Introduction to the Fertility Test Process
Are you having trouble getting pregnant? If so, you are not alone. About 1 in 8 couples of reproductive age experience infertility.
Infertility can be distressing, but remain hopeful. The vast majority of those dealing with infertility do become parents over time!
Do I need help?
If you think you need help getting pregnant, put your worries aside and seek help. If you are over 35 and have not become pregnant after 6 months of trying, make an appointment with a reproductive endocrinologist (RE). An RE, or fertility specialist, is an obstetrician/gynecologist (OB/GYN) that has expertise in diagnosing and treating infertility.
If you are younger than 35, and have been unable to get pregnant after a year of trying, you may also benefit from seeing an RE.
Your first appointment
The first appointment with an RE is usually an in-depth conversation about your fertility. If at all possible, bring your partner along. Your partner is an important part of the fertility treatment process, providing more than just emotional support.
Your partner will often undergo fertility testing as well. At your first visit, you and your partner will need to be prepared to answer questions about your reproductive and medical history. Your doctor may ask about:
- Menstrual and ovulation irregularities
- Previous pregnancies, births, and miscarriages
- Past sexual history, including birth control and sexually transmitted diseases (STDs)
- Medical history, including past and current illnesses, medications, and surgeries
- Other issues relevant to fertility and health, including any exposure to toxins
To make things easier, bring all relevant medical records and test results with you. If you have been checking your basal body temperature (BBT) or using an ovulation predictor kit (OPK) to track ovulation, share those results at your appointment.
Your RE will perform a physical exam early in the process. He or she will examine your breasts, pelvis, and thyroid.
During these exams, your doctor will look for abnormalities that might suggest fertility problems. For instance, excess body hair or oily skin could signal a hormone disorder. To further evaluate your fertility, your doctor will run some blood tests to assess hormone levels.
Your fertility doctor will want to evaluate your ovarian reserve. Your ovarian reserve is a measure of the quantity and quality of your eggs.
To measure your ovarian reserve, your reproductive endocrinologist will check the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol on day 3 of your menstrual cycle. A clomiphene citrate challenge test (CCCT) may also be ordered to further assess your ovarian reserve.
Luteinizing hormone (LH) is a hormone critical to ovulation and a healthy pregnancy. Right before you ovulate, LH surges, signaling your ovary to release an egg. Your doctor may have you come in mid-cycle to have your LH level checked a second time. This mid-cycle LH test can help your doctor determine if ovulation is occurring. Your doctor may recommend that you use an ovulation predictor kit (OPK) or do a blood draw.
Ideally, after the LH surge, your progesterone levels rise, preparing your uterus for pregnancy. If you have a 28-day cycle, your doctor will check your progesterone level between days 19 and 23 of your cycle. This progesterone test can tell your doctor if you are ovulating. It can also pick up whether you are producing enough progesterone to support a pregnancy.
Other important fertility hormones that may be measured include:
- Inhibin B
- Thyroid stimulating hormone
For optimal fertility, these hormones should be within normal ranges.
If your reproductive endocrinologist suspects problems with ovulation or your reproductive organs, he or she may want to perform a vaginal or abdominal ultrasound. Ultrasound testing can help your doctor identify problems related to:
- Ovarian follicle development and ovulation
- Ovarian cysts that may indicate polycystic ovary syndrome (PCOS)
- Your endometrial lining and uterus
For a more comprehensive explanation of what to expect when you visit a fertility specialist, contact your clinic for details.Sources