Diseases & Conditions

Infertility

If getting pregnant has been a challenge for you and your partner, you're not alone. Ten to 15 percent of couples in the United States are infertile. Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year.

If that definition of infertility applies to you and your partner, there's a chance that something treatable may be interfering with your efforts to have a child. Infertility may be due to a single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing.

Fortunately, there are many safe and effective therapies for overcoming infertility. These treatments significantly improve your chances of becoming pregnant.

Before undergoing infertility testing, be aware that a certain amount of commitment is required. Your doctor or clinic will need to determine what your sexual habits are and may make recommendations about how you may need to change those habits. The tests and periods of trial and error may extend over several months. In about one-third of infertile couples, no specific cause is found (unexplained infertility).

Evaluation is expensive and in some cases involves uncomfortable procedures, and the expenses may not be reimbursed by many medical plans. Finally, there's no guarantee, even after all testing and counseling, that conception will occur.

Tests for men
For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman's vagina. Tests for male infertility attempt to determine whether any of these processes are impaired.

• General physical examination. This includes examination of your genitals and questions concerning your medical history, illnesses and disabilities, medications and sexual habits.
• Semen analysis. This is the most important test for the male partner. Your doctor may ask for one or more semen specimens. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A laboratory analyzes your semen specimen for quantity, color, and presence of infections or blood. Detailed analysis of the sperm also is done. The laboratory will determine the number of sperm present and any abnormalities in the shape and movement (motility) of the sperm. Often sperm counts fluctuate from one specimen to the next.
• Hormone testing. A blood test to determine the level of testosterone and other male hormones is common.
• Transrectal and scrotal ultrasound. Ultrasound can help your doctor look for evidence of conditions such as retrograde ejaculation and ejaculatory duct obstruction.

Tests for women
For a woman to be fertile, the ovaries must release healthy eggs regularly, and her reproductive tract must allow the eggs and sperm to pass into her fallopian tubes to become fertilized by a sperm. Her reproductive organs must be healthy and functional.

After your doctor asks questions regarding your health history, menstrual cycle and sexual habits, you'll undergo a general physical examination. This includes a regular gynecological examination. Specific fertility tests may include:

• Ovulation testing. A blood test is sometimes performed to measure hormone levels to determine whether you are ovulating.
• Hysterosalpingography. This test evaluates the condition of your uterus and fallopian tubes. Fluid is injected into your uterus, and an X-ray is taken to determine whether the fluid progresses out of the uterus and into your fallopian tubes. Blockage or problems often can be located and may be corrected with surgery.
• Laparoscopy. Performed under general anesthesia, this procedure involves inserting a thin viewing device into your abdomen and pelvis to examine your fallopian tubes, ovaries and uterus. A small incision (8 to 10 millimeters) is made beneath your navel, and a needle is inserted into your abdominal cavity. A small amount of gas (usually carbon dioxide) is injected into the abdominal cavity to create space for entry of the laparoscope — an illuminated, fiber-optic telescope. The most common problems identified by laparoscopy are endometriosis and scarring. Your doctor can also detect blockages or irregularities of the fallopian tubes and uterus. Laparoscopy generally is done on an outpatient basis.
• Hormone testing. Hormone tests may be done to check levels of ovulatory hormones as well as thyroid and pituitary hormones.
• Ovarian reserve testing. Testing may be done to determine the potential effectiveness of the eggs after ovulation. This approach often begins with hormone testing early in a woman's menstrual cycle.
• Genetic testing. Genetic testing may be done to determine whether there's a genetic defect causing infertility.
• Pelvic ultrasound. Pelvic ultrasound may be done to look for uterine or fallopian tube disease.

Not everyone needs to undergo all, or even many, of these tests before the cause of infertility is found. Which tests are used and their sequence depend on discussion and agreement between you and your doctor.