The first step in diagnosing the problem is to perform an infertility evaluation.
We choose tests according to your individual needs
After a couple has tried to conceive naturally for one year with unprotected, well-timed intercourse, or if a woman has been unable to carry a pregnancy that results in a live birth, then they could consider seeking assistance. Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. Though in some cases , infertility results from problems in both partners or the cause of the infertility may never be explained. Women over 30 years old, or who have a history of pelvic inflammatory disease, painful periods, miscarriage, endometriosis or irregular cycles, may want to seek help sooner. Male factor infertility may be caused by blockages, physical abnormalities, or be the result of radiation and chemotherapy treatments for cancer.
Lifestyle factors that affect fertility
There are a number of tests that can be run from blood tests to determine hormone levels to physical and visual examinations. During your first visit, we will detail your medical and gynecological history and possibly perform a physical examination. Also we will present an outline plan for your evaluation. For this reason, we advise both you and your spouse to be present. Bring past medical records, particularly operative reports and X-rays; they are extremely important. Laboratory tests may or may not be performed during the first visit. Some patients will need a baseline ultrasound and hysterosalpingogram. We will discuss tests that you and your spouse may require, based on information we obtain from the initial interview and from any preexisting records outlining past investigations.
We individualize your diagnostic plan to minimize the cost of the evaluation, as well as to provide expeditious and thorough care. Being a complete infertility center, we are able to perform most tests in the medical office. Some procedures are performed in the radiology department of or in the operating room Tucson Medical Center . Tests are scheduled at specific times in your menstrual cycle, which is why one month, and sometimes more, may be necessary to complete your evaluation. For patients who do not live in the Tucson area, some procedures can be handled through the referring or primary care physician to reduce travel costs.
In order to establish pregnancy naturally, a woman must have at least one functioning ovary and fallopian tube, a uterus and a cervix. The following are factors that may contribute to infertility.
Ovulation The ovaries may not develop and release an egg (ovulation) at the proper time. A wide variety of fertility drugs are now available to induce ovulation. Use of these medications is carefully individualized based on factors such as cost, ease of use, and success rates. Fallopian Tubes The fallopian tubes may be prevented from functioning properly because of tubal disease or factors surrounding the tubes (e.g. adhesions, endometriosis). Adhesions This is scar tissue resulting from inflammation and the healing process that follows an infection or prior surgeries. Once formed, adhesions must be surgically removed. Endometriosis This is a condition where portions of the lining of the uterus are found outside the uterus in the abdomen. It can grow in and on the ovaries, fallopian tubes, bladder, bowel and peritoneum, and can be treated with surgery and drugs. Cervix Sperm and mucus may not interact normally at the cervix. Uterus Disease (fibroids, polyps, infection) inside the uterus may prevent sufficient room for growth of the pregnancy or the lining of the uterus may not mature sufficiently to support implantation and maintenance of pregnancy.
Diagnostic Procedures for Women
This is an X-ray of your fallopian tubes and uterus that shows if your tubes are open and if any uterine abnormalities exist. A physician performs the test in the radiology department. The ideal time for this test is after menstrual bleeding has stopped and before ovulation. For this procedure you will be asked to lie on the examining table for a pelvic examination. A speculum is inserted into the vagina, then an instrument is placed in the cervix that injects dye into the uterus and fallopian tubes to make them appear on the x-ray. You may experience abdominal cramping during the procedure. Vaginal spotting may occur for a couple of days after. Because of the minor discomfort and cramping, you should not eat a full meal prior to the procedure, and plan to have someone drive you home.
Postcoital Test (PCT)
This evaluates the quantity of cervical mucus and the presence, number and motility of sperm in the mucus after intercourse. It is performed near the middle of your cycle, at the time you are ovulating. When a postcoital test is scheduled, you should have intercourse under normal conditions the night before or morning of your visit. There is only a 48 to 72 hour window during which mucus is favorable to the penetration and survival of sperm.
During this procedure a small amount of tissue from inside the uterus is taken to evaluate the timing of ovulation, maturation of the lining of the uterus (endometrium), and any other abnormalities of the endometrium. It is performed in the office during the pelvic examination on day 23 or later of your cycle. You may experience mild to moderate uterine cramping, but it is usually lasts for only a short time. You will have some spotting the day of the test and, perhaps, for the next couple of days. The sample of tissue is sent to the pathology laboratory where it is prepared for microscopic study. Results are available in 4-5 days. To enable us to accurately interpret this test, the day of ovulation should be determined as well as the day your next period begins.
Laparoscopy is a surgical procedure performed in the operating room under general anesthesia (you are asleep). It involves a small incision at the umbilicus (belly button) and the insertion of a small lighted instrument into the abdomen to inspect the fallopian tubes, ovaries and pelvic environment. In most cases, two other very small incisions will be made near or in the pubic hair area. In order to see the pelvic anatomy and minimize the risk of injury to surrounding structures, carbon dioxide gas is placed into the abdomen to displace the bowel for better perspective. Laparoscopy can detect abnormalities such as adhesions and endometriosis. Laparoscopy usually takes 45 minutes to an hour to perform and does not require hospitalization. You may experience some shoulder discomfort for several days due to residual gas in the abdomen under the diaphragm. This is a very safe procedure, but carries a slight risk of injury to pelvic structures, e.g., the bowel, bladder and blood vessels, and lead to hemorrhage and perforation. Such complications are rare. Hysteroscopy uses the same principle as laparoscopy. For this procedure the lighted instrument is placed inside the uterus. It is often performed in conjunction with laparoscopy, or can be performed in the office.
For this procedure, a lighted instrument is guided vaginally into the uterus. This can be done at the time of a laparoscopy or in the office. It is used to detect abnormalities in the endometrial cavity (the inside of the uterus).
Ultrasound is a non-invasive procedure used to examine the abdominal contents including pelvic anatomy and pregnancy. As sound waves pass through the body, they reflect echoes at varying intensities which are displayed on video. Ultrasound is used to examine the development of eggs within the ovaries. It also can reveal the number of eggs, particularly when fertility drugs are used. It can be performed by placing an instrument, called a transducer, on the abdomen, when the bladder is full. However, the most common procedure involves the use of a vaginal transducer inserted into the vagina to examine the ovaries and uterus. This usually takes about five minutes and is painless.
Hormone levels are measured to detect abnormalities and to monitor therapy. This involves taking blood, usually from a vein in the arm or hand.
Evaluation of the man begins with a thorough history. Important events such as previous genital or hernia surgery, exposure to potential sperm toxins, recent illnesses and family history of reproductive difficulties can give important clues to potentially reversible causes of infertility. Physical examination of the testicles, penis and prostate and evaluation of urine and prostatic fluid can give us insight into the possible causes of infertility. After the history and physical examination are completed, a semen analysis is done. The remaining portion of the basic evaluation includes hormonal assessment. Blood taken from a vein in the arm or hand provides information regarding the ability of the testes to produce sperm. In some cases, other testing may be indicated, including biochemical tests for antibodies to sperm. Information gathered during the history, examination, and blood evaluation is interpreted and explained to you so that a plan for further diagnostic tests or treatment can be outlined.
A microscopic analysis of sperm is the cornerstone of laboratory evaluation for the male. The test is performed on a sample of semen freshly collected by masturbation. Abstinence is advised for a minimum of two days and no more than seven days prior to the sample collection. The entire ejaculate must be collected in a clean, wide mouth container (preferably one provided by the clinic or hospital) and delivered to the laboratory within one hour for analysis. If you live a long distance from the hospital, which does not permit immediate delivery of the specimen, arrangements are made for you to produce the specimen at the office, in a private area.
The semen analysis will evaluate:
Results of the analysis are available within two days. Usually we need to obtain between one and three specimens for a complete picture of a man’s sperm producing capacity. The results of the semen analysis give information regarding the likelihood of achieving a pregnancy with a normal partner. There is a wide range of variability in semen characteristics and only rarely is it possible to say, definitely, that a man is infertile based on the semen analysis.
Arizona Center for Reproductive Endocrinology and Infertility
Caring for you, Caring for your heath & Caring for your future
5190 E Farness Drive #114 Tucson, Arizona 85712