Questions About Infertility – Tests Can Be Undertaken to Provide Couples with Answers

Q: My husband and I have been trying to have a baby for one year now without success. How long should we wait before seeing a fertility specialist?

A: I don’t know your age, but for women less than age 35 having regular menstrual periods, infertility is defined as one year of unprotected intercourse without conception. For women older than 35, six months of unprotected intercourse without conception is defined as infertility. Women with irregular menstrual periods do not have to wait and can schedule an appointment to be evaluated right away.

Q: Are there things we can try first at home to improve our chances of conceiving?

A: Ovulation predictor kits, sold in pharmacies without a prescription, can help women determine if and when they are ovulating, which helps determine the optimal time for intercourse.

Q: Is there any way to tell if the problem lies with me or my husband?

A: A visit to a fertility specialist will allow a variety of tests to be performed. Although one cause might be identified, often there is more than one cause, involving both members of the couple. Sometimes, no identifiable cause can be found, but fertility specialists can offer treatment to shorten the time to conception, even if no particular cause is found.

Q: Are there any signs or symptoms to be aware of, other than the length of time trying to conceive, that might indicate an infertility problem?

A: If your menstrual periods stop altogether, you should seek medical advice as you are likely not ovulating. If you or your husband has received chemotherapy or radiation in the past, this could indicate a problem with fertility. If you have had pelvic inflammatory disease in the past (chlamydia or gonorrhea), this could cause infertility. Also, if you have been diagnosed with endometriosis, this could also contribute to an infertility problem.

Q: Should I come for the visit alone? Bring my husband?

A: Infertility is really a diagnosis of a couple, rather than an individual, so the best option is for both of you to come to the visit.

Q: What tests will you need to take?

A: We will do tests to determine ovarian reserve (numbers of eggs remaining in the ovary), a hysterosalpingogram (indicates shape of uterus and whether fallopian tubes are open), a semen analysis (to measure numbers and motility of sperm), and other tests, such as for infectious diseases, endocrine causes (glands), and some genetic testing.

Q: What could some of the reasons be for our not conceiving?

A: Failure to ovulate, blocked fallopian tubes, and too few moving sperm are common reasons.

Q: What treatment options are there, and how successful are they?

A: Medications to cause ovulation (pills or injections), ovulation medications combined with intrauterine insemination (placing the most mobile sperm into the uterus when the egg is there), and in vitro fertilization (combining eggs and sperm in a laboratory dish, then placing the embryo directly into the uterus) are common treatment options.
Medications to cause ovulation are nearly always effective, although there may need to be dose adjustments to be successful. Ovulation medications combined with intrauterine insemination allow about one-third of couples to conceive after three or four months of trying. In vitro fertilization is the most successful treatment for any given month, with about 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of couples conceiving, depending on age.

Q: Will insurance cover this?

A: Locally in Massachusetts and Connecticut, most insurance companies cover the diagnosis and treatment of infertility.