Couples who are going through infertility studies and testing are often overwhelmed by the amount of new information they are absorbing. There is new terminology, schedules, tests, and organization of all of this in order to achieve a pregnancy. Best of all, while they think of their sex life as ‘making love’ the doctor’s office always refers to it as ‘having intercourse’. Everything about making a baby, which was once so spontaneous, and an expression of their love for each other, is now clinical and dry.
This is a perfect time to start a calendar, a diary or some type of journal of the events you are experiencing. The stress of the infertility studies and the overwhelming amount of new information will stretch your memory to the breaking point. Don’t rely on it! In your journal you can record appointment dates, test results, plans the doctor has for the next round of medication or infertility studies. Even if you become pregnant on the first round of medications or after the first change the doctor makes you will want to record your feelings for the future.
Most reproductive endocrinologists will have new patients fill out a very detailed medical history questionnaire so it doesn’t take up office time. During the first visit the doctor may go over that form with you. The form will have questions about any previous pregnancies, how easy was conception, fertility history of the patient, her brothers, sisters, and immediate family members. There will be questions about your current lifestyle, diet, vitamin history and any food supplements. Also you’ll be asked to recall possible exposure to hazardous environments, chemicals, high stress and your sexual history.
A complete history is necessary for the reproductive endocrinologist to determine which infertility studies to initially include in your workup. However, there are also some baseline studies that are done on almost all patients, unless the doctor feels your history warrants a different approach. The first infertility study will be a semen analysis since 40% of all infertility issues are with the male. The semen analysis will evaluate the size, formation and speed of the sperm. Some doctors also request penetration and sperm function studies.
Baseline infertility studies also include vaginal and cervical viral and bacterial cultures to find any subclinical infections that may interfere with conception. A subclinical infection is one that is in the body but that has no apparent signs or symptoms, so the patient often doesn’t know there is an infection.
Next female hormone infertility studies are performed on the third day of the menstrual cycle. These studies usually include thyroid function studies, evaluations of the adrenal gland, ovaries, lactation hormones and the uterus.
At this point the tests may come in a different order depending upon at what point in the cycle you are. And the physician may also decide to stop infertility studies and try you on one or two months of specific medication that will address any issues he may have found in the hormone studies. Most of the infertility studies are timed for a specific period in your cycle. Because of this it can take months for the them to be completed while you also are continuing to try to get pregnant. This is time consuming, frustrating and stressful.
Most reproductive endocrinologists are well aware of the stress this places on the couple and how stress can actually decrease your chances of conception. For this reason most will ask you to find a way to help you reduce your stress. Some patients find writing down the journey they are taking helpful, moderate exercise, enough sleep and possible counseling are all options to consider.
These next infertility studies are performed depending upon the timing of your cycle and which ones will give the doctor more information about your particular problem. A hysterosalpingogram is an xray that will help to uncover many abnormalities in the lining of the uterus and the fallopian tubes. It can detect if the tubes are blocked and if there is scarring around the ovaries and tubes.
Midcycle testing for an LH surge is another study which signals the ovary to release a mature egg. Patients may be asked to monitor her surge at home based on an at home urine testing kits. Once she detects the surge she may have intercourse that morning and then be brought into the office later that afternoon for some timed testing.
At the same time post-coital, or after intercourse, examination may be done to evaluate the cervical mucus looking for the presence of live, active sperm. Midcycle estradiol and ultrasound testing are studies that may be done after other studies have normal results. The estradiol measure tests how well the body interprets the release of LH and the release of a mature egg while the ultrasound will measure the lining of the uterus and the degree of support it will provide to a new pregnancy.
The luteal phase progesterone level is done one week after ovulation. The area on the ovary where the egg was released should produce large quantities of progesterone. The progesterone regulates many crucial functions signaling the uterus that ovulation has happened and preparing for possible implantation. It adds hormonal support to the lining of the uterus and prevents premature breakthrough bleeding. Women with abnormal progesterone levels may actually be conceiving but lose the pregnancy before they even know they are pregnant because the uterus doesn’t have enough progesterone to support the pregnancy. This is correctable with careful monitoring and hormone supplementation.