Evaluation

What is an “Infertility Evaluation”?

The purpose of the diagnostic evaluation is to find out why you are not getting pregnant.

The first step on your journey to parenthood is to get some answers. If you’ve been trying to conceive with no success for at least one year (or six months if age 35yrs or older), then it’s time for you to explore medical treatment for infertility.

There may be several medical reasons for why you and your partner aren’t getting pregnant. Research has shown that 40% of the time, infertility is due to a sperm issue (“male factor” infertility). For another 40% of cases, it’s due to female factors (the remaining 20% of cases may be combined factors).

It’s important to know that for one out of five couples, they never learn exactly why they cannot get pregnant without medical intervention. But…unexplained infertility doesn’t necessarily mean untreatable infertility!

To get you answers, it’s important to start with a thorough fertility evaluation. Here, we want to develop a plan to diagnose the reasons for your infertility that’s not only cost effective, but also gets you answers as quickly as possible.

A simple blood test can tell you if time is on your side, or if time is fast becoming your enemy.

With each test, we learn clues that help us to develop a unique treatment plan for you. Common tests include ovarian reserve, tubal& uterine status, and male factor. Here is a brief outline summarizing these tests:

Test Name How It’s Done What the Result Can Tell Us
History Here, you provide answers to basic medical questions. This gives us detailed information about your general and reproductive health, as well as the health of your relatives. To get the most out of your initial consult appointment, your history information should be provided/uploaded beforeyour first appointment. The history you provide gives us a chance to see if there are any health problems or inherited traits that might contribute to infertility or miscarriage.
Physical exam At CAG, your physical will generally be a focused exam (by ultrasound), as well as some blood tests. The physical tell us if your general health is appropriate to permit fertility treatment safely. If a health concern is identified during the physical, it alerts us to potential risks you might be facing during your treatment or pregnancy.
Male fertility evaluation A semen sample is provided to our office for a semen analysis. Sperm are analyzed under a microscope for basic testing. If sperm DNA fragmentation is suspected, more detailed testing will be performed by our research colleagues off site. A basic semen analysis gives information on sperm count, motility, and cell shape. With a more advanced analysis (SCSA), the percentage of sperm that might have fragmented nuclear DNA can be measured.
Hormone evaluation A series of blood tests are performed at our office (sometimes these need to be done on specific days of the menstrual cycle). Hormone assessments can identify abnormalities in pituitary, thyroid or adrenal function, as well as give indications of any disturbance in ovarian activity.
Ovarian reserve test A blood test performed at our office to measure anti-Müllerian hormone (AMH) levels. Because these levels remain relatively constant throughout your cycle, AMH can be checked on any day of the month. AMH is a substance produced by the granulosa cells within the ovaries. AMH blood levels reflect the size of your remaining egg supply. This test can help estimate “ovarian age,” which is the most important factor affecting the chance to achieve pregnancy.
HSG This is a special kind of x-ray “dye test” that is performed by a radiologist to gain information about the uterus and Fallopian tubes. The HSG provides information about any anatomical problems that might contribute to infertility.
Ultrasound monitoring Using transvaginal ultrasound, we monitor the appearance of your ovaries and uterus on successive days throughout your menstrual cycle. The purpose of ultrasound monitoring is to see that your ovaries and uterus are functioning properly. On day 2 or 3, a baseline scan can confirm that ovaries are “quiet” and do not have any cysts. Later at mid-cycle, the scan can be repeated to verify that ovulation is likely. A follow-up ultrasound can be performed to reassess the ovaries after ovulation. At each ultrasound examination, Dr. Sills will also measure the endometrium (uterine lining) to make sure that your uterus is thickening appropriately—in preparation of implantation (pregnancy).
Post coital test On the morning after intercourse, we can perform a test, similar to a pap test, where we collect a small sample of your cervical mucous to examine under a microscope. Rarely performed in the modern era, the post coital test can tell us how the sperm and cervical mucous interact.
Hysteroscopy A hysteroscopy is a minor surgical procedure that is performed under light sedation in an operating room setting. A thin, lighted tube with a camera, called a hysteroscope is inserted into the vagina and enables the doctor to examine the cervical canal and the uterine interior. A hysteroscopy can tell us if uterine problems are causing your infertility, or why you might be suffering from recurrent miscarriages. During the procedure, small fibroids and polyps can be removed and sometimes fallopian tubes can be opened, often times increasing the likelihood that you can soon become pregnant naturally.
Laparoscopy A laparoscopy is a procedure that is performed under general anesthesia in a surgical setting. Very small incisions are made where instruments can be inserted to help diagnose (or repair) problems. Laparoscopy can assist in making a diagnosis (endometriosis), or actually fix problems that cause pain and/or infertility (ovarian cysts, fibroids).
Endometrial biopsy An endometrial biopsy is a procedure(which can be done in the office) where a small sample of uterine tissue is removed and analyzed under a microscope. An endometrial biopsy gives important information about the uterus lining, which is the surface that the embryo must “land on” to implant properly.

For some patients, the journey ends soon after completing diagnostics. Many find themselves pregnant after drug or surgical treatments that restore fertility. For those requiring more advanced treatments, CAG offers a full range of advanced reproductive technology options.

Copyright © 2015 CAG.All rights reserved.
E. Scott Sills, MD PhD and the Center for Advanced Genetics (CAG) is a reproductive medicine clinic located in Carlsbad, California USA, in North San Diego County, and serves the cities of Carlsbad, Oceanside, Vista, San Marcos, Encinitas, Escondido, Fallbrook, Bonsall, and Camp Pendleton. The fertility clinic specializes in in-vitro fertilization (IVF), frozen embryo transfer (FET), blastocyst transfer, pre-implantation genetic diagnosis/screening/testing of embryos (PGD, PGS) for possible genetic abnormalities and gender selection, Next Generation Sequencing (NGS), intra-uterine insemination (IUI), surrogacy, donor cycles, male-factor infertility, Essure® removal, treatment for recurrent pregnancy loss, and fertility preservation (egg freezing, sperm banking). Dr. Sills is published over 100 times in peer-reviewed publications and just published his book “Fighting at the Fertility Front,” a book that covers infertility, treatments, and issues that are unique to military personnel. CAG is committed to building families, including assisting those of the LGBT community. We offer low-interest fertility treatment financing to make having a baby a reality for virtually everyone.
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