Infertility Centre

Diagnosis

Before infertility testing, your doctor or clinic works to understand your sexual habits and may make recommendations based on these. In some infertile couples, no specific cause is found (unexplained infertility).

Infertility evaluation can be expensive, and sometimes involves uncomfortable procedures. Many medical plans may not reimburse the cost of fertility treatment. Finally, there's no guarantee — even after all the testing and counseling — that you'll get pregnant.

Tests for men

Male fertility requires that the testicles produce enough healthy sperm, and that the sperm is ejaculated effectively into the woman's vagina and travels to the egg. Tests for male infertility attempt to determine whether any of these processes are impaired.

You may have a general physical exam, including examination of your genitals. Specific fertility tests may include:

Semen analysis. Your doctor may ask for one or more semen specimens. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A lab analyzes your semen specimen. In some cases, sperm may be tested for in the urine.
Hormone testing. You may have a blood test to determine the level of testosterone and other male hormones.
Genetic testing. Genetic testing may be done to determine whether there's a genetic defect causing infertility.
Testicular biopsy. In select cases, a testicular biopsy may be performed to identify abnormalities contributing to infertility and to retrieve sperm to use with assisted reproductive techniques, such as IVF.
Imaging. In certain situations, imaging studies such as a brain MRI, bone mineral density scan, transrectal or scrotal ultrasound, or a test of the vas deferens (vasography) may be performed.
Other specialty testing. In rare cases, other tests to evaluate the quality of the sperm may be performed, such as evaluating a semen specimen for DNA abnormalities.

Tests for women

Fertility for women relies on the ovaries releasing healthy eggs. Her reproductive tract must allow an egg to pass into her fallopian tubes and join with sperm for fertilization. The fertilized egg must travel to the uterus and implant in the lining. Tests for female infertility attempt to determine whether any of these processes are impaired.

You may have a general physical exam, including a regular gynecological exam. Specific fertility tests may include:

Ovulation testing. A blood test measures hormone levels to determine whether you're ovulating.
Hysterosalpingography. Hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee) evaluates the condition of your uterus and fallopian tubes and looks for blockages or other problems. X-ray contrast is injected into your uterus, and an X-ray is taken to determine if the cavity is normal and ensure the fluid spills out of your fallopian tubes.
Ovarian reserve testing. This testing helps determine the quality and quantity of the eggs available for ovulation. This approach often begins with hormone testing early in the menstrual cycle.
Other hormone testing. Other hormone tests check levels of ovulatory hormones, as well as pituitary hormones that control reproductive processes.
Imaging tests. Pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a hysterosonography (his-tur-o-suh-NOG-ruh-fee) is used to see details inside the uterus that are not seen on a regular ultrasound.

Depending on your situation, rarely your testing may include:

Hysteroscopy. Based on your symptoms, your doctor may request a hysteroscopy to look for uterine or fallopian tube disease. During hysteroscopy, your doctor inserts a thin, lighted device through your cervix into your uterus to view any potential abnormalities.
Laparoscopy. This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
Genetic testing. Genetic testing helps determine whether there's a genetic defect causing infertility.

Not everyone needs to have all, or even many, of these tests before the cause of infertility is found. You and your doctor will decide which tests you will have and when.

Treatment

Infertility treatment depends on:

1. What's causing the infertility
2. How long you've been infertile
3. Your age and your partner's age
4. Personal preferences

Some causes of infertility can't be corrected.

In cases where spontaneous pregnancy doesn't happen, couples can often still achieve a pregnancy through use of assisted reproductive technology. Infertility treatment may involve significant financial, physical, psychological and time commitments.

Treatment for men

Men's options can include treatment for general sexual problems or lack of healthy sperm. Treatment may include:

Altering lifestyle factors. Improving lifestyle and behavioral factors can improve chances for pregnancy, including discontinuing select medications, reducing/eliminating harmful substances, improving frequency and timing of intercourse, establishing regular exercise, and optimizing other factors that may otherwise impair fertility.
Medications. Certain medications may improve a man's sperm count and likelihood for achieving a successful pregnancy. These medicines may increase testicular function, including sperm production and quality.
Surgery. In select conditions, surgery may be able to reverse a sperm blockage and restore fertility. In other cases, surgically repairing a varicocele may improve overall chances for pregnancy.
Sperm retrieval. These techniques obtain sperm when ejaculation is a problem or when no sperm are present in the ejaculated fluid. They may also be used in cases where assisted reproductive techniques are planned and sperm counts are low or otherwise abnormal.

Treatment for women

Although a woman may need just one or two therapies to restore fertility, it's possible that several different types of treatment may be needed before she's able to conceive.

Stimulating ovulation with fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. Talk with your doctor about fertility drug options — including the benefits and risks of each type.
Intrauterine insemination (IUI). During IUI, healthy sperm are placed directly in the uterus around the time the woman's ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
Surgery to restore fertility. Uterine problems such as endometrial polyps, a uterine septum or intrauterine scar tissue can be treated with hysteroscopic surgery.

Assisted reproductive technology

Assisted reproductive technology (ART) is any fertility treatment in which the egg and sperm are handled. An ART health team includes physicians, psychologists, embryologists, lab technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.

In vitro fertilization (IVF) is the most common ART technique. IVF involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man's sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilization.

Other techniques are sometimes used in an IVF cycle, such as:

Intracytoplasmic sperm injection (ICSI). A single healthy sperm is injected directly into a mature egg. ICSI is often used when there is poor semen quality or quantity, or if fertilization attempts during prior IVF cycles failed.
Assisted hatching. This technique assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).
Donor eggs or sperm. Most ART is done using the woman's own eggs and her partner's sperm. However, if there are severe problems with either the eggs or sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.
Gestational carrier. Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple's embryo is placed in the uterus of the carrier for pregnancy.

Complications of treatment

Complications of infertility treatment may include:

Multiple pregnancy. The most common complication of infertility treatment is a multiple pregnancy — twins, triplets or more. Generally, the greater the number of fetuses, the higher the risk of premature labor and delivery, as well as problems during pregnancy such as gestational diabetes. Babies born prematurely are at increased risk of health and developmental problems. Talk to your doctor about ways to prevent a multiple pregnancy before you begin treatment.
Ovarian hyperstimulation syndrome (OHSS). Fertility medications to induce ovulation can cause OHSS, in which the ovaries become swollen and painful. Symptoms may include mild abdominal pain, bloating and nausea that lasts about a week, or longer if you become pregnant. Rarely, a more severe form causes rapid weight gain and shortness of breath requiring emergency treatment.
Bleeding or infection. As with any invasive procedure, there is a rare risk of bleeding or infection with assisted reproductive technology.

Coping and support

Coping with infertility can be extremely difficult because there are so many unknowns. The emotional burden on a couple is considerable. Taking these steps can help you cope:

1. Be prepared. The uncertainty of infertility testing and treatments can be difficult and stressful. Ask your doctor to explain the steps, and prepare for each one.
2. Set limits. Decide before starting treatment which procedures, and how many, are emotionally and financially acceptable for you and your partner. Fertility treatments may be expensive and often are not covered by insurance companies, and a successful pregnancy often depends on repeated attempts.
3. Consider other options. Determine alternatives — adoption, donor sperm or egg, donor embryo, gestational carrier or adoption, or even having no children — as early as possible in the infertility evaluation. This may reduce anxiety during treatments and feelings of hopelessness if conception doesn't occur.
4. Seek support. Locate support groups or counseling services for help before and after treatment to help endure the process and ease the grief should treatment fail.

 

Managing emotional stress during treatment

Try these strategies to help manage emotional stress during treatment:

1. Express yourself. Reach out to others rather than repressing guilt or anger.
2. Stay in touch with loved ones. Talking to your partner, family and friends can be very beneficial. The best support often comes from loved ones and those closest to you.
3. Reduce stress. Some studies have shown that couples experiencing psychological stress had poorer results with infertility treatment. Try to reduce stress in your life before trying to become pregnant.
4. Exercise and eat a healthy diet. Keeping up a moderate exercise routine and a healthy diet can improve your outlook and keep you focused on living your life.

 

Managing emotional effects of the outcome

You'll face the possibility of psychological challenges no matter your results:

Not achieving pregnancy, or having a miscarriage. The emotional stress of not being able to have a baby can be devastating even on the most loving and affectionate relationships.
Success. Even if fertility treatment is successful, it's common to experience stress and fear of failure during pregnancy. If you have a history of depression or anxiety disorder, you're at increased risk of these problems recurring in the months after your child's birth.
Multiple births. A successful pregnancy that results in multiple births introduces medical complexities and the likelihood of significant emotional stress both during pregnancy and after delivery.

Seek professional help if the emotional impact of the outcome of your fertility treatments becomes too heavy for you or your partner.

Preparing for your appointment

Depending on your age and personal health history, your doctor may recommend a medical evaluation. A woman's gynecologist or a man's urologist or a family doctor can help determine whether there's a problem that requires a specialist or clinic that treats infertility problems. In some cases, both you and your partner may require a comprehensive infertility evaluation.

What you can do

To get ready for your first appointment:

1. Provide details about your attempts to get pregnant. Write down details about when you started trying to conceive and how often you've had intercourse, especially around the midpoint of your cycle — the time of ovulation.
2. Bring your key medical information. Include any other medical conditions you or your partner has, as well as information about any previous infertility evaluations or treatments.
3. Make a list of any medications, vitamins, herbs or other supplements you take. Include the doses and how often you take them.
4. Make a list of questions to ask your doctor. List the most important questions first in case time runs short.

For infertility, some basic questions to ask your doctor include:

1. What are the possible reasons we haven't yet conceived?
2. What kinds of tests do we need?
3. What treatment do you recommend trying first?
4. What side effects are associated with the treatment you're recommending?
5. What is the likelihood of conceiving multiple babies with the treatment you're recommending?
6. For how many cycles will we try this treatment?
7. If the first treatment doesn't work, what will you recommend trying next?
8. Are there any long-term complications associated with this or other infertility treatments?

Don't hesitate to ask your doctor to repeat information or to ask follow-up questions.

 

What to expect from your doctor

Be ready to answer questions to help your doctor quickly determine next steps in making a diagnosis and starting care.

 

Questions for the couple

Possible questions for the couple include:

1. How long have you been actively trying to get pregnant?
2. How frequently do you have intercourse?
3. Do you use any lubricants during sex?
4. Do either of you smoke?
5. Do either of you use alcohol or recreational drugs? How often?
6. Are either of you currently taking any medications, dietary supplements or anabolic steroids?
7. Have either of you been treated for any other medical conditions, including sexually transmitted infections?
8. Are you exposed through your work or lifestyle habits to chemicals, pesticides, radiation or lead?

 

Questions for the man

If you're a man, you might be asked:

1. Do you have any difficulties putting on muscle or do you take any substances to increase muscle mass?
2. Do you ever notice a fullness in the scrotum, particularly after standing for extended periods of time?
3. Do you experience any testicular or post-ejaculatory pain?
4. Have you had any sexual problems, such as difficulty maintaining an erection, ejaculating too soon, not being able to ejaculate or reduced sexual desire?
5. Have you conceived a child with any previous partners?
6. Do you regularly take hot baths or steam baths?

 

Questions for the woman

If you're a woman, you might be asked:

1. At what age did you start menstruating?
2. What are your cycles typically like? How regular, long and heavy?
3. Have you ever been pregnant before?
4. Have you been charting your cycles or testing for ovulation? For how many cycles?
5. What is your typical daily diet?
6. Do you exercise regularly? How much?
7. Has your body weight recently changed?