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Infertility Evaluation: Women

Definition of Infertility

It can be frustrating when a couple is unable to conceive when they want a baby. Sometimes, a couple wants evaluation for the ability to get pregnant, especially if there is a concern about fertility.

Infertility is a couple’s problem. In general, infertility is the failure to get pregnant within 12 months of intercourse without contraception. It is estimated that 15% of couples may experience infertility. Of course, since there are two people involved, there can be problems with either the female (“female factor” in about 50% of cases) or the male (“male factor” in about 30% of cases) that contribute to the difficulty getting pregnant. The remaining 20% of infertility involves problems with both the female and male.

Fertility evaluation is appropriate for women under the age of 35 years who have tried to conceive for 12 months without pregnancy. Women older than 35 years may seek this evaluation after 6 months without pregnancy. For women older than 40 years, it is reasonable to seek the assistance of subspecialists as reproductive endocrinologists.

In most cases of infertility, no single cause can be identified. Over 40% will have a combination of factors contributing to the infertility. When both partners are evaluated, approximately one third of all cases can be resolved with appropriate treatment.

Infertility Evaluation: Female

1. History

A medical history provides important information to evaluate causes of infertility. The electronic medical record is an amazing tool. However, the computer record is not necessarily comprehensive. Some of these questions touch upon intimate details of your life. You want to be honest and specific so that you can get the help that you have requested. You might need to talk with family to get more details of their health history, especially if they have experienced infertility.

Should you need further evaluation for female infertility, please be aware that some of these questions, tests, or procedures may not apply to your situation. Be sure to check with your insurance company and the provider’s office for information concerning evaluation costs and consider your out-of-pocket costs. It is important to have a qualified physician that you trust to guide you during this season of life.

Here are some general categories of information that could be helpful:

2. Physical exam

After a woman’s history is obtained in the detail noted above, a physical exam is needed. Much can be gained from an examination. In the case of an infertility evaluation, the woman’s exam is often completely normal. But a normal exam does not mean that there is no female cause (female factor) of infertility. A physical exam attempts to identify any anatomic or functional cause of infertility. Though problems with ovulation can interfere with conception, there are other anatomic concerns.

The physical exam should include:

3. Laboratory studies

Some lab studies are to catch up on routine care. A Pap smear is useful to prove that the cervix is healthy. Mammograms are initiated after the age of 40 years unless family history or personal experience leads up to earlier assessment. Other information is helpful to establish normal function:

4. Imaging tests

Imaging for infertility evaluation in women is necessary. This kind of evaluation is a non-invasive assessment of anatomy. Non-invasive evaluations do not involve the risks of surgical procedures which may include anesthesia and incisions. Non-invasive imaging should be performed by experienced physicians or skilled technicians. These tests are informative about the appearance of the pelvic anatomy, but it is not a direct picture of the organ. Actual tissue samples are not acquired, so some diagnoses cannot be made.

Examples of such tests include:

5. Surgical procedures

Some surgical procedures may be recommended based upon the compiled information that has been accumulated from the extensive medical history, physical examination, laboratory studies and imaging. There are two different outpatient, minimally invasive surgical procedures that may be suggested:

The surgeon will look at the appearance and condition of the pelvic organs. The status of the uterus, ovaries, Fallopian tubes, and surrounding peritoneal surfaces are important. At the end of the procedure, the evaluation may include the assessment to determine if the Fallopian tubes are open. This exam is performed by filling the uterus with blue-colored solution so that the blue fluid hopefully flows from the ends of each normal Fallopian tube.

Summary

No couple wants to experience unplanned infertility when their dream is to grow their family with the precious life of a newborn. If infertility is a concern, the couple should be prepared for the appropriate evaluation with the appropriate professionals and pursue the next steps to achieve their dream.