Many couples who want to have a child are not able to do so. About 15% of couples in the United States are infertile. Couples may be infertile if they have not been able to conceive after 12 months of having sex without the use of birth control. If you and your partner are trying to have a child and can’t, you may want to have an infertility evaluation. Tests can be done to find the cause of the problem. Based on the results of these tests, treatment may be needed.

Conception

For healthy, young couples, the odds are about 20% that a woman will conceive during any one menstrual cycle. This figure starts to decline in a woman’s late 20s and early 30s and decreases even more after age 35. A man’s fertility also declines with age, but not as early.

Ovulation is the release of an egg from one of the ovaries. In an average 28-day menstrual cycle, ovulation occurs about 14 days after the first day of your last period. Once an egg is released, it is able to be fertilized for about 12-24 hours. Conception can occur if you have sex during or near the time of ovulation.

When the man ejaculates during sex, his semen is released into the vagina. Sperm travels up through the cervix and out in to the tubes. Sperm can live in the woman’s fallopian tubes for 3 days or more. If the sperm and egg join, fertilization occurs.

The fertilized egg then moves through the tube into the uterus. It becomes attached there and begins to grow. All of these events must take place for pregnancy to occur. If there is a problem in this chain of events, infertility may result.

Testing

Infertility may be caused by more than one factor. Some causes are easily found and treated, while others are not. In some cases, no cause can be found in either partner.

You and your partner will receive care as a couple. The decision to begin testing depends on a number of factors. These include the age of the couple and how long the couple has been trying to get pregnant.

The basic work-up of and infertility evaluation can be finished within a few menstrual cycles in most cases. Ask your doctor about the costs involved, and find out whether they are covered by your insurance. The work-up may include: a physical exam, medical history review, semen analysis, checking for ovulation, tests to check for a normal uterus and open fallopian tubes, discussion about how often and when you have sex.

Basic work-up for Men

A semen analysis is a key part of the basic work-up. It may need to be done more than once. The sample is obtained by masturbation. Sometimes it can be obtained at home, and sometimes it is obtained at a lab. Your doctor will give you instructions. The semen sample is studied in a lab. The doctor will study the sperm for number, shape, movement, and signs of infection.

The man may be referred to a urologist (a doctor who specializes in treating problems of the urinary tract). The urologist will perform an exam, and tests may be done.

Basic work-up for Women

The work-up begins with a physical exam and health history. The health history will focus on key points: menstrual function (such as irregular bleeding and pain), pregnancy history, STD history, and birth control. Other tests such as a Pap smear may also be done.

There are many ways to see if ovulation occurs. Some tests are done by the woman, and others are done by her doctor.

• Urine Test:  One way to predict ovulation is by using a urine test kit at home. This test measures luteinizing hormone (LH), a hormone that causes ovulation to occur. If the test is positive, it means ovulation is about to occur. Sometimes these kits are used with basal body temperature charts.
• Basal Body Temperature:  After a woman ovulates, there is a small increase in body temperature. To measure basal body temperature, a woman takes her temperature every morning before she gets out of bed and records it on a chart. This record should be kept for 2-3 menstrual cycles to see if ovulation occurs.
• Blood Test:  After a woman ovulates, the ovaries produce the hormone progesterone. A blood test taken in the second half of the menstrual cycle can measure progesterone to show if ovulation has occurred.

Other tests may be done to look at a woman’s reproductive organs. These tests check if the uterus is normal and tubes are open. The tests you have depend on your factors and symptoms.

• Hysterosalpingography (HSG):  This test is an X-ray that shows the inside of the uterus and fallopian tubes. In most cases, it is done right after the menstrual period. A small amount of dye is placed in the uterus through a thin tube inserted through the cervix. Then an X-ray is taken. The fluid outlines the inside of the uterus and shows (by a spill of the fluid out the tubes) whether they are open.
• Transvaginal Ultrasound: Ultrasound uses sound waves to produce images of pelvic organs. The ultrasound probe is inserted into the vagina. Sometimes fluid may be used in the uterus. This checks the ovaries and uterus.
• Hysteroscopy:  A thin telescope-like device, called a hysteroscope, is placed through the cervix. The inside of the uterus may be filled with a harmless gas or liquid to provide more information. With the hysteroscope, the doctor can see the inside of the uterus. During this procedure, the doctor can correct minor problems, get a sample of tissue for study, or decide whether another procedure is needed.
• Laparoscopy: A small telescope-like device, called a laparoscope, is inserted through a small cut (about ½ inch or less) at the lower edge of the navel. The doctor can look at the tubes, ovaries, and uterus. The doctor can look for pelvic problems, such as endometriosis or scar tissue. Fluid is placed into the uterus to see if the fluid spills from the ends of the tubes. This shows if the tubes are open or blocked.

Treatment

Infertility often can be treated with lifestyle changes, medication, surgery, or assisted reproductive technologies. It depends on the cause. After your evaluation, talk with your doctor about the treatment options for you and your partner.