Infertility
When to have an infertility evaluation?
If you have not gotten pregnant after 1 year of having regular sexual intercourse without using birth control.
If you are older than 35, an evaluation is recommended after 6 months of trying.
How does age affect fertility?
Healthy couples in their 20s and 30s: chance for pregnancy is 30% per single menstrual cycle. This percentage starts to decline in a woman’s early 30s. It declines more rapidly after age 37.
By age 40, a woman’s chance of getting pregnant drops to less than 10 percent per menstrual cycle.
A man’s fertility also declines with age, but not as predictably.
How can lifestyle affect fertility?
Women who are underweight, overweight, or exercise too much may have a harder time getting pregnant. In women, drinking alcohol at moderate or heavy levels and smoking may reduce fertility. In men, smoking, heavy drinking, and using marijuana can reduce sperm count and movement.
What causes infertility?
There are four main categories or causes:
1) Female factor infertility: This is infertility caused by issues with eggs, menstruation, and female sex organs. Age and hormones can contribute to female factor infertility.
2) Male factor infertility: This is infertility caused by issues with sperm and male sex organs. Age and hormones can contribute to male factor infertility.
3) Combination infertility: This is infertility caused by a combination of male and female factors.
4) Unexplained infertility: In 15% to 28% of people, the cause of infertility is never found.
Infertility testing - female partner
BLOOD:
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Cycle day 3: FSH, Estradiol, TSH, prolactin, Antimüllerian hormone and beta hCG
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On Day 21 of your cycle: progesterone level (to see if you have ovulated)
VAGINA:
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Chlamydia testing
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Pap smear
GENETICS
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preconception genetic testing (optional)
IMAGING
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Ultrasound exam—This test can predict when ovulation will occur by viewing changes in the follicles.
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Hysterosalpingography—This X-ray procedure shows the inside of the uterus and whether the fallopian tubes are blocked. This test will require taking antibiotics (usually Doxycycline for 3 days starting the day before the procedure)
Infertility Testing - Male Partner
In men, infertility can be caused when the tubes that carry sperm from the testicles are blocked. There may also be a problem with the semen itself. We ask that the male partner have a sperm check as part of the initial infertility evaluation. Please note, the male should not ejaculate for 2 days before the test.
Hysteroscopy—This procedure uses a camera with a thin light source that is inserted through the cervix and into the uterus. This can show problems inside the uterus and help guide minor surgery.
How long does infertility testing take?
An infertility evaluation can be finished within a few menstrual cycles in most cases.
Is infertility testing covered by insurance?
Some insurance companies may cover the cost of an infertility evaluation. It is a good idea to call your insurance company to find out before you start your evaluation.
Treatment for women
Some women need only one or two therapies to improve fertility. Other women may need several different types of treatment to achieve pregnancy.
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Stimulating ovulation with fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation.
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Intrauterine insemination (IUI). During IUI, healthy sperm are placed directly in the uterus around the time the ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
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Surgery to restore fertility. Uterine problems such as endometrial polyps, a uterine septum, intrauterine scar tissue and some fibroids can be treated with hysteroscopic surgery. Endometriosis, pelvic adhesions, and larger fibroids may require laparoscopic surgery or surgery with a larger incision of the abdomen.
Assisted reproductive technology
In vitro fertilization (IVF) is the most common ART technique. IVF involves stimulating and retrieving multiple mature eggs, fertilizing them with sperm in a dish in a lab, and implanting the embryos in the uterus several days after fertilization.
Other techniques are sometimes used in an IVF cycle, such as:
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Intracytoplasmic sperm injection (ICSI). A single healthy sperm is injected directly into a mature egg. ICSI is often used when there is poor semen quality or quantity, or if fertilization attempts during prior IVF cycles failed.
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Assisted hatching. This technique assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).
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Donor eggs or sperm. Most ART is done using a couple's own eggs and sperm. However, if there are severe problems with either the eggs or the sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.
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Gestational carrier. Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple's embryo is placed in the uterus of the carrier for pregnancy.
Complications of infertility treatment may include
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Multiple gestation. The most common complication of infertility treatment is a multiple pregnancy — twins, triplets or more. Generally, the greater the number of fetuses, the higher the risk of premature labor and delivery, as well as problems during pregnancy such as gestational diabetes. Babies born prematurely are at increased risk of health and developmental problems.
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Ovarian hyperstimulation syndrome (OHSS). Fertility medications to induce ovulation can cause OHSS, particularly with ART, in which the ovaries become swollen and painful. Symptoms may include mild abdominal pain, bloating, and nausea that lasts about a week, or longer if you become pregnant. Rarely, a more severe form causes rapid weight gain and shortness of breath requiring emergency treatment.
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Bleeding or infection. As with any invasive procedure, there is a rare risk of bleeding or infection with assisted reproductive technology or reproductive surgery.
Ovulation Predictor Kits
Ovulation tests come in various forms, such as apps, urine strips, wearables, and at-home blood test kits. They help you determine when is the best time to have sex. These kits can be purchased over the counter in a pharmacy or online. Below is a list to help you decide which test is best for you.
To mark the start and end of your period each month.
Easiest to read: Clearblue Fertility Monitor
The Clearblue Fertility Monitor provides daily fertility status and stores and tracks individual fertility data. The monitor tracks both estrogen and LH levels. The cost is around $124.68 for one fertility monitor. Purchase the test sticks separately.
Ava offers an FDA-cleared, wearable fertility test. Ava can identify a person’s 5-day fertility window up to 4 days sooner than hormone-based tests. You can use your flexible spending account (FSA) and health savings account (HSA) cards when shopping. This product costs around $300.
Best budget option: Modern Fertility Ovulation Test
This test comes with 20 ovulation tests that detect LH levels and work in sync with a person’s cycle. The company also offers a free app that a person can use to log their LH results. You can use your FSA and HSA cards. Each monthly kit costs about $15.
Best for irregular cycles: Mira
The Mira Plus Starter Kit comes with 10 wands that work with the Mira Analyzer monitor. This test is the best option for people with PCOS and irregular cycles. The Mira costs between $200 to $300, depending on the kit you get. Some codes below may help:
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2DRFREY: 20% off kits and nearly 30% off wands with a subscription.
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2DRFREY15: 15% off one-time purchases.
Best test strips: Clearblue Advanced Digital Ovulation Test
This test detects four or more fertile days each cycle and tracks LH and estrogen levels.
