Let’s Talk Fertility

Or more specifically, a lack of fertility. We define infertility as not geting pregnant after one year of unprotected intercourse or, if you are over 35, 6 months. So, once that happens, what does a fertility workup look like. It can be divided into a few basic areas of investigation.

Let’s start with the easiest - for guys, they get a semen analysis. If it’s normal, they are done. If it’s not normal, they will be referred to a urologist for labs, physical exam and possibly genetic testing.

Now, for the more challenging sex, let’s talk about the ladies. The first level we look at is the ovary. We start with looking at ovarian reserve. This is generally done these days with an AMH level. This is a hormone produced by all your remaining follicles. The higher this number, the more follicles you have. For women with PCOS, this number can be crazy high - like 15-30, but for most women, as long as it’s over 1, you are good. The next question is, is the egg actually coming out? We often check this with a day 21 progesterone level and we like to see this over 10.

Moving down, we get to the fallopian tubes. These are evaluated with a test called a hysterosalpingogram (HSG). We put a small catheter through the cervix and into the uterus. We then push dye through the fallopian tubes while watching with an X-ray. If the dye comes through the tubes and out the end, then the tubes are open and all is good. We can also see if a tube is blocked off or if it is damaged/become a hydrosalpinx. It will also allow us to see if there are any issues with the uterine cavity.

For the uterus, we usually start with an ultrasound. Are there fibroids? Is the uterus normal size and shape? Sometimes we need to do a special type of ultrasound called a Saline-Infusion Sonogram - SIS. This is similar to hsg procedure, but we use saline instead of dye and it’s done with ultraound instead of x-ray. It’s much more effective for looking at cavity shape and checking for polyps, but doesn’t help identify if tubes are open. The HSG tell us about polyp and cavity shape as well.

Finally, there is the cervix. Is it open for things to pass through? If you’ve never had a medical procedure on your cervix, this is unlikely to be an issue and if it’s a major stenosis, it makes periods extremely painful and is generally symptomatic.

In addition to the physical things we check, we also check some hormone levels: FSH and LH - best checked on Cycle Day 3, Thyroid Stimulating Hormone (TSH), Prolactin and Testosterone. There may be a few more additions if you have any other medical concerns, but this is what a basic workup looks like.