Reproductive Endocrinology and Infertility
Infertility - Infertility Work-Up

Infertility is defined as the inability to conceive after one year of unprotected intercourse. It is at this time that an infertility work-up should be considered. Both partners should undergo a thorough evaluation to uncover, if possible, the causes of their infertility.

Evaluation of the Female

A thorough medical, surgical and gynecological history is taken. The family history is also reviewed to look for evidence of genetic diseases, infertility or endometriosis in other family members. Any prior infertility evaluation and treatment is reviewed. If you have seen another physician for infertility you should bring copies of all diagnostic test results, office notes, operative reports and x-rays to your first visit. A transvaginal ultrasound of the uterus and ovaries may be performed at the first visit.

The next step is to determine if the woman is ovulating. This can usually be determined from her history, but confirmatory tests will be performed. Techniques to detect ovulation include urinary ovulation predictor kits, mid-cycle ultrasounds or a blood test for progesterone. Measurements of hormones such as follicle stimulating hormone (FSH), estradiol, thyrotropin stimulating hormone (TSH), prolactin, testosterone, luteinizing hormone (LH) are performed as indicated by the patient’s history and physical exam.

A hysterosalpingogram (HSG) is performed to determine if the fallopian tubes are open and to evaluate the shape of the uterus. The HSG is also known as the "dye test". Radiographic contrast dye is injected through the cervix. X-rays are taken as this is done and the passage of dye into the uterus and out the tubes is visualized.

A sonohysterogram may also be performed to evaluate the uterine cavity and ovaries. The sonohysterogram is a technique in which sterile water is used to distend the uterine cavity so that possible lesions can be visualized and any possible abnormalities identified.

A diagnostic laparoscopy is the last step in the evaluation of the infertile female. If no other explanation for the infertility is found, a laparoscopy may be recommended. Whether or not laparoscopy should be routinely performed in all infertile women is a subject of some debate. This is an out-patient surgical procedure performed under general anesthesia.

Evaluation of the Male

Evaluation of the male partner is an integral part of the infertility work-up. A male factor contributes to the infertility in at least 40% of couples. A medical, surgical and sexual history is taken. It is important to know if the husband has fathered, or attempted to father, any children in the past. A history of genital trauma, infection, surgery or hernia repair (especially as a child) may be important. Numerous medications can affect sperm production, therefore a complete list of all medications (both prescription and over the counter) that the husband is currently taking is made. Smoking and excessive alcohol intake can also adversely affect sperm count and motility. The primary test for the male is a comprehensive semen analysis performed after 3-4 days of abstinence. If abnormalities are noted, the test is usually repeated 2-3 weeks later. More detailed testing of the sperm such as hemi-zona test and sperm antibody testing are performed on an individualized basis. Hormone levels in the male may be measured in some cases. If persistent sperm abnormalities are noted, the husband is referred for urological consultation.