Coping with Infertility

Lesson 1: Suspecting and Diagnosing Infertility

The Infertility Exam

Once you have made the choice of which doctor to see, you will then need to schedule an infertility appointment. This appointment can be made with either an OB/GYN or an RE, and in most cases should follow the same patterns of what to expect and what will be done or ordered. In all cases, it is best to ask when scheduling the appointment what will be done or ordered on this visit and if there is a better time during the woman's cycle to schedule the appointment, which we will discuss in this section and others.

First, we will look at what a woman should expect to have done or ordered at the appointment. The first thing will be your medical and reproductive history, which includes age at first period, regularity of periods, any pain experienced during periods, surgical procedures performed in the pelvic area, and any sexual infections or history of. After the history has been recorded, a physical examination will be done.

The physical exam usually includes a pelvic exam, breast exam, Pap smear, and possibly an ultrasound. The doctor will be looking for abnormalities that could be preventing conception during the physical exam. The next most likely part of the infertility appointment will be blood tests. Depending on where the woman is in her cycle, the blood tests may be done that day, or ordered for a future date in the month.

Which blood tests should be ordered and on which days of a woman's cycle they should be performed on will be covered in Lesson 2. However, this is the basic 'schedule' of when the blood tests should be performed:

• Cycle Day 3 – Estrogen, LH, FSH, Prolactin, TSH (Thyroid Stimulating Hormone), GnRH
• Cycle Day 21 or 7 Days Post Ovulation – Progesterone
• Any Day – Testosterone, Androgens

Depending on the results of the blood tests, additional tests or exams may be ordered.

The male should also go to the infertility exam, and this should be kept in mind when scheduling the appointment. Along with the woman's history, the man will need to provide his history including: any surgeries performed in the reproductive or abdominal area, testicle injuries or disorders, sexual infections current or past, and his reproductive history (has he fathered any children and when). A semen analysis should also be scheduled during the exam.

Both the woman and the man should inform the doctor of all medications, including OTC medications, that they take on a regular basis. Some medications interfere with fertility by either lowering the man's sperm count or quality, or by causing a change in the woman's ability to ovulation, produce sperm friendly CF, or by altering her hormone levels. Any use of illegal drugs, alcohol or smoking should also be provided to the doctor as these can decrease both a man's and a woman's fertility as well.

Always be totally open with your doctor. If you withhold any information, no matter how insignificant you might think it is, could be the difference between finding the cause of the infertility and having to undergo invasive and costly testing and procedures.

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