What to Expect When You Want to Expect

close-up of hands and abdominal ultrasound scanner for pregnant women

These days, infertility is no longer rare. In fact the Centers for Disease Control (CDC) reports that “about 12% of women 15–44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term.”  If you have been trying to conceive – meaning having unprotected relations just before and/or during the woman’s ovulation  – for at least 12 months (6 months if you are 35 or older), it is recommended to seek fertility assistance. At the same time, if couples are having trouble conceiving and/or holding a healthy pregnancy, they might not know what to expect when seeking  medical assistance.   Here’s an overview of what you might encounter from an initial infertility screening program.      

Note: If you’ve had at least two consecutive pregnancy losses, it’s also a good idea to seek help. In this article, however, we address the inability to conceive, otherwise known as infertility, as opposed to pregnancy loss, which is not infertility per se.

What to Expect from Infertility Testing

  1. Your gynecologist will ask you initial questions, such as:
    a. Frequency and length of menstrual cycles.
    b. Number of pregnancies, including miscarriages, and whether any ended in still births.
    c. Overall health: Smoking/non-smoking, BMI, any diseases, family history, etc.
    d. Specific gynecological health: Diseases in the reproductive organs, history of irregular menstruation, polycystic ovarian syndrome (PCOS), etc.
  2. Blood work. Fertility blood tests involve checking hormone levels, some of which must be done on specific days of the menstrual cycle. For example: Day 3 labs are FSH (follicle stimulating hormone) and estradiol (a form of estrogen). Progesterone is measured one week after a positive result on an ovulation kit test.  AMH (Anti-Mullerian Hormone) checks for ovarian reserve, and can be done any time in the cycle.  Other levels which might be ordered in a blood test are prolactin, thyroid stimulation hormone (TSH), LH (Luteinising Hormone), and androgens.
  3. Fallopian tube & uterine testing. Sometimes infertility is caused by blockages in the fallopian tubes, or irregularities in the uterus. Therefore, these reproductive organs might be assessed via ultrasound, also known as sonogram. At Miami OBGYN, we also perform a test called FemVue, which is a technique injecting saline and air into the uterus and fallopian tubes, and whose bubbles are viewed via sonogram.
  4. Male Testing. It takes two to tango, and most fertility informational sites quote a statistic that the cause of fertility by percentage is 45/45/10 (female/male/unknown), effectively rendering men and women as equal partners in the fertility conundrum. Men’s semen is tested for sperm count as well as mobility (speed), motility (types of movement) and morphology (shape). Men can also experience varicoceles in the spermatic cord or fertility-related hormone problems which are blood-tested. In addition, men might be on steroids or illicit drugs, smoke, or have other health problems which can impact fertility.

About Genetic Testing

While you are being tested for fertility-related causes, you might also consider genetic testing, especially if both partners have a history of genetic disorders. For example, Ashkenazi Jewish people have a higher chance of being Tay-Sachs carriers, people of African or Mediterranean descent are at higher risk of sickle cell anemia.

Genetic carrier testing is done via a simple blood test. Generally speaking the woman is tested first, and if she is a carrier for any of genetic markers, the man is then checked for those same markers. If it turns out both partners are carriers, you can then go through genetic counseling to determine your options regarding offspring.

Life Is In the Details

We understand every couples’ desire to have children, and we recognize that all of the technicalities can be overwhelming.  We work with you to try to ensure that all of the appointments, tests, and waiting periods are understood by you, so feel free to communicate any questions you might have along the way.   We are here to help you with the process of hopefully having a healthy pregnancy soon.