The Fertility Workup

When you decide to have your fertility evaluated, your healthcare provider is basically 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 follicle stimulating hormone (FSH), luteinizing hormone (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. For this, 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 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 (commonly known as CLOMID^®). 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).

3. Are the egg and sperm able to unite? Several factors can make it hard for the sperm and egg to come together. Sometimes, the mucus around a woman's cervix prevents sperm from reaching the eggs. 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. The healthcare provider may also conduct tests that detect polyps or fibroids. Surgical procedures may help overcome these conditions.

The healthcare provider may order a laparoscopy to detect tubal disorders, scar tissue, or endometriosis. 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 obtain a tissue sample from the uterine lining to see if it is developing properly or conduct an ultrasound to see how thick the uterine lining is.

Important Safety Information
As with all prescription medications, side effects may occasionally occur with use of fertility drugs. Doctors specializing in fertility or reproductive health should only prescribe these products. Patients prescribed gonadotropins and GnRH analogs should be monitored carefully by a trained fertility specialist. Risks include the following events which can be serious: hypersensitivity reactions; ovarian hyperstimulation syndrome (OHSS); pulmonary and vascular complications, and multiple births. For complete product details about a specific fertility drug, please refer to the Full Prescribing Information.