Infertility is a very common problem, causing one in seven couples to experience difficulty conceiving.  The condition is defined as the inability to conceive after one year of unprotected intercourse in women under the age of 35, and the inability to conceive after six months in women over the age of 35.  In the United States, approximately one-third of infertility cases can be attributed to male factors and the same percentage attributed to factors that affect women.  For the remaining one-third of infertile couples, the condition is caused by a combination of problems in both partners or cannot be explained. 

Proper testing can identify roadblocks to successful pregnancy

For a normal pregnancy to occur, there are several steps which need to take place.  First, ovulation must occur to release a viable egg.  Then, the end of the fallopian tube must be open in order to pick up the egg.  Next, the man must be able to ejaculate and the sperm, in turn, must be able to swim into the uterus and the fallopian tubes.  To produce an embryo (a fertilized egg), a single sperm must successfully find and fertilize the egg.  The embryo then travels back down the fallopian tube to the uterus for that final step of implantation, where it will attach to the uterine lining. 

Although there are numerous tests that can be ordered on an individual basis, the three main assessments performed initially include testing the egg (ovulation and ovarian reserve), testing the integrity of the fallopian tubes and the uterus (hysterosalpingogram), and testing sperm quality (semen analysis).

Egg Testing

In most cases, if a woman is having regular cycles then it can be presumed that she is ovulating and additional assessments may not be necessary.  If on the other hand, she is having irregular menstrual cycles or skipping periods, additional testing may be warranted.

Ovarian reserve testing is a test to evaluate how well the ovaries are working and is an indication of how quickly one's  "biological clock” is ticking.  This becomes especially important in women over the age of 35.  A simple blood test is taken on day three of the menstrual cycle and this measures the follicle-stimulating hormone (FSH) and the esteroidal levels.  Ordinarily, if the ovaries are working well, the FSH level would be less than 10 IU/L.  Higher levels  are usually associated with lower pregnancy rates.

Hysterosalpingogram (HSG)

Commonly referred to as the "dye test," this exam is performed in a radiology department after the menstrual cycle concludes but prior to ovulation.  The test provides an X-ray of the inside of the uterus and fallopian tubes.  It checks for abnormalities within the uterus such as polyps, fibroids, scar tissue or congenital abnormalities, as well as the integrity of the fallopian tubes.

Semen Analysis (SA)

A sperm sample is tested for a number of parameters including volume, count, motility (sperm that are alive and swimming) and morphology (the shape of the sperm.)

Patients with polycystic ovarian syndrome, endometriosis, fibroids, pelvic inflammatory disease, and history  of pelvic surgeries or a ruptured appendix or endocrine problems can encounter additional problems.  One of the most important factors, is that of the biological clock and the “race against time".  There are various forms of treatment options for both male and female infertility ranging from low-tech to high-tech medical treatment  as well as surgical  treatments.  These will be addressed in future issues of The Coastal Fertility Gazette.