One of our readers sent in this mail which we decided to address today.
I am getting married in December and i am afraid i may be infertile. Nothing significant has happened in the past to my body but i cannot shake this feeling off that something may be wrong. I want to find whatever it is now and fix it before the wedding. i dont want any issues after. How do i go about it?
WHAT A WOMAN NEEDS TO DO TO KNOW IF SHE IS FERTILE.
When a couple has been unsuccessful at achieving pregnancy after one year of regular unprotected sex at least 3 times a week, both partners need to go through a comprehensive physical and medical assessment. Tests for female infertility and a semen analysis should start immediately, because male factors account for approximately 50% of all infertility cases. It is therefore important to examine both partners for possible infertility issues.
What is the process for female fertility testing?
The first step in diagnosing an issue relating to fertility is a comprehensive appointment with your fertility physician. During this appointment, your medical history and lifestyle will be discussed extensively. Topics such as birth control use, menstrual and pregnancy history, current and past sexual practices, medications used, surgical history, other health issues and your lifestyle, as well as your work/living environment will all be discussed. A thorough physical exam will also be done; Areas such as your thyroid gland, breasts, and hair growth will be looked at. A pelvic exam is also an important part of evaluating fertility, along with a pap smear. Finally an ultrasound scan will be done to rule out any structural issues to the reproductive system.
After this first appointment, your physician may want to proceed with some initial testing. This initial testing will evaluate things such as if ovulation is occurring, when it should be occurring, ovarian function, and uterine function during the ovulation process. Ideally, you will have already begun tracking your ovulation through a fertility awareness. This will provide your reproductive specialists with valuable information about your ovulation. Usually one of the first questions regarding female fertility is whether you are ovulating or not.
Ovulation evaluation may be broken down into types:
- Ovulation testing– to confirm if ovulation is occurring by looking through your temperature charts, using urinary ovulation detector kits, blood tests and ultrasound.
- Ovarian function tests–These tests are looking to see how the hormones are functioning and working during your ovulation cycle. Blood Tests include Day 3 FSH (measuring follicle stimulating hormone), Day 3 Estradiol (measuring estrogen), ultrasound (to confirm ovulation occurred).
- Mid-Luteal Phase testing- Testing will evaluate progesterone levels in the mid luteal phase ( one week after ovulation).
- Hormone tests: Most all of this testing will revolve around thorough hormone tests. These hormone tests include the following:
- Luteinizing Hormone
- Follicle Stimulating Hormone
- Free T3
- Total Testosterone
- Free Testosterone
Your Fertility specialist may also recommend a blood test for AMH to provide an estimate of your ovarian reserve.
The following tests are also commonly used in the first evaluated cycle:
- Cervical mucus tests: This involves a post coital test (PCT) which determines if the sperm is able to penetrate and survive in the cervical mucus. It also involves a bacterial screening.
- Ultrasound tests: This is used to assess the thickness of the lining of the uterus (endometrium), to monitor follicle development and to check the condition of the uterus and ovaries. An ultrasound maybe conducted two to three days later to confirm that an egg has been released.
If both the semen analysis and the above testing return normal results, there is also additional testing that your fertility specialists may recommend. These tests include any of the following:
- Hysterosalpingogram (HSG): This is an x-ray of your uterus and fallopian tubes. A dye is injected through the cervix into the uterus and fallopian tubes. The dye enables the radiologist to see if there is structural blockage or some other problem.
- Hysteroscopy: This is a procedure that may be used if the HSG indicates the possible presence of abnormalities. The hysteroscope is inserted through the cervix into the uterus, which allows your fertility specialist to see any abnormalities, growths, or scarring in the uterus. The hysteroscope allows the physician to take pictures which can be usedfor future reference.
- Laparoscopy: This is a procedure done under general anesthesia, that involves the use of a narrow fiber optic telescopeunder. The laparoscope is inserted into a woman’s abdomen to provide a view of the uterus, fallopian tubes, and ovaries. If any abnormalities such as endometriosis, scar tissue or other adhesions are found, they can be removed by a laser. It is important to confirm that you are not pregnant before this test is performed.
- Endometrial biopsy: This is a procedure that involves craping a small amount of tissue from the endometrium just prior to menstruation. This procedure is performed to determine if the lining is thick enough for a fertilized egg to implant in and grow. It is important to confirm that you are not pregnant before this test is performed.
These tests are not mandatory and your fertility specialists will know which tests to recommend in your situation.