What you need to know about infertility evaluation
Infertility evaluation is a crucial step for couples who have been trying to conceive without success. This process involves exams and tests that help identify potential causes of infertility in both partners. Even if no definitive cause is found, there are still treatments available that can help increase the chances of pregnancy.
Here’s a straightforward guide from ACOG (The American College of Obstetricians and Gynecologists), to help you understand what you can expect from an infertility evaluation, when to seek one, and the types of tests involved.
When to seek an infertility evaluation
- Under 35 years old: If you’ve been trying to get pregnant for a year without success.
- 35 years or older: After 6 months of trying.
- Over 40: Speak immediately with your obstetrician-gynecologist (ob-gyn) to discuss your options.
Who performs the evaluation?
Typically, your OB-GYN conducts the initial assessment. Depending on the findings, you may be referred to a reproductive endocrinologist (a specialist in infertility), while men may need to see a urologist for specific male infertility evaluations.
Common causes of infertility
- Women: The most frequent cause is problems with ovulation, though age, lifestyle, and health conditions also play a significant role.
- Men: Issues with sperm production and function are the primary causes.
Some cases are classified as unexplained infertility, where no specific cause is identified.
Age and fertility
- Women in their 20s to early 30s: 25-30% chance of becoming pregnant per cycle.
- After 35: Fertility declines significantly, with a steep drop after age 37.
- By 40: Less than 10% chance of pregnancy per cycle.
Men’s fertility also declines with age, though not as rapidly or predictably as women’s.
Lifestyle factors affecting fertility
- Women: Being underweight, overweight, or exercising excessively can affect ovulation. Smoking, heavy alcohol consumption, and drug use also reduce fertility.
- Men: Smoking, excessive drinking, and marijuana use can lower sperm count and mobility.
Health conditions and fertility
In women, conditions like thyroid disorders, problems with reproductive organs, past sexually transmitted infections (STIs), or endometriosis can affect fertility. In men, blocked tubes in the reproductive system can impact sperm delivery.
What to expect during an infertility evaluation
The fertility specialist will conduct a detailed medical history review and a physical exam during your first visit. Expect questions about your menstrual cycle, reproductive health conditions, and overall health. For both partners, there will be questions about:
- Medications and supplements
- Health conditions, surgeries, or STIs
- Family history of birth defects
- Lifestyle habits like smoking, alcohol, or drug use
- Sexual history, including birth control methods and frequency of intercourse
Tests for infertility
- Men: A semen analysis assesses sperm count, shape, and mobility. Blood tests may check reproductive hormone levels, and sometimes, an ultrasound is used to examine the testicles.
- Women: Tests include blood and urine tests to assess ovulation, progesterone levels, thyroid function, and ovarian reserve. Imaging tests like ultrasounds, sonohysterography, and hysterosalpingography may be used to check for blockages or abnormalities in the reproductive organs.
How long does testing take?
Most infertility evaluations can be completed within a few menstrual cycles.
Insurance coverage
Some insurance companies may cover infertility evaluations, but checking with your provider before starting the process is important.
Conclusion
If you’ve been trying to conceive without success, an infertility evaluation could provide valuable insights into possible issues and treatment options. While the process may seem overwhelming, it can bring you closer to your goal of starting or expanding your family. Consult with your ob-gyn or a fertility specialist to take the next steps.
Source:
- American College of Obstetricians and Gynecologists. (n.d.). Evaluating infertility. ACOG. https://www.acog.org/womens-health/faqs/evaluating-infertility