As many as 15% of American couples experience infertility at some point during their reproductive lives. That
means that if you don’t have a friend or family member who has struggled with the condition, then you may be
the one touched by infertility. It is often an unexpected blow and can create a deep sense of powerlessness. You and your partner may find it quite challenging to handle a situation over which it feels there is so little control.
Establishing the diagnosis of infertility is the first step in the process toward achieving pregnancy, and it can be
a very empowering step. After trying to conceive unsuccessfully for months or even years, you and your partner
may feel “stuck” and unable to move forward. However, once you make the decision to choose a
specialist and seek testing, things will really start rolling forward.
A fertility specialist, or reproductive endocrinologist, is specially trained to deal with the many causes of infertility,
but may offer special expertise in one specific cause. During a typical first visit, the patient will share with the
specialist such information as menstrual cycle regularity, length of time trying to get pregnant, and any health
conditions which could impact fertility. The specialist will then schedule a series of tests during specific points in the menstrual cycle, to help determine various causes of the infertility.
One of the first tests is referred to as “Day 3 Blood Work”, which is blood work that tests a number of hormones
as well as your FSH (or follicle stimulating hormone) to determine if you have a normal ovarian reserve. This test is performed on day 3 of your menstrual cycle.
An initial pelvic exam and trans-vaginal ultrasound is often performed, and this will help determine whether there are any abnormalities with the ovaries or uterus and will show measurements of any polyps or fibroids you may
Usually scheduled slightly later in the menstrual cycle, a sonohysterogram allows the technician to visualize, by
ultrasound, detailed pictures of the inside of the uterus. This helps to diagnose fibroids, polyps and adhesions
which may have formed from endometriosis.
The specialist may also order a hysterosalpingogram, an X-ray which will show any abnormalities or blockages
of the fallopian tubes.
Early on in the process, the specialist will also order a semen analysis from your partner. This test will show the
number of sperm, the motility and movement of these sperm, and the structure or shape of the sperm. Very low
numbers or abnormalities with the sperm may require the couple to undergo such techniques as intrauterine
insemination or in-vitro fertilization, in order to maximize their chances of success.
While this may seem like a whirlwind of testing, it is an important step to take because the tests help the
specialist decide what treatment path on which to start, and whether to take an aggressive or conservative
For instance, if you have very irregular periods and do not ovulate every month, your specialist may just start with
Clomid, a low level fertility drug that helps to induce ovulation. If a hysterosalpingogram shows that one or both
of your fallopian tubes are blocked, your doctor may suggest surgery,or may want to go straight to an advanced
treatment such as in-vitro fertilization in order to bypass the tubes.
Once you have taken the plunge to seek treatment, you may feel an urgency to get things going as quickly as
possible. Unfortunately, it can take several months for both you and your doctor to get all the diagnostic tests and information you need to formulate a plan.
In the meantime, you can help calm your nerves by practicing a number of relaxation techniques. Acupuncture
may be effective in helping maximize fertility during treatment, and can at the very least provide stress relief.
Taking regular short vacations, attending support groups, practicing yoga and meditation, and spending quality
time with your partner (with no talk of baby-making!) can be enormously helpful in your journey. It can also be
helpful to remember that there is an end in sight, and this constant limbo of tests and uncertainty will not last
Infertility. The Mayo Clinic.
Storck, Susan, MD, FACOG.
Infertility. Medline Plus.
Zieve, David, MD, MHA.
Semen Analysis. Medline Plus.