Fertility Evaluations

Roughly 1 in 10 couples in the United States are battling infertility. Female factors are responsible for 30% – 45% of infertility cases. Male factors are responsible for 30% – 45% of infertility cases. Approximately 10% of couples have no obvious reason for their inability to conceive. In our clinic, there are several tests and procedures performed to assist in diagnosis and treatment.

DIAGNOSTIC TESTS

DIAGNOSTIC TESTS

Infertility is defined as the inability to conceive following one year of unprotected intercourse. Infertility investigations are usually begun then, but can be initiated earlier under certain circumstances, such as in cases of advanced maternal age (35 years of age or greater), if there is a history of previous pelvic inflammatory disease (PID), a history of major abdominal surgery, or a history of irregular menstrual cycles.

INITIAL CONSULTATION

INITIAL CONSULTATION

The initial consultation visit is with the female patient and her husband or partner. During this visit, the doctor will review medical and genetic history, perform a physical examination and discuss diagnosis, prognosis and future plans. At this time, scheduling can be done for further diagnostic testing that has never been performed and possibly repeat tests in which results may be outdated. Blood work may be obtained during this initial visit. The couple should check with their insurance company to determine if a specific laboratory or referral needs to be used. Follow-up visits will be arranged with Dr. Padilla or Dr. Bass depending on the physicians’ availability the day of the next appointment.

SEMEN ANALYSIS

SEMEN ANALYSIS

A semen analysis is done by our andrology laboratory. The male partner is required to have one to three days of abstinence prior to the day the analysis is to be done. The male partner collects the specimen in a private room adjacent to the laboratory. The specimen can be collected at home in a sterile container only if he cannot collect in the laboratory. Semen cultures for bacteria and Ureaplasma are taken since there is a possibility these microorganisms play a role in infertility. The cultures are sent to an outside laboratory who will send a bill to the insurance company. Again let us know if your insurance company requires the use of a specific laboratory. If these microorganisms are present, treatment of one or both partners is recommended. Candidates for in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and intrauterine insemination (IUI) will have another test performed which involves separating the more active sperm. This is called a sperm wash. Out-of-town patients can schedule a semen analysis ahead of time to be done the day of the initial consultation. We recommend 1-3 days of abstinence prior to the semen analysis.

POSTCOITAL TEST

POSTCOITAL TEST

A postcoital test may be performed around the time of ovulation. Within 12 hours after intercourse, the cervix is checked for the quality of mucus and the number of motile sperm. Normal sperm are capable of surviving there for 48-72 hours. Factors involved in poor postcoital tests include poor mucus, inflammation, previous surgeries, antisperm antibodies and poor sperm quality. Medications and/or inseminations can improve the situation.

ULTRASONOGRAPHY

ULTRASONOGRAPHY

Ultrasonography is a diagnostic test used to evaluate the uterus and measure the size and number of ovarian follicles, small “cysts”, which contain the eggs. It allows accurate detection of ovulation disorders and exact timing of the ovulation process. Some of these ultrasounds are done by an ultrasound technician with extensive experience and then reviewed by the doctors. The lining of the uterus can be evaluated for polyps and/or fibroids by injecting saline through the cervix under ultrasound guidance. This is called sono-hysterography.

HYSTEROSALPINGOGRAPHY

HYSTEROSALPINGOGRAPHY

Hysterosalpingography (HSG) involves the use of an x-ray contrast solution which is injected through the cervical canal. The solution fills the uterus, passes through the tubes and spills into the abdominal cavity where it is absorbed by the body. X-rays are taken of the solution’s progress. The purpose of the test is to evaluate the shape of the uterus and patency of the tubes. Patients may take Advil or Motrin one hour before the procedure to reduce the cramping. If you are very apprehensive, the doctors may prescribe a stronger medicine for the discomfort. The results of the test are immediately available and will be discussed with you. Although the radiation exposure is minimal, you need to avoid pregnancy during that cycle. A radiologist assists during the procedure and you will be receiving a bill from us and from the radiologist.

ENDOMETRIAL BIOPSY

ENDOMETRIAL BIOPSY

An endometrial biopsy is done to diagnose progesterone deficiency or chronic infection (endometritis). The endometrium is the lining of your uterus where the early embryo will implant. Two to four days before the expected date of menses, a small piece of endometrial tissue is obtained and sent to a pathologist for evaluation. You should avoid pregnancy this cycle. The procedure takes 30 seconds and causes brief discomfort.You may take Advil or Motrin one hour before the procedure. Since we consult a pathologist, you will receive a bill from us and from the pathologist.

HYSTEROSCOPY

HYSTEROSCOPY

Hysteroscopy is direct visualization of the inner lining of the uterus with an endoscope. Intrauterine adhesions (scars), polyps, fibroids and other abnormalities can be diagnosed and often treated at the same time. In some cases, blocked tubes can be opened by inserting a catheter during this procedure. The recovery period after a hysteroscopy is two to three days.

LAPAROSCOPY

LAPAROSCOPY

Laparoscopy (pelviscopy) is a surgical procedure which involves inserting a telescope (laparoscope) into the abdomen to visualize the abdominal and pelvic organs and any possible abnormalities. Findings may include scar tissue, endometriosis, fibroids and tubal abnormalities. The laparoscope is passed through a small incision in the umbilicus. Sometimes treatment is performed through additional small punctures in the lower abdomen at the hairline. Laparoscopy is usually performed in an outpatient surgery center with general anesthesia. The recovery period after a laparoscopy is three to five days.