Couples should consider seeing a doctor if they have been trying to conceive for a year without success (6 months for women over 35).
The beginnings of a fertility evaluation focus on eggs, tubes, and sperm. With regards to eggs, your doctor will want to confirm that you are releasing your egg and determine how many eggs remain. Signs that you are releasing an egg are regular, predictable menstrual cycles, positive ovulation predictor kits, shifts in basal body temperature, and/or a high progesterone level approximately one week before your period. Ovarian reserve, the number of eggs remaining in the ovary, can be evaluated with blood tests (FSH, AMH) and ultrasound for antral follicle count. Fallopian tubes can be evaluated by a hysterosalpingogram, an X-ray test where X-ray dye is injected into the cervix. The X-ray shows the cavity of the uterus and whether the tubes are open.
Sperm are evaluated with a semen analysis to look for sperm number and motion. If a semen analysis is not normal, it will be repeated to rule out normal fluctuations. If it is normal either the first or second time, no further evaluation is needed. If it is abnormal twice, you will be referred to urology for further evaluation.
The next steps in fertility evaluation and treatment will be based on results to the above tests. While these tests can identify some fertility factors, mother nature is more complex. Occasionally all the tests will be normal, despite a continued delay to pregnancy. Therefore, your doctor will discuss fertility treatment in the context of the evaluation you have completed.
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