More than 7 million American couples struggle with fertility. You may need a fertility evaluation if you have been engaging in regular intercourse without conception. Couples ages 35 and under should undergo fertility evaluation if they have been having timed intercourse for one year and have still not become pregnant. If you are over 35 years old, it is recommended that you undergo fertility testing after only 6 months of timed intercourse. If you are over 40, it is best to undergo complete ovarian reserve testing and seek consultation with a reproductive endocrinologist that specializes in assisted reproductive technologies.
Fertility testing can be time consuming, a little invasive and often expensive. Most insurances do not offer fertility benefits so be sure to discuss your coverage directly with your insurance carrier. Many of the tests are cycle timed so make sure to discuss exact timing with your healthcare provider. It may take 3 to 4 menstrual cycles to complete all your testing.
Some common fertility testing includes:
- A complete well woman exam, including a pelvic and pap exam, STD screening, blood tests, and urine tests. If you have risk factors for diabetes or cardiovascular disease, these screening test should also be performed prior to trying to conceive. Hormone testing is collected at specific times in the menstrual cycle to evaluate ovulation and ovarian reserve. If you are over 35, talk with your provider about an anti-Mullerian hormone blood test to further evaluate your fertility reserve.
- Pelvic ultrasounds to evaluate follicle count and development, and determine ovulation.
- A hysterosalpingogram, which is an X-ray of the uterus and fallopian tubes, is an imaging test that evaluates tubal function and intra-uterine architecture.
- A post-luteal phase endometrial biopsy to evaluate hormonal insufficiencies that can cause irregular cycles, repeated miscarriages, or irregular uterine bleeding.
- Many couples find that they are struggling with combined infertility meaning both a male and female cause. Your partner should undergo a complete semen analysis to evaluate his fertility potential as well.
Tips for a Faster Conception
- Start a prenatal vitamin (multivitamin for men), stick to a healthy diet, get 8 hours of sleep, exercise and eliminate any bad lifestyle habits like smoking, excessive alcohol, contraindicated medications, etc.
- Keep a menstrual calendar or try a fertility app to help you track your cycles
- Use an over the counter ovulation prediction kit to narrow down your fertile days
- Consider acupuncture
- Get a regular yearly physical exam with your primary care provider to screen for any health conditions that could negatively affect your fertility potential
Treatment of Basic Infertility
If your fertility workup determines that you have a normal ovarian reserve and no tubal disease, we can offer you basic ovulation induction with or without intrauterine insemination.
Basic fertility treatment includes ovulation induction with clomiphene citrate (Clomid) and injections with follicle stimulating hormones. Treatment cycles are timed and require multiple office visits, ultrasounds and lab testing to evaluate cycle progress. Intrauterine insemination is accomplished by taking your partner's semen, washing and separating the components, and then placing the sperm into the uterine cavity through the cervix with a soft, tiny catheter tube.
Insemination requires infectious disease testing of all partners and is only done in our office with previously intimate couples.
If you are concerned about your fertility reserve and would like to discuss testing and treatment options, please call to schedule a fertility consultation.
Fertility Services for Same Sex Couple and Single Women
AWC has always been dedicated to offering affordable fertility services to lesbian couples and single women seeking conception with donor sperm. The most difficult part of the process might be picking your donor as now more than ever there are many choices in selecting a cryobank donor.
Cryobank donors are pre-screened for all infectious diseases and many genetic syndromes. It is best to purchase intrauterine insemination prepared specimens for your cycle.
If you are planning to use a known donor, there are many more California Department of Health Services regulations that will need to be followed and all known donors are required to have infectious disease screening prior to sperm donation. You should also consult an attorney regarding any paternity issues.
When undergoing donor insemination, it may take up to 10 cycles to conceive. Conception rates per cycle can be as low as 30%. If you have had more than 6 timed cycles without conception, your provider may recommend further fertility evaluation.
Keeping a fertility calendar is especially important as timing is everything with insemination and it's really important to narrow down your exact fertile window to give the best chances of conception.
Be sure to start your prenatal vitamins at least 90 days prior to starting your fertility journey!
If you have more questions about these fertility services, please schedule a consultation or annual physical exam. To inquire about costs of fertility services, please phone our receptionist and she can email a fee schedule.