August 8, 2021
By Sneha Kamarajugadda
For many couples, getting pregnant and giving birth is a joyous process. However, for the one in eight couples who deal with infertility, it can be a stressful and upsetting time. Infertility is defined as an inability to get pregnant after one year of unprotected sex. For people with ovaries over 35 years old, the time frame is decreased to six months of unprotected sex.
There can be several factors that lead to infertility. Although many think that infertility is a one-sided problem, only 30% of infertility issues are attributed to the gestational partner. Another 30% are attributed to the non-gestational partner while the remaining 40% are associated with both partners or are unexplained.
Fortunately, infertility is a treatable disease. The best way to determine the etiology of infertility and the proper treatments is to see a reproductive endocrinology and fertility specialist. Seeing a specialist can be daunting at first but knowing what to expect can help mitigate that fear.
The visit will typically start with the physician asking questions. These include but are not limited to menstrual, pregnancy, sexual (including STIs) and contraceptive history as well as past medical and surgical history, social history and any fertility workup history. These questions often point toward the correct diagnosis. If you are seeing your doctor in person, they may do a physical exam after. This would consist of checking thyroid size and hair distribution, and doing a breast and pelvic exam. The first visit will likely end with more details about the fertility process and answers to any other questions you may have.
The next series of visits will be more tests to rule in or out potential causes of infertility. For those with testes, it starts with a semen analysis. For those with ovaries, the tests evaluate ovarian reserve, ovulatory function and structural abnormalities.
Ovarian reserve represents the number of oocytes or eggs available for fertilization. Your physician may check your ovarian reserve by checking your blood for levels of certain hormones (estradiol, follicle stimulating hormone (FSH), antimullerian hormone). Additionally, they may do an ultrasound to count antral follicles or follicles that contain eggs.
Ovulatory function or ability to release eggs can be tested with blood levels of other hormones (progesterone and luteinizing hormone (LH)) as well as a history of irregular or absent periods. Usually, causes of ovulatory dysfunction (i.e., PCOS, thyroid disease, hyperprolactinemia) are tested for at the same time with more blood work.
Structural abnormalities can prevent a pregnancy from occurring or being carried through. Two procedures commonly done to check for this are hysteroscopy, which visualizes the interior of the uterus, and hysterosalpingogram, which determines if the fallopian tubes are open.
After completing this initial workup, you will meet your specialist again to go over the results and next steps.
There are many other reasons to see a fertility specialist, including recurrent pregnancy loss, fertility preservation, LGBTQ family planning or intentional solo parenting. The workup may vary depending on the reason it is needed (i.e., no sperm analysis for same-sex couples without testes) but otherwise is similar. When you are ready to take the next step in your fertility journey, hopefully, you feel better prepared about what to expect for your visit with a reproductive endocrinology and infertility specialist.
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