“My doctor checked me and said that I’m fine and that I should keep trying but I’m still not getting pregnant!”
To New Jersey fertility doctor Jane Miller that is so often the patient’s “opening line” in a new consultation. The textbook definition of infertility is the inability of a couple to establish a pregnancy if they have been trying with regular intercourse and without contraception for a year. Approximately 85% of couples will conceive after 12 months of regular (2-3 times a week) intercourse. Consultation with a reproductive endocrinologist (fertility specialist) is warranted if the year’s attempt has been unsuccessful or after only 6 months of trying or sooner if the woman is 35 or older or if she or her partner have a known gynecologic or “male factor” history such as endometriosis, fibroids, or varicocele.
To fertility doctor Jane Miller the term, unexplained infertility, applies only if no contributing problems are uncovered during the course of a couple’s testing. Basic testing includes blood hormone tests coupled with ultrasound of the ovaries to learn if the woman has an “ovarian reserve” appropriate for her age. The uterus is evaluated as well on ultrasound to see if it is structurally normal. The uterine “cavity” and the fallopian tubes are checked with contrast to see if the inside of the uterus contains any abnormalities and if the tubes are open. A semen analysis is performed to learn if there are enough normally shaped, rapidly moving sperm to get the job done. Sometimes a laparoscopy or a hysteroscopy , (outpatient surgical procedures) are required to evaluate the pelvis for endometriosis or the inside of the uterus for polyps or fibroids. Based upon the findings of these test and procedures a factor or factors that have caused the infertility can be addressed and treated.
There are other tests beyond the basic ones that may be appropriate for a couples’ infertility evaluation. New Jersey fertility doctor Jane Miller believes that an unhurried, meticulous and comprehensive first visit consult is essential to guiding the course of a couple’s testing and treatment.
“Second tier” testing may include testing the sperm for the integrity of its DNA and evaluating the woman for autoimmune and blood clotting factors that may disrupt or prevent implantation. Karyotype (chromosome) blood analysis of the couple may be appropriate to learn if either person is “passing on” a genetic problem that might affect some or all of their embryos. Preimplantation genetic screening (PGS) has become instrumental in learning if a couple can make normal embryos and, if so, in helping us to select which embryos to transfer (put in) to a woman’s uterus. PGS is especially helpful when treating couples in whom the woman is 35 or older as “older eggs” are a major cause of reduced fertility.
Testing may also be appropriate to evaluate the uterus’ ability to accept an embryo – implantation. The endometrium (uterine lining) may be inflamed or “out of phase” hormonally and, for either of those reasons, will not allow even a normal embryo to implant. Fertility doctor Jane Miller reassures her patients that there are treatments to correct these situations so that normal pregnancy can then ensue.
Over the past 3 decades we have learned so much about what is necessary to get pregnant and to carry a pregnancy successfully to delivery that the term, Unexplained Infertility, does not apply to most couples who are suffering from infertility. In fact, only up to 10% of infertility is, to date, truly unexplained. For this small percentage of people empiric treatments are often successful in helping them to have a family.
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