A basic fertility workup is the first step to determine all the reasons a couple may be experiencing difficulty conceiving. While the unknown can be daunting and anxieties may run high when you are having trouble conceiving, identifying potential problems will empower you and your medical team to identify solutions. The following is a basic step-by-step guide to what you can expect when you schedule your first infertility workup.
After a careful review of the couples history and available records, a vaginal sonogram may be done to evaluate the reproductive organs for any anatomical abnormalities such as ovarian cysts, advanced endometriosis, uterine fibroids or polyps, polycystic ovaries, and to obtain an assessment of ovarian function by counting the total m=number of follicles visible on the ovaries.
After the history is taken and the vaginal ultrasound completed, specialists will make recommendations for further evaluation and treatment as indicated. Every effort will be made to avoid repeating studies which have been completed or treatments which have been unsuccessful. Beginning the treatment carefully with logic as quick as possible is the treatment begins on the day of initial consultation.
Here, patients have the opportunity to ask all the questions they may have regarding the plans for further evaluation and treatment. To the extent that it may be possible, they will be provided with realistic assessment of their prospects for success based upon all of the information which has been available for review. The risks and complications as well as the specific details regarding any proposed treatment are reviewed and all questions answered. At the end of their consultation couples have a clear understanding their roles in achieving successful outcome.
After this consultation, the doctor will create a diagnostic plan that is tailored specifically for you. In this plan, your medical provider may seek to answer questions such as:
Semen analysis:This is the basic test which is an essential component of the infertility workup and includes evaluation of the count, motility and morphology(sizes and shapes of sperm cells).
Ultrasound Examination: Ultrasounds are an essential part of infertility testing and fertility treatment. Ultrasounds done during mid to late pregnancy are usually abdominal ultrasounds. During infertility testing, ultrasound scans can provide information on the ovaries, endometrial lining, and uterus. Specialized ultrasounds can be used to evaluate ovarian reserves, the uterine shape in more detail, and whether the fallopian tubes are open or blocked.
HSG Test:A hysterosalpingogram, more commonly known as an HSG test, is an X-ray procedure women can use to determine whether the fallopian tubes are open. When a fallopian tube is blocked, this inhibits the sperm from reaching the egg needed for fertilization during normal conception. An HSG can give us important information to detect blockage.
The practice of infertility counseling delivered by mental health and medical professionals has become more sophisticated and widespread over the past decade.
The main role of our mental health professionals (MHP) in infertility clinics was to provide support for the crisis of infertility and/or carry out screening before treatment, and these roles continue to be important. More recently, however, MHPs have also been called upon to develop and evaluate interventions tailored to specific challenges, such as coping with the two-week waiting period before the pregnancy test, helping men prepare for semen analysis, or deciding about fertility preservation.
These more recent developments are due to three main factors. First, many people with fertility problems desire psychosocial help, but not necessarily in an individual, couple or group counseling format, thus creating a need for adjunct self-administered interventions. Second, the high success rate of medical treatment and its protracted nature has created a need for treatment specific interventions. Third, growing awareness of high discontinuation rates in fertility treatment has created a need for psychosocial interventions that can be easily implemented by staff during the routine day-to-day delivery of treatment.
Choosing a form of counseling
When a couple is in need of infertility counseling services, our medical staff and couples are left to determine the timing and type of counseling most appropriate for their situation. Typically, providing psychosocial care and psychological help for infertile couples or individuals is seen as a stepwise process. Patient-centered care can be conceptualized in two parts – first, information gathering and analysis as well as implications and decision-making counseling. Infertility counseling can cover three areas including implications and decision-making counseling, as well as support counseling and short-term crisis counseling. Psychotherapy primarily includes therapeutic counseling, but can also include crisis counseling that is long-term in nature.
Our Medical and mental health professionals can deliver infertility counseling services according to their expertise. Medical doctors and the staff of the fertility center will deliver patient-centered care. They will offer sufficient information about the pros and cons of medical treatments so that the patient knows enough about treatment implications to make informed decisions.
Deciding to have to have a baby is one of life’s biggest milestones. It’s incredibly exciting to be on the same page with your partner and be ready to start a family. It can also be a huge letdown if you don’t get pregnant right away, even if this is common for many couples. After all, conception may not occur immediately and all that waiting can become excruciating.
Save yourself an ounce of heartache by taking the time to learn about getting pregnant and what you might expect. After all, simply knowing your body and taking care of yourself can make a remarkable difference in how long it takes to conceive, and we have our specialists who can help if needed.
Visit Your Gynecologist Prior To Attempting To Conceive
To ensure you’re up-to-date on your health screening and all appropriate preconception testing, it’s important to start your fertility journey with a trip to your doctor.
Take A Daily Prenatal Vitamin That Contains Folic Acid
When you’re trying to conceive and pregnant, you need at least 400 mcg of folic acid daily.
Get To Know Your Body
More specifically your menstrual cycle and “fertile window.” Ovulation may occur at different points for different women. Assuming it will happen in the middle of your cycle may mean you’re missing your chance to get pregnant each month. Check out your options for fertility trackers and get smart about when you’re “trying.”
Identify Healthy Ways To De-Stress
Finding something both you and your partner enjoy is a wonderful way to connect and also important for helping your body de-stress and prepare for pregnancy.
Doesn’t Assume Your Fertility Is like Everyone Else’s
“Fertility is a continuum, which means fertility declines at a different rate for each woman,”
Realize Fertility Is More Than A Numbers Game
Simply having plenty of eggs doesn’t mean your fertility is healthy. Egg quality is controlled by several factors; however, as women age their eggs are more at-risk for having abnormal chromosomes that lower egg quality. This can affect whether or not fertilization will occur and is also the main cause of miscarriage.
Don’t Worry, Fertility Is Not Negatively Impacted By Birth Control
In a recent survey on 1,000 Americans (ages 25-44) conducted by a leading fertility clinic, CCRM (Colorado Center for Reproductive Medicine), nearly 70% of respondents think prolonged use of birth control pills negatively affects fertility, despite that there is no clinical evidence to suggest this. Contrary to what many people think, there is no clinical evidence to support that being on birth control does anything to hurt a woman’s chances of getting pregnant.
Be Aware Fertility Is An Issue That Affects Men And Women Equally
Although society often overlooks this fact, the causes of infertility are typically 40% female-related, 40% male-related and 20% unknown. Translation: fertility is not just a woman’s issue. 30% of survey respondents believe that fertility in men does not decline with age, however men’s fertility does decline, typically beginning after age 40.
Know When To See A Specialist
How long should a couple “try” before a fertility specialist/treatment should be considered? "It all depends on the female’s age and the couple’s prior history. For a couple without prior pregnancies and/or complicating factors, not being pregnant after having had unprotected intercourse during the ‘fertile window’ for 12 months if the female is < 35 years old (or 6 months if she is 35 or older) would warrant a fertility evaluation."
Eat Smart
Which foods should women (and men) eat to help boost fertility?
"It is always recommend to have a balanced diet containing as few processed foods and as many home-cooked organic meals as possible. Eat foods that are high on iron, protein, or both (such as fish, beans, leafy green vegetables, seeds, and meat). Opt for organic fruits, vegetables, meats, and eggs. Avoid processed carbohydrates and trans fats."
Don’t Sweat The Small Stuff
Are there any additional lifestyle tips you’d recommend for couples who are trying to get pregnant?
"Try to maintain a balanced and healthy lifestyle, but don’t stress yourself out by setting unrealistic goals. If you want to have a piece of cake every once in a while it’s ok. If you need coffee this morning go ahead and have a cup!"
Don’t Lose Hope
What is the advice for couples who’ve tried but have yet to get pregnant and are now worried/scared?
“This is a very stressful and difficult process, especially if you are having trouble conceiving. Do not lose hope and remain focused. Schedule a consultation with your gynecologist or fertility specialist to discuss your history and start with some testing that could provide useful information. Seeing a fertility specialist does not mean you will have to have invasive treatment, there are many options available.”
Meet The Experts
(KoorapatiLaproscopy Fertility Centre) is dedicated to delivering leading patient outcomes for people who want to have a baby. It is a leading fertility care and research specializing in the most advanced fertility treatments, with deep expertise in in vitro fertilization (IVF), fertility assessment, fertility preservation, genetic testing, third party reproduction, and egg donation. Unlike many other fertility clinics that outsource their specialists and testing needs, KLFC leverages its own data, as well as a dedicated team of in-house reproductive endocrinologists, embryologists and geneticists in order to deliver consistent, successful results.
Ovulation induction involves taking medication to induce ovulation by encouraging eggs to develop in the ovaries and be released, increasing the chance of conception through timed intercourse or artificial insemination.
It is most suitable for women who are producing low levels of hormones for ovulation or who are not ovulating at all but have normal fallopian tubes and the male partner has a normal semen analysis.
Clomiphene Citrate (Clomid)
An oral medication used to induce ovulation in women who do not ovulate on their own by encouraging the body to produce more follicle stimulate hormone (FSH). Most commonly used if a woman has irregular or long menstrual cycles.
Follicle stimulating hormone (FSH)
Hormone injections of FSH can be used to stimulate the number of follicles that develop in the ovary and therefore the number of eggs that are ovulated during a cycle. Another hormone hCG may be used in injection form to trigger ovulation once the follicles have developed.
Assessment
Your fertility specialist will assess your ovulation cycle with blood tests to measure hormone levels at specific stages of your cycle; and an ultrasound to see the development of follicles in the ovaries and thickness and appearance of the uterus lining.
Stimulation
Your ovaries are stimulated with medications to promote the growth of follicles containing eggs. Your specialist will discuss with you the most appropriate medication or combination of medications for your situation.
Monitoring
Your cycle is monitored very closely with ultrasounds and/or blood tests to check the number and size of follicles developing, this is essential to reduce the risk of a multiple pregnancy.
Timed intercourse or artificial insemination
Near the time of ovulation your specialist will advise the most appropriate day to have sexual intercourse to maximise your chance of pregnancy or perform an intrauterine insemination where prepared sperm is inserted into the uterus.
Intrauterine insemination (IUI) is a simple procedure that puts sperm directly inside your uterus, which helps healthy sperm get closer to your egg.
IUI stands for in Intrauterine Insemination. It’s also sometimes called donor insemination, alternative insemination, or artificial insemination. IUI works by putting sperm cells directly into your uterus around the time you’re ovulating, helping the sperm get closer to your egg. This cuts down on the time and distance sperm has to travel, making it easier to fertilize your egg.
Before having the insemination procedure, you may take fertility medicines that stimulate ovulation. Semen is collected from your partner or a donor. It goes through a process called “sperm washing” that collects a concentrated amount of healthy sperm from the semen.
Then your doctor puts the sperm right into your uterus. Pregnancy happens if sperm fertilizes your egg, and the fertilized egg implants in the lining of your uterus.
IUI is a simple and low-tech procedure, and it can be less expensive than other types of fertility treatments. It increases your chances of pregnancy, but everyone’s body is different, so there’s no guarantee that IUI will work.
Before IUI, you may take fertility medicines that help make your eggs mature and ready to be fertilized. Your doctor will do the insemination procedure during ovulation (when your ovaries release an egg). Sometimes you’ll be given hormones that trigger ovulation. They’ll figure out exactly when you’re ovulating and ready for the procedure to maximize your chances of getting pregnant.
Your partner or donor collects a semen sample at home or in the doctor’s office. The sperm are prepared for insemination through a process called “sperm washing” that pulls out a concentrated amount of healthy sperm. Sperm washing also helps get rid of chemicals in the semen that can cause reactions in your uterus and make it harder to get pregnant. If you’re using donor sperm from a sperm bank, the sperm bank generally sends the doctor's office sperm that’s already “washed” and ready for IUI.
During the IUI procedure, the doctor slides a thin, flexible tube through your cervix into your uterus. They use a small syringe to insert the sperm through the tube directly into your uterus. Pregnancy happens if sperm fertilizes an egg, and the fertilized egg implants in the lining of your uterus.
The insemination procedure is done at your doctor’s office or at a fertility clinic, and it only takes about 5-10 minutes. It’s pretty quick, and you don’t need anesthesia. IUI is usually not painful, but some people have mild cramping.
Intrauterine insemination (IUI) is a simple procedure that puts sperm directly inside your uterus, which helps healthy sperm get closer to your egg.
IUI stands for in Intrauterine Insemination. It’s also sometimes called donor insemination, alternative insemination, or artificial insemination. IUI works by putting sperm cells directly into your uterus around the time you’re ovulating, helping the sperm get closer to your egg. This cuts down on the time and distance sperm has to travel, making it easier to fertilize your egg.
Before having the insemination procedure, you may take fertility medicines that stimulate ovulation. Semen is collected from your partner or a donor. It goes through a process called “sperm washing” that collects a concentrated amount of healthy sperm from the semen.
Then your doctor puts the sperm right into your uterus. Pregnancy happens if sperm fertilizes your egg, and the fertilized egg implants in the lining of your uterus.
IUI is a simple and low-tech procedure, and it can be less expensive than other types of fertility treatments. It increases your chances of pregnancy, but everyone’s body is different, so there’s no guarantee that IUI will work.
Before IUI, you may take fertility medicines that help make your eggs mature and ready to be fertilized. Your doctor will do the insemination procedure during ovulation (when your ovaries release an egg). Sometimes you’ll be given hormones that trigger ovulation. They’ll figure out exactly when you’re ovulating and ready for the procedure to maximize your chances of getting pregnant.
Your partner or donor collects a semen sample at home or in the doctor’s office. The sperm are prepared for insemination through a process called “sperm washing” that pulls out a concentrated amount of healthy sperm. Sperm washing also helps get rid of chemicals in the semen that can cause reactions in your uterus and make it harder to get pregnant. If you’re using donor sperm from a sperm bank, the sperm bank generally sends the doctor's office sperm that’s already “washed” and ready for IUI.
During the IUI procedure, the doctor slides a thin, flexible tube through your cervix into your uterus. They use a small syringe to insert the sperm through the tube directly into your uterus. Pregnancy happens if sperm fertilizes an egg, and the fertilized egg implants in the lining of your uterus.
The insemination procedure is done at your doctor’s office or at a fertility clinic, and it only takes about 5-10 minutes. It’s pretty quick, and you don’t need anesthesia. IUI is usually not painful, but some people have mild cramping.
Diagnostic Hysterolaparoscopy (DHL) has emerged as the essential tool for the evaluation of female infertility and is the gold standard investigation for tubal patency. The importance of DHL lies in the fact that it gives a detailed, direct visualization and analysis of the uterine cavity, endometrium, tubal morphology and patency, uterine, ovarian, and adnexal pathology. These pathology findings are often missed in routine clinical examination and ultrasound scan. In addition to diagnosis, DHL also provides the additional benefit of therapeutic interventions in few conditions. This study was undertaken to find out the role of DHL in evaluation of female infertility.
Abnormalities detected on laparoscopy were more common than those in hysteroscopy both in primary infertility group and in secondary infertility group. Laparoscopy helps the directvisualisation of pathology of fallopian tubes and dye instillation through the cervix allows visualisation of tubal patency. False positives results may be due to tubal cornual spasm. Tubal pathology (43.2%) and pelvic Adhesion (40%) were the most common abnormalities detected in laparoscopy in both groups.
This can be due to previous pelvic infection, endometriosis or surgery. Tubal and peritoneal pathology account for the primary diagnosis in approximately 30 to 35% of infertile couples. This is because of high prevalence of pelvic tuberculosis. Laparoscopy is gold standard technique for evalution of infertility and it is a better predictor of future spontaneous pregnancy in unexplained infertility couples. The most common intrauterine pathology in both the groups was uterine septum (5.88%) and synechiae (5.88%) in both infertility group.
Thesynechiae formation is more seen in secondary infertility women because of this group had previous history of dilatation and curettage ; Out of 8 patients of uterine malformations, 5 was uterine septum and 1 unicornuate and 1 bicornuate and 1 was didelphys. In chromopertubation, primary infertility group and secondary infertility group have tubal blockage in 22.38% and 27 % respectively. Out of each tubal block cases 60% is unilateral and 40% is bilateral seen. Tubal patency can be detected by hysterosalphingogrphy (HSG).
Diagnostic Hysterolaparoscopy is most effective and safe method of evaluation of female infertility, mainly in detecting endometriosis, intraperitoneal adhesions and uterine malformation. These are all correctable abnormalities that can be missed by routine pelvic examination and usual imaging procedures. It is a very useful method that diagnose and treat multiple abnormalities in tubal, ovarian, peritoneal and uterus at single setting, especially in couples with normal hormonal profiles and male factor. Thus, hysterolaparoscopy may be considered as gold standard and definitive investigative daycare procedure for evaluation of female infertility.
There are many causes of infertility. Sometimes there’s a structural problem that can be treated surgically to increase the chances of conception. Before undergoing fertility surgery, consult with your board certified Reproductive Endocrinologist to learn everything you can about the procedure, its benefits and risks, and what you can expect. Ask questions and become well informed before making your decision.
Among the surgical options available to women are:
• Hysteroscopy
• Laparoscopy
A doctor performs a hysteroscopy to look at the lining of your uterus with a viewing tool called a hysteroscope. The procedure is performed to find the cause of abnormal bleeding, to remove uterine growths like polyps and small fibroids, and to examine the uterus to see if there’s a problem with its shape or size that’s preventing you from becoming pregnant or causing repeated miscarriages. A hysteroscopy is both diagnostic and therapeutic.
A polyp is an overgrowth of the glandular surface of the endometrium. Polyps are often removed by hysteroscopic surgery to remove any impediments to implantation. Uterine polyps are found in up to 10% of women. Polyps can take up space within the uterine cavity, cause a zone of inflammation and can decrease pregnancy rates. Polyps may be single or multiple and measure between a few millimeters to several centimeters. The cause of uterine polyps is unknown but they seem to develop in response to the hormone estrogen. Most of the time they are asymptomatic, but some women who experience heavy menstrual bleeds, spotting in between menstrual periods or irregular menstrual bleeding may have polyps
Laparoscopic surgery is a minimally invasive diagnostic and therapeutic procedure that uses a telescopic camera system to visualize abdominal and reproductive organs (uterus, fallopian tubes, and ovaries). The surgeon makes tiny incisions (approximately 0.5 to 1 cm) in the abdomen through which a thin, fiber-optic tube fitted with a light and camera is inserted. Suspicious growths can be biopsied and repairs can be made during a laparoscopy, making more invasive surgery unnecessary.
Fibroids are growths in or on the uterus which are almost always benign. They vary in size and grow inside the uterine cavity (where pregnancies develop), in the uterine muscle wall itself, or on the uterine surface.
Between 30 and 40 percent of women have fibroids. Most uterine fibroids are asymptomatic and women do not even know they have them; they do not require treatment. In some women they can cause abnormal uterine bleeding, abdominal pain, pressure and sub-fertility. These cases are treated surgically with a myomectomy. There are several surgical options, including an abdominal myomectomy, hysteroscopic myomectomy, and laparoscopic myomectomy.
Hysteroscopy is a minimally invasive surgical procedure for viewing the inside of the uterus. Hysteroscopy is performed by inserting a visualizing scope through the vagina and into the cervical opening. Hysteroscopy allows visualization of the inside of the uterus, including the openings to the Fallopian tubes, as well as direct examination of the cervix, cervical canal, and vagina.
Hysteroscopy can be performed for both diagnosis or also for treatment (therapeutic). Hysteroscopy is one of several procedures that your doctor may recommend to evaluate or treat abnormalities of the uterus or cervix. Since hysteroscopy examines the lining and interior of the uterus, it is not suitable for evaluating problems within the muscular wall or on the outer surface of the uterus.
Hysteroscopy may be recommended as one step in the evaluation of a number of gynecological problems, including:
Hysteroscopy can be used to help pinpoint the location of abnormalities in the uterine lining for sampling and biopsy, and it can be used to perform surgical sterilization.
There are a number of different sizes and types of hysteroscopes available, depending upon the type of procedure that is required. Some hysteroscopes are combined with instruments that allow surgical manipulation and removal of tissues if necessary.
Hysteroscopy may be performed in an outpatient surgery center or a hospital operating room, or a physician's office. A number of different methods for anesthesia and pain control may be used, depending upon the individual situation. Sometimes, hysteroscopy using narrow-diameter hysteroscopes that do not require dilation of the cervical opening can be performed without anesthesia. In other cases, a local anesthetic can be applied topically or given by injection. In certain cases, a regional or general anesthetic may be recommended.
A vaginal speculum is often inserted prior to the procedure to facilitate insertion of the hysteroscope through the uterine cavity. Depending upon the exact type of hysteroscope that is used, dilation of the cervical opening with surgical instruments may be necessary. After insertion of the hysteroscope, fluid or gas is injected to distend the uterine cavity and allow for better visualization.
Acetaminophen (Tylenol and others) and nonsteroidalantiinflammatory medications are generally recommended after the procedure to control any pain or cramping that may occur.
Hysteroscopy should not be performed if a woman is pregnant or has an active pelvic infection. It is also not recommended if a woman has known uterine or cervical cancer. Certain conditions (abnormal position of the uterus, obstruction of the cervical canal or uterine cavity, scarring or narrowing of the cervical opening) may make hysteroscopy more difficult or impossible to perform in certain cases.
Women should expect to experience light vaginal bleeding and some cramping after the hysteroscopy procedure. Some cramping may be felt during the procedure, depending upon the type of anesthesia. Complications of hysteroscopy are rare and include perforation of the uterus, bleeding, infection, damage to the urinary or digestive tract, and medical complications resulting from reactions to drugs or anesthetic agents. Accidental perforation of the uterus is the most common complication and occurs in 0.1% of diagnostic hysteroscopy procedures and 1% of therapeutic (surgical) hysteroscopies. Other rare complications are fluid overload or gas embolism (when gas bubbles enter the bloodstream) from the distending medium used in the procedure.
What is the outlook after hysteroscopy?
The outlook depends upon the individual case and the reason for hysteroscopy. Many minor surgical procedures can be successfully performed using hysteroscopy. Complications are rare, and most women recover with only minor post-procedure cramping and bleeding.
Hysteroscopy has evolved from a diagnostic procedure into a therapeutic method for a variety of conditions. Instruments specifically designed for hysteroscopic operative procedures have improved.
The indications for therapeutic hysteroscopy are increasing and its proper applications can improve patient's gynecologic care. These facts should stimulate the gynecologist to become proficient with hysteroscopy for diagnosis and the treatment of many intrauterine abnormalities.
In selected patients there are major advantages including the avoidance of a laparotomy with the potential sequelae that can follow operations requiring entrance into the peritoneal cavity. The operative techniques have been refined and, with experience, good postoperative results and low morbidity have become evident.
The septate uterus can be treated by hysteroscopicmetroplasty with improved reproductive outcome. Symptomatic submucousmyomas in selected patients can be removed hysteroscopically. Lysis of intrauterine adhesions has become the standard method of therapy.
Foreign bodies lost in the uterine cavity or embedded IUDs can be removed atraumatically under direct vision. As the approach to intrauterine problems is refined, other applications are being investigated such as tubal cannulation, endoscopic chorionic villus sampling, and application of hysteroscopy to new reproductive technologies such as the placement of gametes in the fallopian tubes.
Because of the simplicity of approaching the uterotubalostiatranscervically, hysteroscopy remains in the front line of investigation as a possible approach for inducing tubal occlusion as a permanent or temporary method of contraception. Finally, laser energy is being used in patients with intractable uterine bleeding to photocoagulate the endometrium and to create amenorrhea by means of inducing severe intrauterine adhesions.
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