Initial Consultation and Medical History
Personal and Family Medical History: The OB-GYN will start by asking about the woman’s personal medical history. This includes any previous pregnancies, miscarriages, or gynecological surgeries. For example, a history of pelvic inflammatory disease may suggest potential damage to the fallopian tubes. Family history is also important. If there is a family history of infertility, genetic disorders, or early menopause, it could provide valuable clues. In men, the doctor will inquire about any testicular injuries, surgeries, or history of sexually transmitted infections that might affect sperm production or function.
Lifestyle and Reproductive Habits: The couple’s lifestyle factors are evaluated. This involves questions about smoking, alcohol consumption, and drug use. Smoking can reduce fertility in both men and women. In women, it may affect ovulation and the quality of the eggs, while in men, it can damage sperm. Excessive alcohol intake can disrupt hormonal balance and affect sperm quality. The OB-GYN will also ask about the frequency and timing of intercourse. Understanding the couple’s reproductive habits helps to determine if there are any modifiable factors that could improve their chances of conception.
Physical Examination for Women
Pelvic Examination: A pelvic exam is a routine part of the fertility evaluation. The OB-GYN will check the external genitalia for any abnormalities. Using a speculum, they will examine the vagina and cervix. This helps to look for signs of infection, such as abnormal discharge or cervical lesions. The doctor will also palpate the uterus and ovaries through the vaginal wall to assess their size, shape, and position. For example, an enlarged uterus or tender ovaries could indicate conditions like fibroids or endometriosis, which can affect fertility.
Breast Examination: Although not directly related to fertility, a breast examination is often done. It helps to detect any breast abnormalities that could be associated with hormonal imbalances. Some hormonal disorders that affect fertility, such as polycystic ovary syndrome (PCOS), may also have manifestations in the breast, like breast tenderness or the presence of cysts.
Ovulation Testing for Women
Basal Body Temperature (BBT) Charting: Women can track their basal body temperature daily. A special thermometer is used to measure the body’s temperature first thing in the morning before any activity. A slight increase in temperature indicates that ovulation has occurred. The OB-GYN may guide the woman on how to perform this charting accurately. However, BBT charting has limitations as it can be affected by factors like illness, stress, or disrupted sleep. The thermometer for BBT charting usually costs between $10 and $50.
Ovulation Predictor Kits (OPKs): These kits detect the surge in luteinizing hormone (LH) that precedes ovulation. The woman starts using the kits a few days before she expects to ovulate, based on her menstrual cycle. A positive result on the OPK indicates that ovulation is likely to occur within the next 24 to 36 hours. OPKs are available over-the-counter and typically cost between $20 and $50 for a pack.
Hormone Level Testing
Follicle-Stimulating Hormone (FSH): This hormone is measured on the third day of the menstrual cycle. Elevated FSH levels may indicate diminished ovarian reserve. The cost of an FSH test is around $50 to $100. A high FSH level, for example, above 10 mIU/mL in a woman under 35, could suggest that the ovaries are not functioning optimally.
Luteinizing Hormone (LH): Along with FSH, LH levels are important. An abnormal LH to FSH ratio can be a sign of hormonal imbalance, such as in PCOS. The cost of testing LH is similar to that of FSH.
Estradiol: This estrogen hormone is also measured during the early part of the menstrual cycle. It helps to assess the health of the ovarian follicles. The test cost is approximately $50 to $150. Abnormal estradiol levels can affect ovulation and the quality of the uterine lining.
Tests for the Uterus and Fallopian Tubes in Women
Hysterosalpingogram (HSG): This test involves injecting a contrast dye into the uterus and fallopian tubes and then taking X-ray images. It helps to detect any blockages or abnormalities in the uterine cavity and fallopian tubes. The cost of an HSG is around $300 to $1000. It can be a bit uncomfortable, with some women experiencing mild cramping during the procedure. The OB-GYN will carefully insert a catheter through the cervix into the uterus and then slowly inject the contrast dye. As the dye fills the uterus and tubes, X-ray images are taken to visualize the flow and look for any obstructions.
Sonohysterogram: This is an alternative to the HSG that uses ultrasound instead of X-rays. It provides detailed images of the uterine cavity and can detect issues like polyps or fibroids. The cost is usually between $200 and $500. A thin catheter is inserted into the uterus, and a saline solution is injected. The ultrasound transducer is then used to visualize the uterus as the saline distends the cavity, allowing for a clear view of any internal abnormalities.
Semen Analysis for Men
Sample Collection: The man is required to provide a semen sample, usually through masturbation. The sample should be collected in a clean, sterile container and delivered to the laboratory within a short time frame. In some cases, if the man has difficulty with masturbation, alternative methods like using a special condom during intercourse may be considered. The OB-GYN will provide detailed instructions on how to collect the sample properly.
Analysis Parameters: The semen sample is analyzed for sperm count, motility (the ability of sperm to move), and morphology (the shape of sperm). A normal sperm count is typically considered to be around 15 million to 200 million sperm per milliliter of semen. The cost of a semen analysis is usually between $50 and $200. The laboratory technician will examine the sample under a microscope to assess the quality of the sperm. Abnormal sperm parameters, such as low sperm count, poor motility, or abnormal morphology, can be a cause of infertility.
