After 12 months of regular unprotected intercourse, 85% of couples will achieve a pregnancy. The remaining 15% of couples are considered infertile, and should seek a basic evaluation to identify contributing factors and guide treatment options. The main components of the workup evaluate ovulation and ovarian function, tubal and uterine anatomy, and possible male factor issues. Efficient and thorough testing is the key to helping couples achieve the ultimate goal of a healthy baby.
All couples should undergo a detailed history and the female partner a physical examination by a women’s health provider or infertility specialist. During a new patient consultation with one of our physicians at the Utah Fertility Center, we routinely perform a pelvic ultrasound to evaluate uterine and ovarian anatomy. Ultrasounds are a safe and relatively painless way of diagnosing any abnormalities such as uterine fibroids or ovarian cysts. Other typical screening includes cycle day 2 or 3 blood tests for FSH (follicle stimulating hormone) and estradiol levels, sometimes with testing for anti-Mullerian hormone levels, all of which evaluate egg reserve. We also screen for thyroid disorders because abnormal levels can affect ovulation and increase the risk of miscarriage. If there is a history of ovulatory dysfunction, additional hormone tests may be run to evaluate the underlying cause and guide treatment.
In addition to the above blood tests, female patients will typically undergo a hysterosalpingogram, also known as the “dye test”, to evaluate the inside of the uterine cavity and patency of the fallopian tubes. This test evaluates for any tubal blockage or dilation that could interfere with conception. It also evaluates the inside of the uterus for scarring, fibroids or polyps. These procedures are performed at our Pleasant Grove office by one of our infertility specialists. If there is any suspicion for an abnormality inside the uterus, further testing with a sonohysterogram, also called a “water ultrasound”, may be done. This is also a relatively painless procedure, similar to a pelvic ultrasound, performed by our infertility specialists to get a better view of pathology inside of the uterus.
Last but not least, the male partner should undergo a semen analysis to diagnose any male factor issues. The three most important components of the semen analysis are the count (how many sperm), the motility (what percentage are swimming forward), and morphology (what percentage are shaped normally). Semen analyses are optimally performed at a fertility center because we tend to be more discriminating. However, if this is not feasible, having it done anywhere will still yield very helpful information.