There is often more than one cause for infertility, and they must be identified before any therapy can be effective. At the initial visit to our fertility center, a complete reproductive gynecologic and medical history is obtained from the patient, and a complete physical examination is performed.
The physical exam includes a transvaginal ultrasound of the pelvis. The ultrasound is often useful in identifying abnormalities within the reproductive tract. Polyps and fibroids can be elucidated by ultrasound, often followed by additional tests such as a hysteroscopy. Ultrasound is also used extensively during ovulation induction for Assisted Reproductive Technology (ART) procedures to monitor follicular development; the number and size of the follicles is documented. Conditions such as polycystic ovary syndrome (PCOS), where multiple cysts are present on the ovaries, can also be observed via ultrasound.
We will conduct a hormonal evaluation both on initial visit and on the third day of the menstrual cycle. Specifically, we evaluate the levels of anti-mullerian hormone (AMH), estradiol (E2), and follicle stimulating hormone (FSH).
FSH is the hormone responsible for recruitment and development of the eggs within the ovarian follicles. If the FSH level is elevated on day three of the menstrual cycle, it could signal declining ovarian function, or in severe cases, ovarian failure. Ovarian failure means that the eggs are no longer viable and the treatment of choice will be in vitro fertilization (IVF) using a donor’s eggs. We have a very successful Donor Egg Center.
We will also conduct a hysterosalpingogram, which is used to demonstrate normal uterine anatomy and fallopian tube patency. The hysterosalpingogram is performed by injecting radio opaque dye in the uterus and following its flow with X-rays back through the fallopian tubes. Collections of dye seen on the X-ray can often identify tubal obstructions or uterine abnormalities. Tubal obstruction is often caused by endometriosis. In cases of moderate to severe tubal obstruction, IVF is often the treatment of choice.
Other tests may be performed where appropriate and may include the following:
- Hysteroscopy: This involves viewing the interior of the uterus using a telescope-like device. Polyps and fibroids are often diagnosed via hysteroscopy.
- LH testing for ovulation monitoring: These tests identify when ovulation is most likely to occur and helps the couple time intercourse to coincide with the most fertile period.
Once our infertility specialists conduct a complete workup and establish a diagnosis, we can identify a treatment approach. We often use laparoscopic surgery to treat endometriosis, correct tubal abnormalities, and for many other conditions. Laparoscopic surgery is usually an outpatient procedure and has many advantages compared to traditional surgery including less pain, scarring and risk, as well as quicker recovery.