After your doctor has taken your medical history and gone over your options he will administer tests that will hopefully pin down what is specifically impeding your progress.
Unfortunately, these exams are uncomfortable as well as very costly for you, while your partner's tests are simple semen analysis. Your partner will be asked to ejaculate into a specimen cup and deliver it to a lab - and he is usually required to do his test first.
His semen is checked for the following:
- sperm count,
- the movement;
- the shape and maturity of the sperm cells to determine the quality,
- consistency;
- volume - about 1 teaspoon is normal; and
- the pH balance which should be slightly alkaline.
If his test results are abnormal, he will be asked to see a male infertility doctor to repeat the exam, at least two times over a period of 12 weeks. There are many different factors which can make his test read abnormally, such as fevers and sexually transmitted diseases which affest his sperm count.
If these next 2 exams still bring abnormal results, your partner will then be referred to a urologist and/or urologist. Many male fertility doctors are qualified as both.
He will then be checked for the following:
- A sperm antibody test,
- Hormonal blood tests,
- Testicular biopies to determine if he is sterile,
- Vasography which checks for any obstructions,
- Fructose test,
- Bovine cervical mucus test which checks the sperm's ability to penetrate cervical mucus from cows), and
- Hamster egg test which determines sperm penetration strength. This test is important, because if his sperm can't penetrate the egg, invitro will not be successful.
Now if your partner's semen analysis results are normal, then you will both be referred to a gynecologist who specializes in reproductive endocrinology. By now, you will have both realized that it is important that you both attend these appointments.
Your doctor will want to see your charts, and from there will begin the interview process for the two of you. Medical histories, previous surgeries such as appendicitis, myomectomy or fibroid surgery will be documented - but that is not all .
Depending on how your doctor likes to conduct this phase of the interview, you will both be asked about your physical relationship. This interview may be conducted separately or together.
Questions like how long you've known each other, and how long you have been trying to get pregnant are to be expected. You will both be asked about previous pregnancies. Has he fathered any children in the past? Have you ever been pregnant? If so, what happened? Abortion? Miscarriage?
These questions aren't meant to be invasive - but your answers are very important in determining and/or pinpointing the problems you are having as a couple, trying to conceive.
Next it's your turn to be examined. A full pelvic exam, sexually transmitted diseases, a Pap smear, and any other exams will now be performed, as well as a complete physical.
Here is a list of other things your doctor will be looking for:
- Reproductive hormone levels,
- Thyroid hormone levels,
- Heart and lungs, and
- An Ultrasound to check the condition of your pelvis.
As covered in the Causes Of Fertility section, your doctor will also ask you about excessive body hair, since most women routinely shave excess hair. Please answer truthfully.
Polycystic ovary syndrome, in where your ovaries have small cysts that interfere with ovulation and hormone production is a problem in many women. Questions pertaining to skin problems, such as acne, will be documented, as well as any history of irregular periods and/or battling with obesity.
Obesity, severe skin problems, irregular cycles, and excessive hair growth are all symptoms of polycystic ovary syndrome. You may have noticed already, through your own charting and fertility observation techniques whether you have any irregularities regarding your period. If so, your doctor check for any elevated levels of androgen, a male hormone all women secrete in small amounts.
These elevated androgen levels and don't necessarily mean you have polycystic ovary syndrome. If the problem is androgen you will be put on female hormone supplements to offset it.
Please note that it is imperative that a fertility specialist takes a full menstrual and contraceptive history. They will also look for signs of endometriosis or PID which has also been covered in the Causes of Infertility section.
A successful and thorough course of events should conclude in the following:
- Your fertility specialist makes sure your menstrual cycles during the period you have been trying to conceive (at least a year),is regular,
- That you and your partner have been making love at the proper times (according to your charts and other readings),
- You and your partner have been making love as much as possible during your ovulation peak time.
To get to this point with your doctor, you should have been doing a BBT chart, keeping track of your cycles for at least three months.
