You’ve been trying – unsuccessfully – to conceive. And you’re thinking that maybe it’s time to see a specialist. But you’re not sure if you should seek help yet…
Here are some general rules of thumb.
First, if any of the following conditions applies to you, you should seek help as soon as you notice that you are having difficulty conceiving:
If you have a history of pelvic infection or endometriosis
If you have had gynecologic surgery
If your menstrual cycles are irregular
If you periods are unusually long, heavy, or painful
If none of those applies to you, you should seek help if you are:
Under 35 and you have been trying for one year.
Between 35-40 and have been trying for six months.
Over 40 and have been trying for three months.
If you are not having trouble conceiving, but have experienced multiple miscarriages, it is recommended that you seek a diagnosis and treatment from a fertility specialist after two consecutive miscarriages, before attempting pregnancy a third time.
So you’ve decided it’s time to see a fertility specialist. What should you expect?
The first thing he/she will do is take a complete medical history of yourself and your husband and perform a gynecological exam. Then a number of tests will be recommended. This is known as the “fertility evaluation.”
Your evaluation will include a semen analysis for your husband (in which the number and condition of his sperm are assessed) and some blood tests to measure your hormone levels: FSH and estradiol (done on “day 3” of your menstrual cycle), progesterone (done near the end of the menstrual cycle), thyroid and prolactin.
A “post-coital test” (similar to a pap smear) will be done at mid-cycle to assess, under a microscope, the reaction between the sperm and vaginal mucus. At the same time, some of the cells obtained can be sent to a laboratory to rule out pelvic infections such as chlamydia or Ureaplasma.
A hysterosalpingogram (sometimes known as “HSG” or simply “tubal x-rays”) will assess the condition of your uterus and fallopian tubes and an endometrial biopsy (in which a tiny amount of tissue is taken from the lining of your uterus and examined in a laboratory) will tell your doctor whether your womb is preparing properly for pregnancy following ovulation.
If indicated, your doctor may also recommend laparoscopy and/or hysteroscopy. These are outpatient diagnostic procedures which can identify pelvic adhesions, endometriosis, and various problems of the uterus and fallopian tubes.
Having completed all these tests, there is about a 95% probability that your doctor will be able to pinpoint the cause of your infertility. And once this is done, you can proceed to treatment and – hopefully – a successful outcome. You can click here for more infertility treatment.