Female Fertility Issues
At Viera Fertility Center, we are committed to helping you achieve your dream of growing your family. Formal testing for infertility is advised in all couples who have been unable to achieve a successful pregnancy after 12 months of unprotected intercourse. Earlier testing is encouraged in women over the age of 35 years, irregular menstrual cycles, blocked tubes, severe endometriosis or when there is a suspected male problem. We believe that evaluation of both partners should begin at the same time.
Testing is designed to help identify problems that may be contributing to your infertility and to help craft solutions that will be most effective in helping you achieve a pregnancy. With the information we gather through the testing process, we will fully explain the options available and their likelihood of bringing you success.
History and Physical Examination
At Viera Fertillity Center, the initial consultation is designed to obtain a thorough medical, reproductive and family history, review any available medical records, and allow sufficient time to perform a physical and pelvic examination including a pelvic ultrasound as needed. This evaluation stage is critical because it helps us determine what if any additional testing is necessary and begin formulating a treatment plan.
Following a history and physical examination, the initial evaluation of the male partner involves at least one properly performed semen analysis. Ideally, semen should be collected by masturbation, after 2 to 3 days of abstinence, into a clean container provided by the facility and examined within an hour after collection. A 2nd sample is usually recommended in the event of an abnormal initial semen analysis. A comprehensive analysis includes an evaluation of sperm count, overall motility and proportion of normal sperm (morphology) present in the sample. The objective is to get a sense of the semen quality and determine the need for additional testing including hormonal or genetic testing or referral to a specialist in male reproduction/urologist.
Blood testing is a critical part of the infertility evaluation and includes the following:
- Testing for ovarian reserve – An indirect estimation of the amount and quality of the remaining eggs. There are a number of tests used in combination to best assess the ovarian reserve including:
- Basal follicle stimulating hormone (FSH) and Estradiol (E2) levels measured on day 3 of the menstrual cycle
- Antimullerian Hormone (AMH) measured on any day of the menstrual cycle and nicely reflects basal antral follicle count (AFC) measured by transvaginal ultrasound
- Testing for ovulation function – Blood progesterone levels are a good measure of ovulation function. Ovulation can also be predicted by a menstrual history, basal body temperature charting (BBT) and ovulation predictor kits.
- Testing for other hormones – Based on the medical history, addition hormone testing may include a blood thyroid stimulating hormone (TSH) and prolactin level as well as male hormone levels.
Hysterosalpingography (HSG) is an outpatient radiologic procedure, routinely performed in women having difficulty conceiving or in women who have experienced two or more miscarriages, and is used to:
- Inspect the shape of the uterine cavity
- Make sure the cavity is normal and free of polyps, fibroids and scarring
- Determine whether the fallopian tubes are open.
The test is usually performed with radiographic contrast medium (dye) injected into the uterine cavity through the vagina and cervix with the help of a thin plastic catheter. The procedure involves fluoroscopy, a type of X-ray. The amount of radiation is very small and does not cause any unwanted effects. The HSG is done in the first half of the menstrual cycle (follicular phase) but before ovulation. It does not involve anesthesia. The entire procedure usually takes less than 5 minutes to complete. It can be painful, so Ibuprofen or similar over the counter non-steroidal anti-inflammatory medications are advised ½ – 1 hour prior to the procedure. Many doctors will also prescribe an antibiotic prior to the procedure to reduce the risk of an infection. Most women will resume normal activity after the test. It is recommended that you refrain from sexual intercourse for a few days after the test. Complications are rare. Infection is the most common complication. Most women experience spotting for 1-2 days after the procedure. Rarely, a woman may get light-headed during or shortly after the procedure. If you think you are allergic to iodine or contrast dye (used in CT scan, IVP) you need to notify your physician prior to the procedure. Laparoscopy, hysteroscopy and sonohysterography are alternatives that can provide the same information as an HSG.
A pelvic ultrasound is a noninvasive outpatient imaging procedure used to inspect the female pelvic organs such as the uterus, cervix, fallopian tubes and ovaries. It is routinely used during the evaluation and treatment of women who have been unable to conceive, women with multiple miscarriages and in women with a history of pelvic pain. Pelvic ultrasound may be performed in either one of 2 methods:
- Transvaginal – transducer through the vagina. Used regularly in reproductive medicine
- Transabdominal – transducer over the abdominal wall.
Ultrasounds use soundwave instead of radiation. There are no known harmful effects of ultrasounds on humans. It is generally painless. Some women however may experience slight discomfort with the insertion of the transvaginal transducer into the vagina. You should be able to resume normal activities after the procedure. The purpose of the pelvic ultrasound is to provide information about the size, shape and position of the female reproductive organs, check for abnormalities in the pelvis such as fibroid or other types of tumors, check for ovarian cysts or masses, examine the lining of the uterus, look for causes of infertility and monitor follicle (egg) growth during infertility treatment, monitor both normal and abnormal pregnancies and look for reasons for pelvic pain.