Evaluating Infertility

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Evaluating Infertility: When You Want to Become Pregnant – And Can’t

Congratulations! You’ve decided you want to start a family or add to it. We know the anticipation of seeing that pregnancy test show positive is exciting, and that waiting to get that positive sign, even for a few months, can be frustrating. You start thinking about the possibility of infertility.

If you’re not getting pregnant, try to be patient. But there comes a time when seeing your doctor for an infertility evaluation is a smart next step. Consider talking to your doctor if you:

  • Haven’t become pregnant after a year of trying by having sex on a regular basis and not using birth control
  • Are older than 35 and haven’t become pregnant after 6 months of trying
  • Are older than 40 and haven’t become pregnant within 6 months of trying
  • Have an irregular menstrual cycle
  • Know either you or your partner has a fertility problem

What Causes Infertility?

For women, the most common cause of infertility is not ovulating or ovulating irregularly. But there are many other factors that could contribute to you not getting pregnant, including:

  • Problems with hormone levels
  • Problems with your reproductive organs
  • Scarring or blockages in your fallopian tubes, possibly related to endometriosis or a past sexually transmitted infection (STI)
  • Problems with your thyroid gland or pituitary gland
  • Age – for healthy couples in their 20s and 30s, your chance of getting pregnant during any menstrual cycle is about 25-30%. By the time you are 40, that goes down to less than 10%.
  • Being underweight or overweight
  • Exercising too much
  • Moderate to heavy alcohol consumption

For men, the most common cause of infertility relates to problems in the testes that affect how sperm are made or how they function. Other factors that can contribute to infertility include:

  • Blockages in the tubes that carry sperm from the testes
  • Older age, but fertility doesn’t decline as predictably in men as it does in women
  • Moderate to heavy alcohol consumption
  • Smoking cigarettes and/or marijuana, which can reduce sperm count and sperm movement

Talking to Your Doctor 

To try and determine the reason you’re not getting pregnant, start by seeing your regular OB/GYN as a couple. He or she may refer you to an infertility specialist, but your doctor may be able to provide you with the answers you need.

You and your partner may want to see your doctor together for your first visit to talk about your problems getting pregnant. He or she will likely ask you about these to start:

  • Your menstrual period
  • Any abnormal bleeding or vaginal discharge
  • Pelvic pain
  • Disorders you may have such as thyroid disease that could affect your fertility

He or she will also ask both of you questions about your health, lifestyle, and sexual history, such as:

  • Medications you are taking, including prescription, over-the-counter, and herbal
  • Use of alcohol, tobacco, and illegal drugs
  • Past illnesses (including STIs) and surgeries
  • History of birth defects in either of your families
  • Past pregnancies and their outcomes
  • How long you have trying to become pregnant
  • Prior sexual relationships

Testing for Infertility

There are a number of different tests your doctor can perform or recommend to help determine why you’re not getting pregnant. Whether you have these or not may depend on your answers to your doctor’s questions. For a woman, these tests include:

  • Urine test – Helps determine if and when you ovulate
  • Progesterone test – Taken a week before you have your period, it can tell if you ovulated
  • Thyroid function test – Checks to see if your thyroid is working normally, as problems with your thyroid can affect your fertility
  • Prolactin level test – Measures the level of the prolactin hormone, as too much can disrupt ovulation
  • Ovarian reserve test – Checks to see how many eggs you have in your ovaries
  • Imaging tests and procedures – Allow your doctor to look at your reproductive organs for blockages, scar tissue, endometriosis, and other conditions that may be preventing you from becoming pregnant

Basic infertility testing for a man may include:

  • Semen analysis – Assesses the amount of sperm, the shape of the sperm, and how they move
  • Blood tests – Measure levels of male reproductive hormones
  • Ultrasound of the scrotum – Looks for problems in the testes

For most couples, time (plus some fun in the bedroom) is all it will take for you to become pregnant. But if you’ve given it time or you have reason to believe there might be something getting in the way, don’t hesitate to make an appointment to talk to your doctor.

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