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Infertility

List of Infertility Specialists

Infertility is described as a disease or condition of the reproductive system. Infertility is often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages. 
 

Who gets infertility?
Infertility is a medical problem, which may be caused by both males and females.  Typically, about 40% of infertility is due to a female factor and 40% is due to a male factor. 
 

What are the risk factors for infertility?
There are several  factors which may cause Infertility, such as:

Age
Sexually Transmitted Diseases (STDs)
Tubal Disease
Endometriosis
DES Exposure
Smoking
Alcohol
Weight
 

Tests performed by the infertility specialist (Reproductive Endocrinologist): 

Tests usually performed by the infertility specialist are shown below. However, it is likely that specialists will have their own protocols. Accordingly,  the following should be used as basic guidelines: 
 

YOUR FIRST APPOINTMENT:
Try to schedule your first consultation with your RE during the first week of your cycle so that you don't "waste" a cycle. Baseline tests for follicle stimulating hormone (FSH) and luteinizing hormone (LH) must be done on day three of your cycle. If your consultation should take place before that, you'll be instructed to come in for these tests on day three of your cycle. Additional tests will be conducted on the day of Luteinizing Hormone (LH) surge (mid-cycle), and again about seven days after ovulation.

At the first appointment, most REs also do routine screening of both partners---AIDS, hepatitis, etc. Medical histories for both partners will be taken. Try to keep track of the length of your menstrual cycles for several months beforehand. Charting Basal Body Temps (BBTs) for several months will also give your doctor some insights---as will using home Ovulation Predictor Tests (OPTs) and recording the results. A semen analysis will be scheduled. Some doctors will accept your medical records for review prior to your appointment. If not, bring your medical records with you.
 
 

YOUR SECOND APPOINTMENT: 
This appointment should be scheduled on the day of LH surge---BEFORE ovulation. In most cases, you will be directed to use home ovulation test kits and call for an appointment on the day you detect a surge. Included in this exam will be: 

Cervical Mucus Tests---These include a postcoital test (PCT) to see that the sperm can penetrate and survive in the cervical mucus and a bacterial screening. It is important to note that the appropriate time to do PCTs is just before ovulation, around the time of luteinizing hormone (LH) surge, when mucus is the most "fertile." PCTs at other times may give false results.

Ultrasound Exams)---On the day of LH surge, Ultrasound Exams are used to assess the thickness of the endometrium (lining of the uterus), monitor follicle development and assess the condition of the uterus and ovaries. If the lining is thin, it indicates a hormonal problem. Fibroid tumors and ovarian cysts can often be detected via ultrasound, as well as abnormalities of the shape of the uterus. In some cases, endometriosis can also be detected. Many doctors order a second ultrasound two or three days after the first. This second ultrasound confirms that the follicle actually did release the egg, and can rule out luteinized unruptured follicle (LUF) syndrome---a situation in which eggs ripen but do not release from the follicle. 

Hormone Tests---If the blood test at your first appointment indicated a high LH to FSH ratio, an indication of polycystic ovarian disease (PCOD), your doctor will order an "Androgen Panel" to check levels of free testosterone and dihydroeprandrostone (DHEAS). Prolactin and Progesterone should be tested seven days post LH surge. Tests which can be done at any time (and therefore done at the second appointment) include: Prolactin, Thyroid Stimulating Hormone (TSH), Free T3, Free Thyroxine (T4), Total Testosterone, Free Testosterone, DHEAS and Androstenedione. The normal hormone levels for each of these during specific parts of your cycle are as follows: 
 

Luteinizing Hormone (LH)

Follicular Phase (day two or three): <7mIU/ml 
Day of LH Surge: >15mIU/ml 
Follicle Stimulating Hormone (FSH) 

Follicular Phase: <13mIU/ml 
Day of LH Surge: >15 mIU/ml 
Estradiol

Day of LH Surge: >100 pg/ml 
Mid Luteal Phase (seven days after O): >60 pg/ml 
Progesterone 

Day of LH Surge: <1.5 ng/ml 
Mid Luteal Phase >15 ng/ml 
Prolactin:<25 ng/ml 
Free T3: 1.4 to 4.4 pg/ml 
Free Thyroxine (T4): 0.8 to 2.0 ng/dl 
Total Testosterone: 6.0 to 89 ng/dl 
Free Testosterone: 0.7 to 3.6 pg/ml 
DHEAS: 35 to 430 ug/dl 
Androstenedione: 0.7 to 3.1 ng/ml 

KEY: 
<= less than; >= greater than; mIU=milli International Units; ml=milliliter; pg=picograms; ng=nanograms; uIU=micro International Units; dl=deciliter; ug=micrograms 
 

ADDITIONAL TESTS:
After the initial workup, many doctors continue with some of the following tests. 

HYSTEROSALPINOGRAM (HSG): 
This test is used to examine a woman's uterus and fallopian tubes. It is essentially an x-ray procedure in which a radio-opaque dye is injected through the cervix into the uterus and fallopian tubes. This "dye" appears white on the x-ray, and allows the radiologist and your doctor to see if there are any abnormalities, such as an unusually shaped uterus, tumors, scar tissue or blockages in the fallopian tubes. If you are trying to get pregnant in the same cycle as an HSG, make sure to schedule the test PRIOR to ovulation so that there is no danger of "flushing out" a released egg or developing embryo. Although most women report only minor cramping and short-term discomfort during this procedure, some women, especially those who DO have blockages, report intense pain. Speak to your doctor about taking a pain medication about 30 minutes prior to the actual procedure.

HYSTEROSCOPY
If a uterine abnormality is suspected after the HSG, your doctor may opt for this procedure, performed with a thin telescope mounted with a fiber optic light, called a hysteroscope. The hysteroscope is inserted through the cervix into the uterus and enables the doctor to see any uterine abnormalities or growths. "Photos" are taken for future reference. This procedure usually is performed in the early half of a woman's cycle so that the build-up of the endometrium does not obscure the doctor's view. However, if the doctor is planning to do an endometrial biopsy at the same time, it is done near the end of the cycle. 

LAPAROSCOPY
A narrow fiber optic telescope is inserted through a woman's abdomen to look at the uterus, fallopian tubes, and ovaries and to discern endometriosis or pelvic adhesions, and is the best diagnostic tool for evaluating the ovaries. This test us usually done two or three days before menstruation is expected, and only after an HCG beta blood test ensures the woman is not pregnant. 

ENDOMETRIAL BIOPSY
This procedure involves a scraping a small amount of tissue from the endometrium shortly before menstruation is due---between 11 and 13 days from LH surge. It should ONLY be performed after an HCG blood test shows the woman is not pregnant. This test is used to determine if a woman has a luteal phase defect --- a hormonal imbalance which prevents a woman from sustaining a pregnancy because not enough progesterone is produced. (More information)