More than 8 in 10 couples, where the woman is under 40, are likely to conceive naturally within a year of having regular unprotected sex. Regular unprotected sex means having sex every two to three days in a week without using contraception.
The decline in fertility speeds up when reaching your mid-30s. Fertility tests can take time and female fertility decreases with age, so it’s best to make an appointment early.
The whole idea of fertility tests is to do an initial assessment to check for things that may be causing your fertility problems and advise you about what to do next.
It’s always best for both of you to visit the clinic because fertility problems can affect either or both of you. The doctor will ask about your medical and sexual history, previous pregnancies, births and any complications with previous pregnancies including any miscarriages you’ve had and how long you’ve been trying to conceive.
An evaluation for infertility is appropriate if you are a woman who has not become pregnant after having 12 months of regular, unprotected intercourse. Being evaluated earlier is appropriate after six months if you are older than 35 or you have a medical history of irregular menstrual cycles, known or suspected problems with your uterus (womb), fallopian tubes, or other problems in the abdominal cavity, such as endometriosis or adhesions.
The least invasive methods that can detect the most common causes of infertility are often done first. The speed and extent of evaluation take into account your preferences, your age, the duration of infertility, and other unique features that could enable fertility experts to trace what could be the cause of your inability to conceive.
Rule of thumb is to check with the doctor if you are under 35 years old and you’ve not conceived despite having regular sex without birth control for 12 months, and for six months if you are over 35.
It’s important for the two of you to go for testing together. Be ready to answer questions about your health and lifestyle. Things about your medical history, any long-term conditions or surgeries, medicines you take, and also your sex life.
For you the woman, tests are usually more diverse and some may be rather invasive. Your doctor will ask questions connected with your periods such as whether you have been pregnant before, how often you have had periods over the last year, and if you had irregular and missed periods or had spotting between periods.
You may get a Pap smear which can detect cervical cancer, other problems with the cervix, or sexually transmitted infections which can all interfere with getting pregnant.
To get pregnant, you need to release an egg each month that is, ovulate. You may need tests that check for this. You can take a urine test at home for luteinizing hormone, or LH. This hormone shows up in high levels just before you ovulate.
Your doctor also may check levels of the hormone progesterone in your blood. Increases in progesterone show that you are ovulating. On your own, you can check your body temperature each morning. Basal body temperature rises a bit just after ovulation. By checking it each morning, you’ll learn your pattern of ovulation over several months. I need to mention that this test may be limited by the presence of febrile diseases like malaria.
Your doctor may also run tests on your thyroid, or check for other hormonal problems, to rule out conditions that might cause missed or irregular ovulation.
Before you can get pregnant, your uterus, fallopian tubes, and ovaries all need to work right. Different procedures can be utilized to check the health of these organs.
One test known as the Hysterosalpingogram (HSG) is an X-ray procedure to see if the fallopian tubes are open and to check if the shape of the uterine cavity is normal. The HSG test is usually done just after your menstrual period.
You may get a blood test to check your levels of follicle-stimulating hormone, or FSH, which triggers your ovaries to prepare an egg for release each month. High FSH can mean lower fertility. The FSH blood levels get checked early in your menstrual cycle (often on day 3).
When attempting to test for your ovarian reserve, the intention is to predict whether you can produce eggs of good quality and how well your ovaries are responding to hormonal signals. The most common test to evaluate ovarian reserve is a blood test for FSH drawn on day 3 of your cycle although other blood tests may be recommended.
Ovarian reserve testing is more important if you have a higher risk of reduced ovarian reserve, particularly if you are over 35 years, or if you have a history of previous ovarian surgery or unexplained infertility.
Your doctor may also suggest a blood test to check for what is known as Anti-mullerian hormone (AMH) levels that show how many eggs you have. This is your ovarian reserve. The higher the level, the better your chances of getting pregnant.
Hysteroscopy is a surgical procedure in which a lighted telescope-like instrument (hysteroscope) is passed through the cervix to view the inside of the uterus. Hysteroscopy can help diagnose and treat abnormalities such as polyps, fibroids, and adhesions (scar tissue).
Laparoscopy, on the other hand, is a surgical procedure in which a lighted telescope-like instrument (laparoscope) is inserted through the wall of the abdomen into the pelvic cavity. Laparoscopy is useful to evaluate the pelvic cavity for endometriosis, pelvic adhesions, and other abnormalities.
You may not need to have all these tests. Your doctor can discuss with you which ones are best in your situation. After the testing is done, you are likely to have a very good idea about why you’re having trouble getting pregnant.
Abayomi Ajayi
MD/CEO Nordica Fertility
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