Often times the most frustrating part of infertility is to answer the question of "Why?"
The best way to find the cause of a couple's infertility is by performing a complete fertility evaluation of both partners. This process includes the following components:
A thorough review of the medical and sexual histories of both the man and the woman
When you meet with a Reproductive Endocrinologist at InVia Fertility Specialists, you will be asked a series of questions regarding your sexual history. You will be asked if you have had a successful pregnancy, if you have ever been treated for an STD as well as a list of medical conditions that may have an impact on your fertility.
Male Fertility Testing
Men will be asked to have a semen analysis. This is needed to evaluate your sperm count and to rule out male factor as the cause for infertility.
If your physician has referred you to InVia Fertility for a semen analysis, we ask that you follow the collection directions carefully.
- Abstinence Period: You should abstain from ejaculation for at least 48 hours, but no more than five days prior to producing the specimen.
- Specimen Collection: The specimen should be obtained by masturbation only. Optimally, the specimen should be produced in our office. We have private rooms for this purpose. If you are unable to produce in our office due to time or other constraints, you may pick up a sterile container from your physician, our office, or a local pharmacy. The specimen should be ejaculated directly into the sterile container. It is important that you do not use any lubricant (i.e. lotion, oil, or saliva) in obtaining the specimen. This may affect the results of the analysis. Collection into commercially available condoms is not acceptable. If you have difficulty producing by ejaculation, please consult your physician.
- Specimen Handling: If you collect the specimen at home, it should be delivered to our laboratory within one hour. Keep the container with the sperm tightly capped, and maintain it at body temperature by keeping it close to your body (i.e. under your arm or tucked in under your shirt).
- Specimen Labelling: The following pieces of information must be on the container:
- Partner's name
- Time collected
- Days of abstinence
- Was any of the specimen lost during the collection? Yes/No
Female Fertility Testing
Women will undergo a hormone evaluation as well as an evaluation of the uterus and fallopian tubes.
Hormone levels are checked in the blood between days 2-4 of the menstrual cycle. In women who do not have regular menstrual cycles, this testing can be done at any time. Among the hormones which may be evaluated are:
- Follicle Stimulating Hormone (FSH)
- Luteinizing Hormone (LH)
- Thyroid Stimulating Hormone (TSH)
- Anti-Müllerian Hormone (AMH)
The uterus and fallopian tubes will be evaluated by one or more of the following female fertility testing procedures:
- Hysterosalpingogram (HSG). Dye is injected into the uterus and the tubes and its flow is followed by real time x-rays as it fills the uterus and spills out of the tubes. This is an excellent test to detect blocked tubes.
- Hysterosonogram (saline infusion scan). During this procedure, fluid is injected into the uterus and is seen with an ultrasound. This is an excellent test to detect problems within the uterine cavity
- Hysteroscopy. This is a minor surgery in which a camera is inserted through the cervix and into the uterus. This is an excellent test to detect scar tissue within the uterine cavity
Some of the common infertility diagnoses are:
Ovarian Dysfunction - A problem with the ovary where the egg is not matured or released properly.
Tubal Diseases - A disorder in which the fallopian tubes are blocked or damaged. Scar tissue, infections and tubal ligation are often causes of tubal disease. Scar tissue resulting from endometriosis, previous ectopic pregnancies or abdominal and gynecological surgery can block an egg from entering or traveling down the fallopian tube. Infections can damage the cilia, the tiny hairs lining the fallopian tubes that help transport the egg, often preventing the sperm and egg from meeting.
Advanced Maternal Age - The most profound factor influencing fertility is age. In women, there is a subtle decline in fertility starting in the late 20's. In the years between age 38 and 40, fertility declines more rapidly. Once a woman turns forty, there is a significant and rapid decline in fertility with each year.
Endometriosis - A disease whereby cells lining the uterus (or endometrium) grow outside of the uterus and stick to other organs, causing inflammation. Symptoms, if they occur, may be painful menstruation, painful bowel movements and/or painful intercourse. Infertility is an important symptom of endometriosis.
Polycystic Ovarian Syndrome - Also called Stein-Leventhal syndrome. The formation of cysts in the ovaries that occurs when the follicle stops developing. This is due to a hormonal imbalance in the ovary. A reason for infertility caused by an overabundance of androgens, small cysts on the ovaries, and lack of ovulation. Symptoms may include obesity or weight gain, acne, excessive hair growth and amenorrhea. PCO may also occur without outward symptoms.
Premature Ovarian Failure This is a critical part of an infertility evaluation in which we test the reproductive potential of the eggs. A diagnosis of "diminished ovarian reserve" is made when the tests suggest that the ability of the eggs to result in a pregnancy is compromised.
Amenorrhea - The absence of menstrual period.
About 20 percent of couples have unexplained infertility, for which a cause is not found. Unexplained infertility means that the reason for your infertility is unable to be identified at the present time. It does not mean that there is no reason for infertility.
Fibroids - Benign (not malignant or life-threatening) tumor of fibrous tissue that can occur in the uterine wall. May be totally without symptoms or may cause abnormal menstrual patterns or infertility.
Hypothalamic - Cessation of menses caused by disorders that inhibit the hypothalamus from initiating the cycle of neurohormonal interactions of the brain, pituitary, and ovary necessary for ovulation and subsequent menstruation.
Recurrent Miscarriage - There are some known causes for recurrent pregnancy losses such as genetic abnormalities, hormonal imbalance and autoimmune factor. There are cases where no cause can be found for recurrent miscarriages. For a more detailed explanation, vist our Female Infertility Treatment page.
Ectopic Pregnancy - Implantation of an embryo in a place other than the uterus. Most commonly in the fallopian tube.
Pelvic Adhesion Disease - Inflammatory disease of the pelvis (usually caused by infection) that can lead to scarring and infertility.
Anatomical issues (Uterus, cervix) - Abnormal development and function of reproductive organs resulting from birth defects or scarring can affect fertility.
Once all of the testing is completed and you have an infertility diagnosis, a thorough discussion with a reproductive endocrinologist will take place to design a detailed treatment plan.