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Diagnosing Infertility

The most frustrating part of infertility treatment can be working out why you’re having trouble getting and staying pregnant in the first place. There are so many causes of infertility, and some causes we don’t fully understand yet.

When you meet with Dr. Karande, Dr. Klipstein, Dr. Puscheck, or Dr. Luu at InVia Fertility Specialists, we will take a complete medical history in order to evaluate your fertility. We will ask you:

  • If you have ever had a successful pregnancy
  • Whether you have ever been treated for a sexually transmitted disease
  • Whether you have ever had conditions known to cause infertility

We will carry out a thorough review of histories and conduct tests on both men and women. Once we have results, we can begin to develop a treatment plan with you.

Male Fertility Testing

We will ask you to have a semen analysis. This is needed to evaluate your sperm count and to rule out male factor as the cause for infertility. We will look at:

  • Sperm motility (whether your sperm cells are moving and swimming effectively)
  • Sperm morphology (whether they are shaped properly)
  • Sperm vitality (the percentage within a given sample that are alive)
  • Overall sperm count

Semen Specimen Collection Guidelines

If your physician has referred you to InVia Fertility for a semen analysis, we ask that you follow the collection directions carefully.

Abstinence Period: Prior to producing the specimen, you should abstain from ejaculation for at least 48 hours, but no more than five days.

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 information must be on the container:

  • Name
  • 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.

We check your blood hormone levels 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. We evaluate the following:

  • Follicle Stimulating Hormone (FSH)
  • Luteinizing Hormone (LH)
  • Thyroid Stimulating Hormone (TSH)
  • Prolactin
  • Estradiol
  • Progesterone
  • 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 viewed with an ultrasound. This is an excellent test to detect problems within the uterine cavity.
  • Laparoscopy. This is 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.

Common Infertility Diagnoses in Women

Some of the common infertility diagnoses for women are:

  • 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.
  • Amenorrhea - The absence of menstrual periods.
  • Anatomical issues (Uterus, cervix) - Abnormal development and function of reproductive organs resulting from birth defects or scarring can affect fertility.
  • Ectopic Pregnancy - Implantation of an embryo in a place other than the uterus. Most commonly in the fallopian tube.
  • 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.
  • 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.
  • Ovarian Dysfunction - A problem with the ovary where the egg is not matured or released properly.
  • Pelvic Adhesion Disease - Inflammatory disease of the pelvis (usually caused by infection) that can lead to scarring and infertility.
  • Polycystic Ovarian Syndrome - Also called Stein-Leventhal syndrome or PCOS. 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. PCOS 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.
  • 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, visit our Female Infertility Treatment page.
  • 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.

Unexplained Infertility

About 20 percent of couples have unexplained infertility.  This means we don’t yet understand how to identify what is causing your infertility—it does not mean there is no reason for infertility.

This is probably one of the most frustrating diagnoses for both you and your fertility specialists. When we have a concrete cause for infertility, it is often easier to know how to proceed with treatment. But just because your fertility can’t currently be explained doesn’t mean there isn’t anything that can be done.

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We are here to help you find out what’s behind your difficulty getting pregnant. Contact us today to make an appointment with our experienced, supportive team of fertility specialists in Chicago!

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