Diagnosing Infertility
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Infertility is defined as the "failure to conceive following one year of unprotected sexual intercourse." For young and healthy couples having frequent intercourse, about 85% will be pregnant after one year of trying and about 93% will be pregnant after two years of trying to conceive. Mid-Iowa Fertility believes infertility to be defined as failure to conceive following one year of unprotected intercourse if under age 35 or six months if over age 35.
This definition is a useful guideline for who should be evaluated for infertility; rigid adherence to the definition can be a disservice to many people desiring to create a family. Some insurance companies and health plan administrators set policies on fertility coverage based on one year's definition even though it does not apply to everyone in every situation. For example, couples with specific infertility risk factors, such as women with a history of endometriosis or irregular menstrual periods should be evaluated as soon as they plan on starting a family. In these cases it is likely they would require some form of assistance in achieving a pregnancy. Other cases include single women or lesbian couples who may need the services of fertility specialists, but may not qualify under their insurance policy's definition of infertility.
FAQ
What is a hysterosalpingogram (HSG)?
It is an x-ray that allows assessment of both the fallopian tubes and the uterine cavity.
Am I infertile?
Couples should be evaluated for infertility if they have not conceived after one year of unprotected sex if the woman is less than 35 years old. In the case of the female older than 35, six months is reasonable due to the impact of age on fertility. In addition, if a woman does not have regular periods, she should be evaluated right away as this is a sign of anovulation/PCOS (not putting an egg out). Other problems, such as family history, endometriosis, painful periods or pain with sex, and maile issues may also prompt a more immediate need for evaluation.
What do the results mean?
Based on results from our laboratory, we use cut-offs of FSH >10, Estradiol >75, and AMH <0.8. However, this information needs to be put in context with each woman's age, health history, etc. The results are most informative when they are abnormal. A normal FSH in a 50 year old is obviously different than a normal FSH in a 30 year old.
If the results are abnormal, a more aggresive approach to treatment may be suggested, such as super-ovulation with artificial insemination, in-vitrofertilization, or donor eggs. The use of donor eggs result in extremely high pregnancy rates. The eggs may come from either a known donor (sister, friend), or anonymous.
What is ovulation?
Ovulation is the process of an egg being released from a woman's ovary. Most women who are not ovulating do not have regular periods (less than 25 days apart or greater than 35 days). Tests to evaluate ovulation include ovulation predictor kits (Clear Blue Easy digital), ultrasound, and hormone tests (progesterone).
What about problems with my tubes?
Tubal disease can be corrected either with surgery or in-vitro fertilization (IVF). Surgery may help with mild scarring of the tubes but if severe damage is found, it may be nexessary to remove one or both tubes and proceed to IVF. Treatment with IVF involves stimulating a women's ovaries with medicines, extracting the eggs through an office ultrasound procedure, combining the eggs and sperm in a dish to make an embryo, and then transferring the embryo (s) to the uterus with a small straw (catheter). This is all done in our office under sedation.
Is my age an issue?
Female age plays a very important role in conceiving and having a successful delivery. A woman reaches her peak fertility at age 27 and then decreases through her 30's, more rapidly after age 35. Evaluation of egg quality (ovarian reserve) includes a blood test on day 3 of her cycle (first day of full flow is cycle day 1) combined with a vaginal ultrasound. The blood test currently measures FSH (follicle stimulating hormone), Estradiol, AMH (anti-mullerian hormone), Thyroid and a few other hormones. The ultrasound is to count the number of egg sacs in each ovary (basal antral follicle count). This testing can be made more accurate by then taking the fertility drug Clomid (clomiphene citrate) cycle days 3 thru 7 and another blood test on day 10. This is called a clomiphene citrate challenge test (CCCT).