The Fertility Workup

The workup demystified.

What happens when you see a healthcare provider for fertility concerns? Generally, your healthcare provider will conduct an evaluation that begins with a review of your medical and personal histories. You'll likely discuss everything from family medical history, to diet and lifestyle, to your current sexual practices.

Your healthcare provider will also conduct an exam. Depending on your medical and lifestyle history, he or she will then conduct some tests, beginning with the simplest and least invasive ones. At a later point, you may need to undergo more advanced evaluation.

It is important to check your insurance coverage before your workup. To learn more, visit Paying for Treatment or call Fertility LifeLines^TM at 1-866-LETS-TRY (1-866-538-7879).

What happens during the female exam.

The female exam consists of a general physical exam, a breast exam, and a comprehensive pelvic exam. During the pelvic exam, the healthcare provider will determine the size, shape and position of your reproductive organs. Many healthcare providers will also complete a routine Pap test to detect any infections and rule out cervical cancer.

What happens during the male exam.

The male exam includes a general physical along with an examination of the testes, penis, and scrotum. The healthcare provider will look for varicoceles in the scrotal sac that are found in about 40% of men who are undergoing evaluation for infertility.[1] The healthcare provider may also take a culture from the opening of the penis in order to rule out infection.

What your healthcare provider is looking for.

Basically, your healthcare provider is attempting to answer four key questions:

1. Is there a sperm problem?

Men will be asked to provide a semen sample to determine the quality, volume, concentration and motility of his sperm. The healthcare provider may also conduct blood tests to check FSH, LH and testosterone hormone levels.

2. Is there an ovulation problem?

Just because a woman is having periods, it doesn't mean she's ovulating. The healthcare provider will attempt to determine if her ovulation is irregular or if she's ovulating at all. A number of tests can help determine her ovulatory status.

Some healthcare providers may gather information about the menstrual cycle using a basal body temperature (BBT). A woman takes her temperature each morning and plots its daily changes. After a few months of charting, the healthcare provider can often determine if ovulation is happening and if problems are occurring within the cycle.

A number of tests may also be performed to determine if hormonal imbalances exist. If your healthcare provider discovers a hormone imbalance, he or she will prescribe a medication for you, often clomiphene citrate. If this fails, you may move onto seeing a Fertility Specialist, Reproductive Endocrinologist (RE), for advanced treatments and medications such as Gonal–f® (follitropin alfa for injection).

Find a Fertility Specialist, or Reproductive Endocrinologist (RE), in your area.

3. Are the egg and sperm able to unite?

A number of factors can make it difficult for the sperm and egg to come together.

Sometimes the mucus around a woman's cervix prevents sperm from reaching the fallopian tube. If your healthcare provider suspects a problem, he or she may order a cervical mucus or postcoital test to determine if the quality and consistency of the mucus is allowing this to happen.

Often, sperm and egg can't unite due to structural problems in the reproductive organs. The healthcare provider might perform tests to look for blockages within the uterus, fallopian tubes, or pelvis. One of these tests is an x-ray procedure called a hysterosalpingogram (HSG) that allows the healthcare provider to assess the contour of the inside of the uterus and determine whether or not the fallopian tubes are open. She/he may also conduct tests that look for polyps or fibroids. Surgical procedures may help overcome these conditions.

The healthcare provider may also order a laparoscopy to detect tubal disorders, scar tissue, or endometriosis — the presence of uterine tissue outside the uterus. This surgery, however, is usually performed late in the workup, if at all.

4. Can the embryo implant and be sustained in the uterus?

If sperm and egg are able to unite, the embryo may have difficulty implanting and sustaining itself in the uterus. The healthcare provider may also obtain a tissue sample from the uterine lining to see if it is developing properly or a conduct an ultrasound to see how thick the uterine lining is.