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Can’t conceive? Here’s what your doctor will do first

If you and your partner haven’t been able to conceive, it may be comforting to know that you’re not alone. Infertility affects an estimated 2.1 million couples in the United States—about 10 percent of the reproductive-age population, according to the American Society for Reproductive Medicine.

Generally, a couple is considered infertile if they haven’t been able to conceive after 12 months of having sex without using any form of birth control. That’s when most couples begin the process of finding out what’s causing the problem and what can be done to solve it.

If you’re over age 35, however, it doesn’t make sense to wait an entire year before seeing a doctor. Six months would be more appropriate because the longer you wait, the less time you’ll have to address the problem.

The first step is to set up an appointment with your regular Ob/Gyn or one who specializes in infertility. During this initial visit, your doctor most likely will ask you and your partner a lot of questions. Expect to be asked if you’ve had irregular periods, severe menstrual cramps, pelvic pain, abnormal vaginal bleeding or discharge, genital infections or illnesses. Your doctor will also want to know the details about any prior pregnancies, miscarriages, operations and methods of contraception.

Your partner may be asked about genital injury, operations, infections, medication usage, illnesses and history of prior paternity.

A complete physical exam, focusing heavily on the reproductive organs, usually follows the history. If your doctor determines that there’s no underlying medical reason for your infertility (such as thyroid disease or diabetes) and that it can’t be remedied by simple adjustments (such as changing the timing of intercourse), he or she will initiate a series of tests to help identify the problem.

A basic infertility workup, which can usually be completed within a few menstrual cycles, generally includes the following four major components:

  1. Semen analysis. About 30 percent of all infertility relates to men. A man may be infertile for many reasons. Some of those reasons include not having enough sperm, having sperm that aren’t active enough, blockage of the passage (called the vas deferens) that carries sperm to the urethra and difficulties with ejaculation. To see if any of these problems are impairing infertility, your partner’s semen must be examined under a microscope.
  2. Evaluation of ovulation. Irregular or abnormal ovulation accounts for about 25 percent of all infertility cases. There are several ways for your doctor to find out if and when you’re ovulating. The simplest and least expensive is to chart your basal body temperature with a special thermometer every day for two or three months. (A midcycle rise of 0.5 to 1.0 degrees Fahrenheit means that ovulation has taken place.)

    Another option is an over-the-counter ovulation prediction kit designed to detect elevated levels of luteinizing hormone in urine. (This hormone stimulates the ovaries to release eggs.) Yet another alternative is a blood test to measure your progesterone level. (The ovaries begin producing large amounts of this hormone following ovulation.)

  3. Postcoital test. In this procedure, the doctor collects a sample of your cervical mucus shortly after intercourse and examines it under a microscope to determine whether your partner’s sperm is able to move through it properly. Sometimes, the cervical mucus is too thick. In rare cases, a woman actually produces antibodies that destroy her partner’s sperm.
  4. Tubal testing. Factors involving the fallopian tubes and/or peritoneum (the lining of the abdominal cavity) are responsible for an estimated 35 percent of infertility. A special X-ray test called a hysterosalpingogram (HSG, for short) enables a doctor to detect fallopian-tube blockage, uterine scar tissue, polyps, fibroids or an abnormally shaped uterus.

    Ultrasound, which utilizes sound waves to produces images of internal organs, can be used to check the ovaries and uterus, as well as the thickness of the uterine lining and the development of the egg in the ovary.

What happens next

Depending on the results of these tests, your doctor may recommend more extensive testing, drug therapy, surgery and/or a visit to a fertility specialist. Pregnancy is possible for well more than half the infertile couples who pursue treatment.

What happens next