Talking With Your Healthcare Provider

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 Considerations
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.

Know Before You Go

Check into your insurance coverage before you see your healthcare provider. Your policy may determine what kind of healthcare provider you see, what kinds of fertility tests you undergo and in what sequence. To have a benefits specialist assist you, call Fertility LifeLines™ at 1-866-LETS-TRY (1-866-538-7879). All calls are free and confidential.

Can We Afford Fertility Treatment?

Get the facts about paying for treatment. Learn how you can save up to $500 on Gonal-f® (follitropin alfa for injection) with the FertilityAssist 2 program.

Important Considerations:
Gonal-f® RFF Pen (follitropin alfa injection) is indicated for the induction of ovulation and pregnancy in the oligo-anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® RFF Pen is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program. Gonal-f® RFF Pen (follitropin alfa injection) should only be prescribed by physicians specializing in fertility or reproductive health. Gonal-f® is a potent gonadotropic substance capable of causing mild to severe adverse reactions, including Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications, and multiple births. Gonal-f® is contraindicated in women who exhibit prior hypersensitivity to FSH preparations, primary gonadal failure, uncontrolled thyroid or adrenal dysfunction and pregnancy. Nursing women should not use Gonal-f®. Common side effects include headache, abdominal pain, enlarged abdomen, and injection site disorders. For complete product details, see full prescribing information.

Important Considerations:
Women: Gonal-f® (follitropin alfa for injection) is indicated for the induction of ovulation and pregnancy in the anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program.
Men: Gonal-f® (follitropin alfa for injection) is indicated for the induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism in whom the cause of infertility is not due to primary testicular failure. Gonal-f® (follitropin alfa for injection) should only be prescribed by physicians who are thoroughly familiar with infertility problems and their management. Gonal-f® is a potent gonadotropic substance capable of causing Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications. Gonal-f® is contraindicated in women and men who exhibit prior hypersensitivity to recombinant FSH preparations or one of their excipients, high levels of FSH indicating primary gonadal failure, uncontrolled thyroid or adrenal dysfunction, sex hormone dependent tumors of the reproductive tract and accessory organs, and an organic intracranial lesion such as a pituitary tumor; and in women who exhibit abnormal uterine bleeding of undetermined origin, ovarian cyst or enlargement of undetermined origin and pregnancy. Women who are pregnant or nursing should not use Gonal-f®. The most common side effects in patients using Gonal-f® include headache, ovarian cysts, nausea and upper respiratory infections in women and in men, acne, breast pain and growth, and fatigue. Injection site reactions were also reported. Reports of multiple births have been associated with Gonal-f® treatment. For complete product details, see the full prescribing information.

For complete product details, please read the Prescribing Information offered below.


© EMD Serono, Inc. CIM Last Update 2008-09-16
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