system that induce ovulation and boost egg production. Fertility drugs are typically recommended for women who do not ovulate regularly or who have partners with poor sperm quality. They are not recommended for women with damaged or blocked fallopian tubes or scarring from endometriosis.
Intrauterine insemination. This is when the sperm is inserted directly into the uterus. Doctors often recommend using fertility drugs along with this method to increase the chances of fertilization. IUI is usually recommended if the male partner has poor sperm health or for a woman whose cervical mucus is too thick or acidic to transport the sperm properly.
Donor sperm. This is when the sperm is donated by another man to use during IUI or IVF. Donor sperm is used when the male is experiencing infertility or carrying genetic disorders that could be passed onto his children.
In vitro fertilization. This is a multiple step process where the woman’s eggs are extracted, fertilized in the lab, and then some are implanted back into the uterus and the rest are stored for later use. This method is best for older women or women with blocked or damaged fallopian tubes. It also is recommended to couples where the male partner has poor sperm quality and those with unexplained infertility.
Donor eggs. Donor eggs are the eggs obtained from another woman and fertilized with the sperm from the male partner. The fertilized eggs are then transferred into the female partner’s uterus. Using this method is typically recommended to women whose ovaries are damaged, those who have undergone chemotherapy/radiation, older women with poor egg quality, and women who carry genetic disorders that they could pass along to their children.
Surrogacy. This is when another woman carries a baby for the female partner. The surrogate achieves pregnancy by artificial insemination using the father’s sperm or through IVF with the couple’s embryo. This is best for women who are unable to carry a baby due to a disease, hysterectomy, or infertility.
Donor embryos. This is where embryos are donated by couples who have undergone IVF and no longer plan to use the rest of their fertilized eggs. This is useful for couples wherein both the male and female are infertile, yet wish to still experience pregnancy.
Reproductive surgery. This is surgery that the man or woman may undergo in order to fix anatomical abnormalities, remove scarring, or clear blockages.
Questions To Ask
During your first consultation with your doctor, it will help to be prepared with some questions that you will want to be sure to have answers to before leaving the room.
Examples of such questions are:
- What do you suspect is causing my infertility problems?
- Should we proceed with treatment right away or wait a bit longer so we can make up a timetable for evaluation and treatment?
- What additional tests do you think I need and what do they cost? Will they be covered by my insurance?
- What are the treatment options that you think I will need and how much do they cost?
- What is the success rate for live births with these treatments?
- What else can I do to help improve my chances of getting pregnant?
- How many times has this clinic performed procedures of this type?
- What are the success rates of live births in comparison with other clinics?
- How many doctors work here and are they all certified in infertility?
Preparing For Your First Consultation
Important things to keep in mind as you prepare for your first consultation include:
- The more information that you can provide your doctor with about your health, the better your chances are of determining the cause and reaching a solution
- It’s a good idea to bring your calendar with you so you can plan ahead accordingly for fertility treatments and possible vacations that you may need to reschedule
- Your first consultation will provide you with a lot of information, bring a notepad because there is no way that you will remember all of the details
- The treatment that you end up going forward with is your decision and no one else’s, make sure that you are comfortable and confident with the plans that your doctor is making for you
- If at any time you feel as though your relationship with your doctor or clinic is not right, assess the feeling carefully and do not feel guilty if you think it is best to get a second opinion
Determine If You Need A Second Opinion
If you have been diagnosed by a specialist and are unsure about their conclusion, or you have undergone treatment and are considering changing doctors, do not be overly worried about your doctor’s feelings.
There are many people who seek out a second opinion when:
- they have doubts about the diagnosis
- they are unsure if the course of treatment recommended is right for them
- they simply want a second opinion to solidify this plan of action
- they are concerned about their ability to finance the treatment
- they do not feel confident that they are completely comfortable with the doctor
There is simply nothing wrong with wanting to be sure that you are taking the right path when it comes to infertility treatment. Now that you know that there are many different ways it can be treated and that certain treatments are more appropriate depending on the issue, you should be sure that your doctor has made all of the necessary assessments and considerations.
This journey should be one that you hold the reigns for. Carefully consider the moves that you make and trust your gut. If you have more questions about the different types of treatments that may help you, set up a consultation today. What can it hurt?