Infertility

Infertility

Symptoms

• You have not become pregnant after one year of having regular sexual intercourse without the use of birth control.

• You are older than 35 years and have not become pregnant after six months of having regular sexual intercourse without the use of birth control.

• Your menstrual cycle is not regular.

• You or your partner have a known fertility problem.

Diagnostics

 The first visit usually involves a detailed medical history and a physical exam. During the medical history, you will be asked questions about your menstrual period, abnormal vaginal bleeding or discharge, pelvic pain and disorders that can affect reproduction, such as thyroid disease. If you have a male partner, both of you will be asked many questions about your current health status, medical history and sexual history.

The testing for women includes tracking basal body temperature, a urine test, a progesterone test, thyroid function tests, prolactin level test and tests of ovarian reserve. Imaging tests and procedures include an ultrasound exam, hysterosalpingography, sonohysterography, hysteroscopy and laparoscopy. You may not have all of these tests and procedures. Some are done based on results of previous tests and procedures.

The testing for men often involves a semen analysis (sperm count). If the result is abnormal or areas of concern are found in the man’s history, other tests may be considered. For example, an ultrasound exam may be done to find problems in the ducts and tubes that the semen moves through. Ultrasound also may be used to find problems in the scrotum that may be causing infertility.

Treatments

 Treatment options depend on the cause of your infertility. Lifestyle changes, medication, surgery or assisted reproductive technology (ART) may be recommended. Different treatments may also be combined to improve results.

Ovulation induction is the use of drugs — usually clomiphene citrate or Clomid — to induce a woman’s ovaries to release an egg. This treatment is used when ovulation is irregular or does not occur at all and other causes have been ruled out. About 40 percent of women achieve pregnancy with the use of this drug within six menstrual cycles.

If clomiphene citrate is not successful, drugs called gonadotropins may be tried to induce ovulation. Gonadotropins also are used when many eggs are needed for IVF or other infertility treatments. This is called super ovulation. Gonadotropins are given in a series of shots early in the menstrual cycle. When test results show that the follicles have reached a certain size, another drug called human chorionic gonadotropin (hCG) may be given to trigger ovulation.

In intrauterine insemination (IUI), healthy sperm is placed in the uterus as close to the time of ovulation as possible. It often is used with ovulation induction. The woman’s partner or a donor may provide the sperm. Sperm that has been retrieved earlier and frozen also can be used.

In vitro fertilization (IVF) is done in cycles, and can take more than one cycle to succeed. The sperm may come from your partner or a donor. Sperm can be retrieved and then frozen for later use in IVF. Ovulation usually is induced with gonadotropins so that many eggs are produced and removed from the ovaries when they are mature. Donor eggs or eggs that have been previously frozen can also be used.

Healthy sperm then are added to the eggs in the lab. The eggs are checked the following day to see if they have fertilized. If so, one or more embryos are placed in your uterus a few days later. The embryo may come from a previous cycle or a donor. Healthy embryos that are not transferred can be frozen and stored for later use.