You should talk to your doctor about your fertility if you:
- are under age 35 and, after a year of frequent sex without birth control, you are having problems getting pregnant, or
- are age 35 or over and, after six months of frequent sex without birth control, you are having problems getting pregnant, or
- believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant).
Your doctor can refer you to a fertility specialist, a doctor who focuses in treating infertility. This doctor can recommend treatments such as drugs, surgery or assisted reproductive technology. Don't delay seeing your doctor, because age also affects the success rates of these treatments.
Talk to your primary care physician and OB/GYN about any difficulty you might experience while trying to become pregnant. They might be able to determine whether it's beneficial to consult an infertility specialist. You may also discuss your situation directly with a physician who has added training in the subject of infertility medicine.
Testing for the Woman
Testing for the woman first looks at whether she is ovulating each month. This can be done by having her chart changes in her morning body temperature, by using an FDA-approved home ovulation test kit (which she can buy at a drug store), or by looking at her cervical mucus, which changes throughout her menstrual cycle. Ovulation also can be checked in her doctor's office with an ultrasound test of the ovaries or simple blood tests that check hormone levels, like the follicle-stimulating hormone (FSH) test. FSH is produced by the pituitary gland. In women, it helps control the menstrual cycle and the production of eggs by the ovaries. The amount of FSH varies throughout the menstrual cycle and is highest just before an egg is released. The amounts of FSH and other hormones (luteinizing hormone, estrogen and progesterone) are measured in both a man and a woman to determine why the couple cannot achieve pregnancy. If the woman is ovulating, more testing will need to be done. These tests can include:
- an hysterosalpingogram (an x-ray to check if the fallopian tubes are open and to show the shape of the uterus
- a laparoscopy (an exam of the tubes and other female organs for disease)
- an endometrial biopsy (an exam of a small shred of the uterine lining to see if monthly changes in it are normal)
Testing for the Man
Testing on the man focuses on the number and health of his sperm. The lab will look at a sample of his sperm under a microscope to check sperm number, shape and movement. Blood tests also can be done to check hormone levels. More tests might be needed to look for infection, or problems with hormones. These tests can include:
- an X-ray (to look at his reproductive organs)
- a mucus penetrance test (to see if sperm can swim through mucus)
- a hamster-egg penetrance assay (to see if sperm can go through hamster egg cells, somewhat showing their power to fertilize human eggs)
Other tests can be done to show whether the sperm and mucus are interacting in the right way or if the man or woman is forming antibodies that are attacking the sperm and stopping them from getting to the egg.
Once the proper diagnosis is made as to an abnormality related to reproductive immunology, then treatment of that condition can be implemented properly. It used to be that dangerous treatments such as leukocyte immune therapy (LIT), wherein the male partner’s white blood cells are injected to the female partner or intravenous immunoglobulin (IVIG), pooled blood cells from many different donors has been used.