If you’re under 35 and have been trying to get pregnant for more than 12 months or are 35+ and have trying for more than six months without success, it’s time to see a fertility specialist. Forty percent of infertility problems are female-related, forty percent are male-related, and twenty percent are either both or unknown.
Many insurance plans cover fertility diagnostics and oftentimes infertility treatment, if that is the underlying issue, is easily treated and not as expensive as you think. In this article we’ll review some of the tests your fertility doctor may oversee to determine whether or not treatment is needed.
Clomiphene citrate challenge test
Your ovarian reserve is an estimate of your potential to get pregnant. If your doctor suspects that your ovarian reserve is low, he or she may recommend a clomiphene citrate challenge test (CCCT) to learn more. Here is how the CCCT works:
1. Your doctor will measure FSH and estradiol levels on day 3 of your cycle.
2. You will take 100 mg of clomiphene citrate on cycle days 5 through 9.
3. On day 10, your doctor will measure FSH and estradiol again.
Results of the CCCT may help your doctor identify the next step in the fertility treatment process.
Hysterosalpingogram
Hysterosalpingogram (HSG) is an x-ray that examines the inside of your uterus and fallopian tubes. This test can help your doctor see if your fallopian tubes are blocked. This test can be very helpful, since blocked tubes are one of the more common causes of infertility. Here is how the hysterosalpingogram process works:
1. Your doctor injects a dye through the vagina and cervix into the uterine cavity.
2. Dye fills the fallopian tubes if they are open, but may not enter the tubes if they are blocked.
3. If the dye spills out into your abdominal cavity, your doctor will know that your fallopian tubes are open.
A hysterosalpingogram can also help your doctor discover any uterine abnormalities, polyps, fibroids, and scar tissue. This procedure may cause mild to moderate cramping.
Laparoscopy
If pelvic abnormalities are suspected causes of infertility, your doctor may recommend laparoscopy. In this minimally invasive surgery your doctor will insert a laparoscope (a small fiber optic telescope) into your abdomen. Through small incisions (0.5 cm), your doctor can inspect your fallopian tubes, ovaries, and uterus. Not only will your doctor be able to view and treat pelvic structure abnormalities, he or she can also treat blockages, scar tissue, and other damage. Recovery from laparoscopy is rather quick, and carries a low risk for developing adhesions (fibrous scar tissue that can cause fertility problems).
Hysteroscopy
Hysteroscopy helps to identify and treat uterine conditions. Your doctor inserts a thin hysteroscope (a fiber optic telescope) through the cervix and into the uterus. During this procedure, your doctor can view your uterine cavity and diagnose fibroids, polyps, scar tissue, and other problems. Hysteroscopy may be performed in the office while you are awake, or as an operation under general anesthesia.
Saline hysterogram
A saline hysterogram (SHG) is also known as a saline infusion sonogram (SIS), water ultrasound, or sono-hysterogram. An SHG takes place during a transvaginal ultrasound. Your doctor injects saline into your cervix and uterus to observe the walls of your uterus. This procedure allows your doctor to detect any growths in the uterine walls, like fibroids or polyps.
Endometrial biopsy
An endometrial biopsy can help your doctor identify uterine, menstrual, and hormonal disorders that may be causes of infertility. If you undergo the procedure, here is what to expect:
1. Your doctor will give you a pregnancy test in order to protect a possible pregnancy.
2. The biopsy will take place several days before your period starts.
3. A small sample of tissue will be taken from the endometrium (inner uterine lining) for observation.
Some women experience pain and cramping during and after the procedure.
Cervical mucus test and postcoital test
At times, problems with cervical mucus (CM) can inhibit pregnancy. The cervical mucus test and postcoital test (PCT) can offer your doctor some information on the quality and consistency of your CM. It can also offer information on how your partner's sperm interacts with your CM. A good time to evaluate your CM is around the time of the LH surge, right before ovulation takes place.
Find comfort
The idea going through fertility testing may feel overwhelming and invasive. Finding a fertility doctor who you trust and can express your concerns with should be your first step when seeking help. Remember, your doctor had many specialties to choose from and the one they chose was reproductive endocrinology. They have dedicated their careers to helping men and women – like you – realize their dream of becoming a parent and are sensitive to the emotional toll fertility testing and treatment can take.
Reviewed September 2011 by Dr. Jennifer Mersereau, Medical Director at the University of North Carolina (UNC) Division of Reproductive Endocrinology and Infertility.
Sources: American Society for Reproductive Medicine: Infertility: An Overview http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/infertility_overview.pdf American Pregnancy Association: Female Fertility Testing http://www.americanpregnancy.org/infertility/femalefertilitytesting.html
