Struggling with getting pregnant and feeling ready to seek help? Schedule an appointment with a reproductive endocrinologist, who can help with your infertility.

The Workup
Your doctor will review your medical history before any fertility tests.  Your doctor will check for previous pregnancies, miscarriages, or exposure to sexually transmitted diseases (STDs). You will also have a physical exam and pelvic ultrasound, checking your ovulation and the best course of treatment based on the results.

Ovulation
If you are currently having regular periods for the past 6 months that last between 26 and 32 days, you are most likely still ovulating.  To check any changes in ovulation, your doctor may do a blood test to check your progesterone on day 21 of your cycle.  For further examination, your doctor may also do an ultrasound on your ovarian follicles. Ovulation is a crucial part of conception.

Ovarian Reserve
The ovarian reserve evaluation will determine your ovarian follicle health (egg).  Depending on the results, your doctor may recommend treatment options such as egg donation or additional tests. Some ovarian reserve tests include:

  • Follicle-stimulating hormone (FSH) Test
  • Estradiol (E2) Test
  • Ultrasound Test
  • Blood Test
  • Clomiphene Citrate Challenge Test (CCCT)

A Clomiphene Citrate Challenge Test is common for women age 38 or over. After the CCCT, your doctor will have a better idea of the best course of treatment for you. Here are the steps involved:

  1. Day 3 of your cycle: your doctor will draw your FSH/E2 levels.
  2. Day 5-9: take 100 mg of clomiphene citrate daily.
  3. Day 10: your doctor will draw an FSH level.

Tubal Health
If you are ovulating and in good health, your doctor may recommend a hysterosalpingogram to check your tubal health.  In this test, fluid is injected into your uterus right after your period.  An x-ray is taken to show if your uterus and fallopian tubes are healthy and functioning.

Anovulation
Anovulation is another word for “not ovulating”. Some treatment options for lack of ovulation include:

  • Ultrasound- determine thickness of endometrial lining and check for cysts
  • Endometrial biopsy- check for thicker uterine lining
  • Tests of FSH, luteinizing hormone (LH), prolactin, thyroid-stimulating hormone (TSH), DHEA-sulfate, and testosterone levels

Some symptoms of anovulation are as follows:

  • Absence or presence of goiter
  • Abnormal secondary sex characteristics
  • Acanthosis nigricans (abnormally thick, dark skin growth)
  • Excess hair growing on the face and body
  • Nipple discharge
  • Turner’s stigmata
  • Reproductive tract abnormalities
  • Striae (stretch marks)

Insulin Resistance
Insulin resistance is linked with a fertility problem called polycystic ovary syndrome (PCOS) and can also prevent ovulation. There are a few ways to check insulin resistance:

  • High levels of male hormones
  • Inverted FSH/LH ratio
  • Male pattern hair growth
  • Obesity
  • Ovarian cysts
  • Acanthosis nigricans (abnormally thick, dark skin growth)

Female Infertility and Age
Age plays a huge factor in fertility conception. If you suspect any issues with trying to get pregnant, request an appointment with a fertility specialist. After 12 months of trying, women under age 35 may want to seek help from a specialist.  If you’re over 35, try for 6 months, and if unsuccessful, visit your fertility specialist.