Female infertility is a condition which affects around 6.7 million women in the United States, which is around 11% of the female population of reproductive age (Source: National Survey of Family Growth, Centers for Disease Control and Prevention 2006-2010).
If you and your partner have been trying to conceive for a while and it’s still not happening for you, then chances are you may be wondering if there is something else going on that you need to know about. However, it is important not to jump to conclusions of infertility too quickly.
If you suspect that you may be experiencing infertility issues, then the first step is to talk to your doctor if at present you have already been trying for at least one year. However, if you are over the age of 36 or have been or are being treated for any serious health condition such as cancer, then it is advisable to go to the doctor sooner than the standard one year period.
Female fertility declines with age, therefore, once you are on the latter side of 36, every month counts and the doctors would like to use that time to the best advantage if intervention is necessary.
When you first visit the doctor, it is advisable that your husband also attends with you as the physician will need to assess whether there may be infertility on both sides.
The First Steps of Diagnosis
Initially, the doctor will take you through a thorough consultation pertaining to your health, sexual history and your lifestyle including your social activities.
It is important to be as open and honest as possible with your doctor as this will greatly enhance the chances of your doctor reaching an accurate diagnosis.
Your doctor will discuss various factors with you such as your age, diet and lifestyle and will also want to know about any previous births, pregnancies, miscarriages or abortions that you may have had. If you had a successful pregnancy before then, you would also be asked about how long it took you to conceive on this occasion and how were you throughout the pregnancy.
The doctor will also need to enquire about your sex life and may ask how frequently you and your partner are having sex and if either of you experience any issues during intercourse.
If you are aged between 19 and 26 and you are having unprotected sex with your partner on a regular basis (every 2-3 days) then statistics have shown there to be around a 92% conception rate within the first year and a 98% conception rate after two years.
This, of course, decreases with age. However, conception rates are still high for women in the 35-39 age group at an 82% rate of conception within one year and 90% after trying for two years.
Regarding your lifestyle and social activities, you will likely be asked questions relating to your stress levels, whether you are a smoker, your average alcohol consumption and if you partake in any illegal substances as these are all factors that may impact your fertility.
It is also important to discuss any medication including supplements and herbal remedies that you may be taking as there may also be a chance that these could be contributing to infertility depending on what you are taking.
Following the consultation process, the doctor may want to examine you physically in various ways. Very commonly, they may want to examine the pelvic area to check for any discomfort or lumps, which could indicate the presence of pelvic inflammatory disease (PID), fibroids, endometriosis or tumors.
Body weight is also an important factor for fertility so the doctor will need to check body mass index (BMI) against your height and build structure to ascertain whether you fall within the healthy range for fertility.
At this point, if the doctor feels that further tests are needed then they may refer you on to an infertility clinic where a reproductive endocrinologist will assess you.
At a fertility clinic, you may be required to undergo the following tests;
Through a blood sample, your levels of progesterone will be tested, which will determine if you are ovulating. If your menstrual cycle also irregular, then you will a further test to check a hormone called gonadotrophin as the presence of this hormone is necessary to stimulate the ovaries for egg production.
Checking the Ovaries
When checking the ovaries, the doctors will assess the level of various hormones, again via a blood test. They may also check the follicles in the ovaries via ultrasound.
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are also important to assess. These two hormones work together to stimulate ovarian follicles, which enable the growth of an egg. These hormones are typically tested from a urine sample.
Basal Body Temperature
This test indicates whether the woman is releasing eggs from the ovaries.
During the days of ovulation, a woman’s body temperature rises by slight increments. The woman will be asked by the fertility clinic to keep a daily record of her body temperature on a chart usually for a few months. An assessment of these recordings by the fertility clinic will help to show if the woman is releasing eggs produced by the ovaries.
Following the results of the basal body temperature test, if more information is needed then an endometrial biopsy may be necessary. During this procedure, the doctor will examine a piece of tissue removed from the lining of the uterus. This will then help to determine egg release and progesterone levels.
Chlamydia is a very common disease that can be transmitted to both men and women sexually and can impact fertility. It is possible that a person may have chlamydia but display no outward symptoms. Therefore, a woman may also be given a chlamydia test and if found positive, will receive a treatment of antibiotics.
A hysterosalpingogram (HSG) is used to assess whether there are any blockages within the fallopian tubes, which may be contributing to infertility.
The procedure involves injecting a dye into the uterus and then scanning the fallopian tubes and uterus with an X-ray. If there are any blockages in the tubes, then they will most likely show up during the scan.
A laparoscopy is a procedure in which the physician will make a small incision in the lower abdominal area and insert a telescopic camera in order to take a closer look at the uterus, ovaries and fallopian tubes.
In this procedure, a dye may also be placed inside the fallopian tubes, which will show any blockages that may be present.