Medical Contribution by: Mark Perloe, M.D.
How do you know you have infertility? That’s a question that many of our patients ask themselves after they’ve been trying to get pregnant on their own without any success. The only way to know the cause behind infertility is to be tested. Diagnosing infertility is the first step toward being able to successfully become pregnant. In order to recommend a treatment that is tailored precisely to your unique needs, a diagnosis comes first.
Infertility may be caused by many different conditions, and your doctor can often establish a cause with a review of your medical history and a few simple tests.
At SGF Atlanta, we’ve streamlined the diagnostic process. Our physicians do not require repeat testing if you have completed previous testing within 1 year. The initial work-up for diagnosing infertility includes standardized fertility tests for both the male and female partner. Most often, this testing is covered by insurance.
When to Seek an Evaluation for Infertility
“Couples often wonder how long they should try on their own before seeking help from a fertility specialist,” says Dr. Mark Perloe of SGF Atlanta. Patients under the age of 35 should be evaluated after 1 year of trying to conceive and between the ages of 35-39 should be seen after 6 months of trying to conceive. Patients over the age of 40 should see a fertility specialist after 3 months or right away. “Women who have known pre-existing conditions such as PCOS, irregular periods, a known male factor, or multiple miscarriages should seek an evaluation sooner than the recommended guidelines,” says Perloe.
How to Get Started with Diagnosing Infertility
The first step is simple. It’s a conversation with a fertility specialist. SGF Atlanta has three physicians in three locations across the Atlanta region. The initial consult with your physician is a comprehensive evaluation of your history and medical records. The appointment typically lasts 45 to 60 minutes. During this visit, you will have the opportunity to have your questions answered and to participate in developing a plan for further evaluation and/or treatment. We strongly encourage that both partners attend this consult.
Why a fertility specialist for diagnosing infertility?
When a couple meets the definition of infertility, or if they suspect infertility because of a known pre-existing condition that may prevent them from conceiving, it is time to seek help from a fertility specialist. A fertility specialist, or reproductive endocrinologist (RE), is a physician who not only completed the rigorous educational requirements to become an obstetrician/gynecologist (OB/GYN) but also advanced training and a fellowship specifically in reproductive endocrinology and infertility (REI). In most cases, this advanced training requires an additional 3 years of intensive and highly focused study and practicum. The breadth and depth of experience combined with SGF Atlanta’s state-of-the-art laboratories and technology available properly equip our physicians to offer you an ideal treatment plan and the best chances of success.
The Initial Work-up for Diagnosing Infertility
There are four simple tests used for diagnosing infertility. Three tests for the female and one for the male. These tests are intended to answer the following questions:
- Are you ovulating?
- Are your Fallopian tubes normal?
- Is your uterus receptive to implantation?
- Are the sperm normal in number and function?
For the women, blood test, ultrasound, and a hysterosalpingogram (HSG) are performed to assess the most important aspects of female reproduction: the ovaries, Fallopian tubes, and uterus
Bloodwork: Identifies the female hormones and checks for any hormonal imbalances. The bloodwork is also used to measure your levels of E2 (estrogen), FSH (follicle-stimulating hormone), and AMH (anti-Müllerian hormone).
Ultrasound: Paired with bloodwork, an ultrasound counts the antral follicles and helps to give a complete picture of your ovarian reserve.
HSG: The HSG is an x-ray test that lets your physician examine the inside walls of your uterus and Fallopian tubes to see if they are open, normal in shape, and not affected by polyps, scar tissue, or fibroids.
For the male, one simple test is required: semen analysis.
Semen Analysis: This simple diagnostic test provides valuable insight into the sperm’s ability to fertilize an egg.
How is the cause of infertility determined?
Many people are surprised to learn the causes of infertility are pretty evenly split between the male and female partner. In fact, 40 to 50 percent of infertility diagnoses are male factor infertility. Based on the initial consult with your physician and the infertility work-up, your physician will be able to establish an accurate diagnosis. Establishing a diagnosis will enable your physician to advise you on the best treatment plan.
What are the common causes of infertility?
Female infertility can have many potential causes but predominantly fall into four main categories:
- Problems with the uterus, Fallopian tubes, or ovaries
- Irregular or no ovulation
- Hormonal imbalances
- A woman’s age, which affects ovarian reserve
Male factor problems essentially fall into one of two categories: productive or obstructive. Problems with sperm production can stem from congenital (present at birth) problems with the testicle, hormone-related issues, varicose veins, environmental exposures, or cancer. In these cases, a detailed consultation with a reproductive endocrinologist or reproductive urologist can help pinpoint potential causes as well as facilitate treatment with the intent of improving a patient’s numbers.
“The most important takeaway is that if you aren’t sure if you have infertility, and haven’t been able to conceive, make an appointment to see a fertility specialist,” says Perloe. “Early intervention offers the best possible chance for success.”
SGF Atlanta has three locations in Alpharetta, Atlanta-Northside, and Buckhead-Piedmont. To schedule an appointment with one of Shady Grove Fertility Atlanta’s three physicians, Drs. Mark Perloe, Desireé McCarthy-Keith, or Anne Namnoum, please call 877-971-7755 or complete this brief online form.