Infertility is a very stressful time in a couple’s life. Sometimes it is hard to know where to begin, how to figure out where the problem lies, and which treatment options could be available. The good news is that a fertility workup does not take long and can provide valuable information to identify reasons for the struggle and appropriate treatment options to help make your family dreams come true.
Infertility is very common, affecting one in six couples. When a workup is performed, there are three parts of a triangle to evaluate a couple’s potential for getting pregnant. We will go through these three categories here.
The first is a hormonal evaluation that is done shortly after a woman’s menstrual cycle starts.
These hormones will look at everything that could affect the quality of ovulation, including female hormones, male hormones, thyroid, prolactin, sugar, and insulin. And, specifically, the follicle stimulating hormone (FSH)–which gives us an idea of how young the ovaries are. That level should be less than 10. Greater than 10 states that the ovaries are starting to get older, and this will impact the decision-making and timing of different fertility treatments.
Anti-mullerian hormone (AMH) gives an idea of “how many eggs we have left.” That AMH number should be greater than one. Less than one states that there are less eggs to work with.
These two values in combination with an ultrasound, looking at your ovaries to measure an antral follicle count (the number of little cysts in the ovaries that hopefully could give us an egg) together will give a woman her fertility potential. With consideration of your age and BMI, this fertility potential will then guide fertility specialists to recommend certain medication or treatment plans based on what we call ovarian reserve.
Secondly, we look at the structure.
Structure is very important because you need a normal uterine cavity as well as the tubes to be open. There are two tests we use to assess structure.
The first is an HSG, this is done in the hospital in the radiology department. The HSG procedure requires injecting radioactive dye into the uterus to assess the uterine cavity and tubes. The second is a sonohysterogram, which is done in the office. With a sonohysterogram, normal saline is used. The HSG is a better test to assess the tubes. The sonohysterogram is a better test for the uterus.
These tests should be done between cycle day 6 through 12 of your cycle so that you’re not bleeding to increase risk of infection, but also before you ovulate. If there is something in the cavity like polyps or fibroids, they can decrease your chance of success of pregnancy by up to 50%. Dilated tubes will decrease the chance of success by 50%.
If we see a problem in the uterus, many times that can be surgically corrected. IVF would most likely be required if the tubes are blocked. And, if tubes are dilated, there is an increased risk of ectopic and this can decrease success by 50% because fluid could go back into the uterus and be toxic to an embryo. Many times, if you have a dilated tube (it’s called a hydrosalpinx), we recommend removing that before proceeding with further treatment.
And lastly, we look at male factor.
30% to 50% of the time, there is a concern with the partner’s sperm count, and sperm parameters. Therefore, while his partner is getting the hormone and the structural workup, he should be getting a semen analysis. This is done by masturbation at home, abstaining from sex or masturbation for 2 to 7 days, and getting the sample to the office within an hour and kept warm. With a semen analysis, the sperm count, motility, shape, and volume, as well as any suggestion of infection, are evaluated and interpreted to determine his fertility potential.
These three parts of the triangle can be accomplished within the first two weeks of a woman’s menstrual cycle. The couple can then plan to start a fertility game plan.
A Message from Dr. K During National Infertility Awareness Week
To those struggling . . .
Don’t give up hope, there are SO many treatment plans available for success. Do not feel alone. We are with you on this fertility journey. You got this! WE got this! Take care of you and your partner. Take the time to love yourself and each other.
With love,
Dr. Kowalczyk
