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Evaluating Infertility

About 10% of couples in the United States are infertile. Couples may be infertile if the woman has not been able to conceive after 6 to 12 months of having sex without the use of birth control.

If you and your partner are trying to have a child and you have not gotten pregnant, you may want to have an infertility evaluation.

Conception
The process of becoming pregnant starts with ovulation, the release of an egg from a woman’s ovary. In an average 28-day menstrual cycle, ovulation occurs about 14 days after the first day of your last period. Once an egg is released, it can be fertilized for about 12–24 hours. Fertilization can occur if you have sex during or near the time you ovulate.

Causes
Infertility may be caused by more than one factor. Some are easy to find and treat, while others are not. The factor may relate to the woman (65%) or the man (20%). In some cases, no cause can be found in either partner (15%).

The couple’s age can be a factor. For healthy, young couples, the odds are about 20% that a woman will conceive in any one menstrual cycle. This figure starts to decline in a woman’s late 20s and early 30s and decreases even more after age 35 years. A man’s fertility also declines with age, but not as early.

Male factors most often involve problems with the amount or health of the sperm. Abnormal hormone levels may be a cause. Infection or scarring from a sexually transmitted disease (STD) also may be a cause.

Testing
The decision to begin testing depends on a number of factors. They include your age and your partner’s age, as well as how long you have been trying to get pregnant.

The basic workup of an infertility evaluation can be finished within a few menstrual cycles in most cases. Ask your doctor about the costs involved. Find out whether they are covered by your insurance.

Basic Workup for the Man
A semen analysis is a key part of the basic workup for a man.

Basic Workup for the Woman
The workup for a woman begins with a physical exam and health history.

Tests. There are many tests to see if ovulation occurs.

  • Urine test. This test can be done by the woman at home with a kit.
  • Basal body temperature. This test can be done by the woman at home.
  • Other tests may be done, depending on a woman’s risk factors.

Procedures. Procedures are used to look at a woman’s reproductive organs. They check if the uterus is normal and the fallopian tubes are open.

  • Hysterosalpingography (HSG). This test is an X-ray that shows the inside of the uterus and fallopian tubes.
  • Transvaginal ultrasound. This test checks the ovaries and uterus by using sound waves to produce pictures of pelvic organs.
  • Hysteroscopy. This procedure lets the doctor look inside the uterus.
  • Laparoscopy. This procedure lets the doctor view the tubes, ovaries, and the outside of the uterus.

Treatment
Infertility can be treated in many ways, including lifestyle changes, medication, surgery, and assisted reproductive technologies. The choice depends on the cause. After your evaluation, talk with your doctor about the best treatment options for you and your partner. You also may choose adoption or to live without children.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months

Copyright © November 2007 The American College of Obstetricians and Gynecologists

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