Infertility is diagnosed through a comprehensive fertility workup. With the right diagnosis, your chances of becoming pregnant increase significantly. The information below contains everything you need to know about fertility testing and treatment.
When you decide to pursue fertility treatment options, the first thing you will have to decide is which fertility doctor to see, and at what practice. Often, you will have more than once choice. How do you know who will give you the best chance of a successful pregnancy and healthy baby?
Modern fertility treatments rely significantly on science to determine a cause of infertility and the best way to treat it. That makes the fertility doctors at any practice very important. You want them to have in-depth diagnostic experience, a thirst for new knowledge, and compassion.
A board-certified Reproductive Endocrinologist has received the highest level of training in reproductive medicine. This position requires medical residency and examination in obstetrics and gynecology, followed by another three years of training in reproductive endocrinology and infertility, and additional oral and written examinations. If you are diagnosed with the following conditions, a board-certified Reproductive Endocrinologist is the best option for treatment:
Don’t be embarrassed to ask questions about your doctor’s background and experience. Any physician can call themselves a fertility specialist. It doesn’t mean they have met the standards to provide the best treatment and guidance.
The company you work for is required to offer “open enrollment” for the insurance plans that cover employees and their families. Open enrollment usually begins on Nov. 1 and ends on Dec. 15, so review your employer’s plan offerings, ask questions, add family members, upgrade your plan or even change medical insurers.
The open enrollment period is usually the only chance to make changes each year (with few exceptions like changing jobs or getting married). Watch company webinars or attend on-site meetings with insurance providers and/or your Benefits Administrator. Ask questions about what the plans offer, obtain and read a copy yourself, and determine specifically what the plan covers for fertility treatments.
Not every fertility clinic offers the same opportunities. At RMA of Connecticut, your first contact will be with a New Patient Liaison, who will schedule an appointment. Soon you will be meeting with your Patient care team, which includes a board-certified Reproductive Endocrinologist.
Budget for about an hour, give or take 15 minutes, for your initial fertility consult. When you arrive, you will be checked in and asked for some information about your referring OB/GYN. Next, you’ll meet a clinical assistant who will take your vitals – height, weight and the date of your last period.
Then you’ll meet with your reproductive endocrinologist, who will ask you about your history and your partner’s history and learn how long you’ve been trying. Your doctor will discuss which exams to schedule. It will probably be a mix of tests to look for hormonal and physical abnormalities. These tests will be scheduled for both the woman and the man because 40 percent of the time, the male will show signs of infertility.
Don’t forget to bring:
A test conducted on Day 3 of your period can also establish the quantity and quality of eggs (ovum).
A woman’s menstrual cycle is measured from the first day of her period (blood flow, not spotting), so Cycle Day 3 is the third day of her period. When a woman is undergoing a fertility workup, Cycle Day 3 is the day she has blood work performed to check the levels of three important levels: follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2).
FSH is secreted by the pituitary gland. It stimulates the production of estradiol (estrogen) and eggs (oocytes) during the first half of the menstrual cycle. The eggs begin to grow in their individual fluid sacs, or follicles, which is the first step in the ovulation process. High levels of FSH are an indication of poor ovarian reserves; in other words, the quality and quantity of eggs is low. This does not necessarily mean that pregnancy is impossible, but it may be more difficult to achieve.
A check of progesterone levels, a hormone that indicates whether ovulation has occurred, is done on or near Day 21 to confirm that ovulation has occurred. A low Day 21 progesterone level suggests the cycle was anovulatory (no egg was produced). The timing of ovulation and the associated peak in progesterone is related to the subsequent menstrual period, not the preceding one. In an average cycle of 28 days, the time between ovulation and the next period is about two weeks, so progesterone is measured about seven days before the expected period, or on Day 21. However, if a woman’s cycle is longer or shorter than 28 days, the testing day will be adjusted accordingly. For example, a woman with a 35-day cycle would be tested for progesterone on Day 28.
When hormone testing is concluded and analyzed, physical testing might begin, including:
Your doctor will want you to provide a semen sample. The sample is collected by masturbation at your doctor’s office in a private, comfortable room. You will be asked to collect your semen in a sterile specimen cup. Another option is to collect your semen at home. You must deliver your sample to the doctor’s office within 45 to 60 minutes after collecting it. Speak with your doctor about instructions for transporting the sample to the office. Theoretically, it only takes one sperm to fertilize an egg, but the odds of one sperm reaching the egg are very low. Consequently, a low sperm count reduces a man’s chances of fathering a child. A urologist can suggest medical or surgical treatments to increase those odds, and men are advised to avoid smoking, excessive drinking and illegal drugs, maintain a healthy weight, and stay out of sources of excessive heat (like tubs and saunas) that can temporarily reduce sperm count.
How long must I abstain from sex before the analysis?
You should abstain from sex for at least two to five days before the analysis, but not longer than one week. Check with your doctor to see if there are any other recommendations specific to you.
How long does it take to get the results?
The test results are generally available within a 7-10 days.
