IVF Babble

An Overview of Fertility Diagnosis

When we are first taught about our reproductive health, it’s often about how to prevent an unwanted pregnancy

However, when the time comes when you hope to conceive, many are unaware of how to proceed best and what conditions might prevent your efforts. In this blog, TTC Warrior Jennifer Jay Palumbo breaks down the basics of trying to conceive and various conditions associated with infertility.

The Basics Of Trying To Conceive

Before we explore infertility, let’s review how basic conception works because, as I often say, they teach you how NOT to get pregnant in school… but not how to get pregnant when you’re ready!

The most fertile time is when the female is ovulating. This is why determining when your most fertile days are is key to conceiving.

You can chart your daily basal body temperature (BBT), which entails tracking your temperature every morning. You can also use an ovulation prediction kit (they sell them at any local drug store). Both look at when your luteinising hormone (LH) surges right before your ovaries release an egg. With BBT, you’ll know your LH is surging because your temperature will go up slightly from its average. With an ovulation prediction kit (OPK), you’ll get a positive, letting you know you are at your most fertile. You can also check your cervical mucus daily to see when it resembles “egg white cervical mucus,” indicating impending ovulation.

When you have sex while ovulating, the idea is that the sperm (which can last 5 to 7 days in the body) will be there waiting for the egg to be released. But the egg typically only lives anywhere from 12 to 24 hours, so it’s a smaller window for the two to meet than many realize.

The American Society of Reproductive Medicine recommends seeing a fertility specialist if the female partner is under 35 and has been trying to conceive for at least one year or if the female partner is over 35. You have been trying to conceive for at least six months without success.

When You Should See A Fertility Doctor

You may want to see a fertility doctor, known as a reproductive endocrinologist (RE), sooner if you:

  • Don’t seem to be ovulating
  • Have irregular or missed periods
  • You are someone who has been diagnosed with a pelvic inflammatory disease
  • Need treatment for tubal damage or endometriosis
  • Have had two or more miscarriages
  • Are someone with a known fertility concern or issue

A fertility workup can be incredibly valuable in gaining insight into what may be causing a delay in conceiving. It will include a physical examination and a review of your and your partner’s health histories, including many factors that might be causing issues (smoking, weight, etc.)

For women, this will include blood tests to look at the FSH (follicle-stimulating hormone), LH (as mentioned earlier), and AMH (anti-mullerian hormone) levels. These three hormones can overview your ovulation regularity, egg supply, and quality. An ultrasound will also be included to see if you have any anatomical issues, such as cysts or polyps.

For men, semen analysis and infectious disease tests (HIV, Hepatitis B, Hepatitis C, etc.) will be performed. In addition, a semen analysis is used to evaluate his sperm count, the shape of the sperm (sperm morphology), and how well the sperm swim (sperm motility).

Common Causes of Infertility

There are many reasons why you may not be conceiving as easily as you had hoped. The most common causes of fertility issues may be:

  • Age: As women age, their fertility declines, particularly after age 35.
  • Ovulation Disorders:
    • Polycystic Ovary Syndrome (PCOS)
    • Premature Ovarian Failure (POF)
    • Irregular menstrual cycles
  • Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus.
  • Tubal Blockage or Damage: Blocked or damaged fallopian tubes can prevent eggs or sperm from reaching the uterus or sperm from reaching the egg.
  • Uterine Issues:
    • Uterine fibroids
    • Abnormalities in the uterus shape
    • Scar tissue in the uterus (Asherman’s syndrome)
  • Male Factors:
    • Low sperm count
    • Poor sperm motility (movement)
    • Abnormal sperm shape
    • Erectile dysfunction or ejaculation problems
  • Sexual Dysfunction: Difficulty with intercourse or maintaining an erection.
  • Weight: Both obesity and being underweight can affect fertility.
  • Smoking and Alcohol: These substances can reduce fertility in both men and women.
  • Chronic Illnesses:
    • Diabetes
    • Hypothyroidism
    • Autoimmune disorders
  • Infections:
    • Sexually transmitted infections (STIs) can damage the reproductive organs.
    • Pelvic inflammatory disease (PID)
  • Cancer and Its Treatment: Radiation and chemotherapy can harm fertility.
  • Medications: Some drugs, like certain antidepressants and chemotherapy drugs, can affect fertility.
  • Environmental Factors:
    • Exposure to toxins or chemicals in the workplace or environment.
    • Prolonged exposure to high temperatures (e.g., hot tubs for men).
  • Lifestyle Factors:
    • Stress
    • Excessive exercise
    • Poor nutrition
  • Genetic Factors: Inherited genetic conditions that affect reproductive function.
  • Unexplained Infertility: In some cases, the cause of infertility remains unidentified.

It’s important to note that infertility can be a complex issue, often involving multiple factors. If you are struggling with infertility, seeking medical evaluation and assistance from a reproductive endocrinologist is advisable to determine the specific causes and treatment options.

Read more about infertility and the next steps:

Infertility and next steps



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