Since the majority of women become pregnant within one year of having unprotected intercourse, most couples are advised to try to conceive on their own for a year before beginning fertility testing. For women over 35, those with known medical problems that might affect fertility (such as polycystic ovarian disease or pituitary tumors), or women who are attempting to get pregnant through artificial insemination, earlier testing may be appropriate. It is important that both partners be tested initially to carefully assess the extent of the fertility problems.
The basic infertility evaluation for women includes a history and a physical examination. Additional testing to further refine the diagnosis is often completed as well.
The evaluation starts with a careful review of the history of each woman's symptoms and previous experiences. This can include:
The physical examination is performed to evaluate the pelvic organs and assess potential hormonal problems. Finally, additional hormonal testing or ultrasounds may be required to evaluate ovulation and ovarian age. An x-ray of the uterus and tubes (hysterosalpingogram or HSG test) may be completed to assess uterine or tubal status, and surgical procedures such as a laparoscopy or hysteroscopy may be indicated to evaluate the structure of the uterus or fallopian tubes in more detail.
Approximately 45% of couples will have associated male infertility. It is for this reason evaluation and treatment of the male is critical to develop a comprehensive treatment program for the infertile couple. A combined approach is essential to ensure successful evaluation and management.
An initial male fertility work-up includes a history, physical examination, general hormone tests and one or more semen analyses, which measure semen volume as well as sperm number, motility and quality of motion.
The initial evaluation typically begins with a series of questions that may include:
Next a thorough physical examination is performed to evaluate the pelvic organs - the penis, testes, prostate, and scrotum.
Laboratory tests, such as a urinalysis, semen evaluation, and hormonal assessment are also conducted. The urinalysis indicates if an infection is present. The semen evaluation assesses sperm motility or movement, the shape and maturity of the sperm, the volume of the ejaculate, the actual sperm count, and the liquidity of the ejaculate. Hormonal tests evaluate levels of testosterone and FSH (follicle stimulating hormone) to determine the overall balance of the hormonal system and specific state of sperm production. Serum LH (luteinizing hormone) and prolactin are other hormonal tests that may be done if initial testing indicates the need for them. When a diagnosis is not obvious after the initial evaluation, further testing may be required. One or more of the following tests may be recommended:
After the diagnostic evaluation is completed, a decision is made as to which therapies to choose; they may include medical or endocrinologic treatment, surgical correction, or a decision to manipulate or process the sperm which already exists to achieve a pregnancy.
|The UCSF Center for Reproductive Health, located in Northern California's San Francisco Bay Area offers a comprehensive array of infertility evaluation and treatment options for both men and women. Our services include: Infertility Evaluation, Male Reproductive Health, Fertility Preservation, Reproductive Surgery, Tubal Reversal Surgery, In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), Pre-implantation Genetic Diagnosis (PGD), Intrauterine Insemination (IUI), Ovulation Induction, Donor Sperm Insemination, Egg Donor Program for Donors, Egg Donor Program for Recipients, EPolycystic Ovarian Syndrome (PCOS), Recurrent Pregnancy Loss, Gestational Surrogacy, Genetic Screening and Counseling Psychological Support.|