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Fertility Evaluation

Approximately 85% of couples should achieve a pregnancy within one year of regular unprotected intercourse.  This translates into about 12-15% of couples seeking some form of fertility investigation at some point during their lifetime.  It is extremely common and you are definitely not alone.  The diagnosis of sub fertility is immensely anxiety provoking and stressful.  At Advanced Reproductive Specialists, we have extensive experience not only in the realm of diagnosis and the surgical and medical management of sub fertility, but also in managing the stress and anxiety that this diagnosis brings.  We have a comprehensive approach that will enable couples to know all of the options.  You have a choice and it should be a well informed and knowledgeable one made only after understanding the underlying diagnosis and all of the available options.

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When to evaluate?

Recommendations for an evaluation stem mainly from age, duration of sub fertility, and whether there are additional underlying factors that may impact reproductive success.  For instance, a woman that is under 35 years of age with regular menstrual cycles and no other diagnoses that has been attempting to conceive with a healthy partner for over a year should seek an evaluation.  Women over 35 years of age should seek a specialist after 6 months if everything else seems normal.  Couples should seek assistance immediately if menstrual cycles are irregular/unpredictable, they suffer from pelvic pain, or the partner is known or suspected to have a potential health factor that may impact the quality of sperm.  Many times a brief history can uncover issues that have never been addressed.

At Advanced Reproductive Specialists we also believe that we are able to reduce the stress associated with infertility by evaluating a couple when they are concerned that there may be a problem, regardless of the time interval over which fertility has been attempted.  Some are reassured in knowing that ovulation is efficient, the fallopian tubes and uterus are normal and the sperm quality is optimal.  At Advanced Reproductive Specialists, we offer a fertility assessment that addresses these concerns.  It is also an excellent option for women that may not have a serious partner as of yet, however, would like to determine how to optimize fertility for the future.  Please see our “fertility check” link.

What does an evaluation entail?

Any fertility specialist should investigate four primary areas that impact fertility.  This must include the following:

1.  Ovulation: the regular, efficient release of the egg.  Many women have cycles that although seem regular may have subtle changes that          impact the quality of ovulation and the hormonal support of the luteal phase (phase after ovulation).  We evaluate this area by performing a progesterone level on cycle day 21 which not only confirms ovulation but allows us to determine whether the ovary is producing the optimal amount of hormone for a pregnancy.  This is one of the most common reasons for sub fertility.  Many women have irregular cycles and the goal is to determine the reason and correct the underlying condition.  Nutrition, stress, exercise, as well as a variety of hormonal issues can impact ovulation – we at Advanced Reproductive Specialists address all of these aspects.

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2.  Anatomic:  It is essential to make sure that the egg will be able to meet the sperm within the fallopian tube to foster fertilization.  Some women may be at increased risk of having a tubal factor if they have had surgery in the past, a history of an infection or ectopic pregnancy.  A hysterosalpingogram (HSG) is a radiologic test that only takes approximately five minutes and allows us to verify tubal patency.

3.  Ovarian Reserve:  Many know that fertility potential is largely based on age.  This is due to the fact that women are born with all of the eggs they will ever have.  As a matter of fact, at 20 weeks gestation the female fetus has 5-7 million eggs.  By birth she is down to 1-2 million and by puberty approximately 400,000.  Every month hundreds of eggs are lost.  Natural fertility begins to decline around the age of 32 years and in some circumstances even sooner.  We have the ability to test this reserve through a number of different laboratory avenues as well as ultrasound.  Baseline FSH and estradiol measurements, Clomiphene Citrate (Clomid) Challenge Testing, Anti-mullerian hormone, and antral follicle count may be used for this purpose.  A reduced ovarian reserve in a young patient may in fact be associated with endometriosis.  Although endometriosis is a surgical diagnosis, we are able to increase our clinical suspicion significantly through a detailed history and laboratory evaluation.

4.  Male factor:  A semen analysis performed with a 2-5 day abstinence interval will enable the physician to determine whether we would need to go any further on the male side.  Men contribute to the fertility issue in approximately 40% of the cases.  We also find that much of the time it may be associated with a hormonal issue.  Men with a history of taking testosterone almost always have a reversible abnormality in sperm production.  We also manage men with low testosterone in ways that are not detrimental to sperm production.

How long does this take?

At Advanced Reproductive Specialists, we take one menstrual cycle to figure out all of the underlying problems.  In women with irregular cycles we would stimulate a menstrual cycle prior to the investigation. Each test is performed at a particular point in the cycle.  After a short time (usually a few weeks), we have all of the information back.  We would then sit down and go over each test and what options are available for the particular conditions.  Success rates from continuing to try on your own through aggressive treatments would be discussed along with our own recommendations.  It is readily apparent that  many couples get “pressured” into aggressive treatment like IVF (In Vitro Fertilization) when it is often not needed.  By far the majority of our patients achieve a healthy pregnancy with less aggressive means.

Our comprehensive, compassionate and successful approach is what sets us apart from the rest.  Please feel free to read “Why Choose Us” under Patient Resources.