Infertility isn’t really a diagnosis in and of itself but instead refers to another medical problem that can make it hard to have a baby. For some men and women getting a diagnosis is impossible. About 20% of all couples who are unable to have a baby never find out why. Everything appears to be working normally, but conception just doesn’t happen. For others couples, getting a proper diagnosis can help tailor treatments and help couples conceive more quickly.
The first step
The first step in any diagnosis of anything is an exam. To rule out a spectrum of causes both the man and the woman should be seen. Men should visit a urologist for an evaluation and women should see their gynecologist. Your doctor will ask about your sexual history, any medical conditions you or your partner has, and your overall health history.
The physical exam
After the verbal history, your doctor will do a physical exam. This will include a pap smear if you need one, and a pelvic exam. A pelvic exam may help your doctor feel any masses or abnormalities in the shape, size or structure of your uterus and ovaries. Your doctor may also suggest an ultrasound to look for abnormalities, and blood work to monitor hormone levels. Hormonal problems are a common cause of infertility—specifically failure to ovulate. Women who have longer days between periods or irregular periods are likely to have problems with regular ovulation—making it hard to know when the most fertile days for trying will be. If hormonal problems are identified, your doctor will work with you to correct and regulate your cycle for more predictable ovulation.
A special X-ray may also be used to introduce dye into the reproductive organs. This dye will show up on X-ray and may help your doctor identify any blockages that could be keeping the sperm and egg from joining. Getting a diagnosis on your first visit to the doctor probably won’t happen, so be patient while your doctor works to see the bigger picture.
Men will need to make their appointments for testing and can expect semen analysis testing to ensure that sperm are present in semen and that they are mature enough, formed and moving properly to make the journey to the egg for fertilization. Doctors now believe that some problems with sperm could be genetic. More research is being done to identify the link that this plays.
After the easy and least invasive tests have been completed, if an answer is not found your doctor may suggest surgical procedures like a laparoscopy to examine the reproductive organs and pelvic cavity. In some cases this procedure can find endometriosis, scar tissue or adhesions that may be causing problems.
What’s right for you?
Testing that’s right for you can only be identified by you and your doctor. The journey through infertility can be long and painful—so it’s worth it to find a physician you can trust and who will be on your side. Dr. Hessel offers extensive infertility assessment and care for patients just like you. If you are having trouble getting pregnant, come see her soon.