Infertility is diagnosed if a patient under the age of 35 doesn’t conceive after one year of unprotected intercourse and if the patient is 35 years old or older, the provider should initiate evaluation after six months of unprotected intercourse. Patients concerned about their fertility or with obvious medical problems affecting their ability to conceive should begin an infertility workup immediately. Such issues can include irregular menstrual cycles, polycystic ovarian syndrome (PCOS), sexual dysfunction, history of pelvic disease, or if the partner has a known fertility issue. Brown Fertility follows the recommended infertility workup guidelines as set by the American Society of Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG).
Infertility workup steps include:
- New patient consultation
- Day 3 bloodwork
- Hysterosalpingogram (HSG)
- Semen analysis
New Patient Consultation
To initiate an infertility workup, our patients begin with a new patient consultation to discuss their specific circumstances. A comprehensive medical history is obtained from both partners to identify any potential causes of infertility including the following: prior pregnancies and any complications if applicable, menstruation history including age of menarche and menstrual cycle patterns, previous methods of contraception, sexual history, medical and surgical history, social factors, family history, and any prior infertility testing and treatment. Our providers perform a physical examination of the female partner checking for abnormalities in basic vital signs, possible thyroid enlargement, breast secretion, excess androgen, tanner staging of breasts, pubic and axillary hair, vaginal or cervical abnormalities, pelvic or abdominal tenderness or masses, and uterine shape, size and position.
Day 3 Bloodwork
Our female patient will complete day 3 bloodwork as well as imaging testing. Tests will focus on ovarian reserve, ovulatory function, and structural evaluation of the fallopian tubes, cervix and uterus. Ovarian reserve can be assessed through serum tests or ultrasound. It is thought that a patient may have a diminished ovarian reserve if they meet the following: AMH values less than 1 ng/mL, a follicle count that is less that 5-7, or FSH values greater than 10 IU/L. It is important to test for ovulatory function in our patients; for many patients, menstruation history may be sufficient to assess ovulatory function. We know that a progesterone value greater than 3 ng/mL means that our patient is ovulating. Lack of ovulation, also known as anovulation, may be due to obesity, hypothalamic and pituitary dysfunction, or PCOS.
Structural evaluation is typically done through a hysterosalpingography (HSG) which views the uterus and fallopian tubes by injecting a contrast through the cervix during fluoroscopy; through an HSG, we are able to identify any blockage or adhesions which may be attributing to infertility.
In our male patients, the semen analysis will focus on the number, volume, morphology and motility of their sperm. Obtaining a semen analysis is vital as male factor is attributed to 40% of infertility in couples. Once testing is complete and an underlying prognosis is identified, our patient’s treatment plan can begin immediately.
It’s important to remember that 1 in 7 couples experience difficulty getting pregnant. While it’s easy for patients to lose hope, 85-90% of infertility cases are treated with conventional medical therapies such as medication or surgery. Brown Fertility is committed to helping our patients conceive.
Infertility Workup for the Women’s Health Specialist. (2019). American College of Obstetrics & Gynecology, 133(6), 1294-1295.