Evaluating and Treating Infertility

Couples and individuals hoping to have children never dream it may be hard to get pregnant. If it still hasn’t happened after trying for 1 year, doctors diagnose you with infertility.

Path to improved well being

Infertility is evaluated in several ways. It will likely include a pelvic exam, lab tests, imaging tests, a review of your medical and menstrual history, and certain procedures. For women, the first test is a pelvic exam. During a pelvic exam, you will undress from the waist down and lay down on a padded table in your doctor’s office. Your doctor will sit near your feet. They will insert an instrument called a speculum into your vagina. This helps open your vagina so your doctor can see inside. Your doctor will insert two lubricated, gloved fingers into your vagina. With their other hand, they will push gently on the outside of your lower abdomen. This is how your doctor will check the size and shape of your uterus and ovaries, tenderness, or unusual growths.

Laboratory tests include checking your basal body temperature. This checks your temperature at rest (it will be slightly higher when you are ovulating). Additional lab tests include a urine test, a progesterone (hormone) test, thyroid function tests, prolactin (hormone) level test, and an ovarian reserve test (checking your egg supply).

Imaging tests may include an ultrasound (moving a wand over the top of your stomach to create pictures of your uterus, ovaries, and fallopian tubes) and a hysterosalpingography (an X-ray test that examines your uterus, ovaries, and fallopian tubes).

Infertility procedures include a hysteroscopy (inserting a thin tube attached to a camera to examine your uterus) and a laparoscopy (a small surgical procedure in which the doctor inserts a small, thin tube through your stomach to see your uterus, ovaries, and fallopian tubes). You may not have to have all of these tests and procedures. Some are done based on results of previous tests and procedures. Some are done in your doctor’s office. Some are done in the lab or hospital.

When performing these evaluations, your doctor is looking for the cause of your infertility. Causes can include:

• Endometriosis. This is the growth of endometrial tissue on the outside of your uterus. Swelling and scarring caused by endometriosis can keep your egg from reaching the fallopian tube.
• Poor ovulation. This means you are not producing enough eggs. This also happens with the medical condition known as polycystic ovarian syndrome (PCOS). When you don’t produce enough eggs, it can decrease fertility.
• Tubal blockage. A blockage in your fallopian tubes prevents an egg from meeting with sperm.
• Pelvic Inflammatory Disease (PID). This is an infection that can lead to infertility. It can cause scar tissue on your reproductive organs. This scar tissue can block your fallopian tubes, preventing an egg and sperm from reaching each other.
• Sexually transmitted disease or infection (STD or STI).Certain STIs raise your risk of infertility because of the swelling and scarring that they cause.
• Age. The older a woman is, the more difficult it is to become pregnant.
• Low sperm count. If a man has a low sperm count, that means there are fewer sperm trying to make their way to an egg.
• Cancer treatments. Some treatments can postpone trying to get pregnant (for men and women). Other cancer medicine can actually stop your menstrual cycle for a period of years. This makes it nearly impossible to get pregnant.
• Unexplained. Sometimes, doctors cannot determine the reason for your infertility. In some cases, all your tests are normal.

Infertility treatment depends on the reason you are not getting pregnant. Common treatments include:

• Medicines for ovulation. Your doctor may prescribe an ovary-stimulating medicine. This causes your ovaries to produce more eggs than normal. With more eggs, you have a better chance of getting pregnant. However, it raises your risk of multiple births. There also is medicine to treat polycystic ovary syndrome.
• Surgery. Laparoscopic surgery can help unblock fallopian tubes and eliminate endometrial tissue growth on the outside of your uterus (endometriosis).
• Hormones. Certain hormones can boost those hormones that are low in your body. Another type of hormone can put your body into a false state of menopause. This causes your body to stop having menstrual periods. This is particularly helpful for treating endometriosis. Endometrial tissue growth increases each time you have a period. When you stop having periods, it gives your body time to shed the excess growth.
• Insemination. This treatment takes male sperm and prepares it for inserting into the woman’s vagina, cervix, or uterus during the time she is ovulating. There are two types. Intrauterine insemination (IUI) is the least expensive form. It can be performed in the doctor’s office. Doctors have you use an ovulation kit to determine when you are ovulating. Once you are, your uterus is inseminated with the sperm from your male partner (collected in the office that day or sperm from a sperm bank). There is little discomfort. Artificial insemination inserts the sperm into a woman’s vagina or cervix.
• In vitro fertilization. This is a much more complex and expensive treatment. It involves combining the egg and sperm in a lab and then transferring it to the woman’s uterus. It takes many months of preparation to prepare the woman’s body with hormones.

Things to consider

Infertility evaluation and treatment can take its toll on you physically, financially, and emotionally.

Physically, there is little discomfort with a pelvic exam and lab tests. Lab tests involve providing a urine sample or undergoing a simple blood test. There is some mild discomfort associated with procedures. For example, during a laparoscopy, your doctor will pump a small amount of gas into your abdomen. This is to help separate your organs so they can get a better look at your uterus and ovaries. After the test, the gas makes you feel bloated. It also causes a mild amount of discomfort in your shoulders.

Financially, some infertility treatments can be expensive. Check with your insurance company to see what types of testing and treatment expenses are covered. Even if a portion of it is covered, it can be an extra, unplanned cost.

For most people, infertility testing and treatment can take its biggest toll emotionally. Testing and treatment can take months, even a year or longer. That’s because doctors have to time it with your ovulation and menstrual cycle. That only happens once a month. You often have to take time off from work for testing and treatments. And there is a certain cost involved, whether your insurance covers it or not. Many people feel emotionally drained by the experience. It makes it even more difficult when friends, family, and co-workers are getting pregnant with ease. Therefore, it’s important to talk with your spouse or partner to address these issues and how you will cope when it gets difficult. Talk to your doctor to find healthy ways to cope.

Questions to ask your doctor

• Is there a certain age when you should worry about infertility sooner rather than later?
• Do fertility treatments increase the risk of miscarriages?
• What are the chances of success with each treatment type?
• Can fertility treatments increase a woman’s risk of breast, ovarian, or uterine cancer?

Resources

World Health Organization, Infertility