How is Infertility Diagnosed?
How is Infertility Diagnosed at Denver Fertility Care?
The Academy Society for Reproductive Medicine defines infertility as the inability to achieve a successful pregnancy after one year of regular, unprotected sexual intercourse. A fertility evaluation and possible treatment are recommended at one year for those 35 years and younger and at six months for those 35 years and older. In women >40 years old, more immediate evaluation and treatment may be needed (ASRM, 2021).
According to the World Health Organization, around 17.5% of the adult population is infertile, which is roughly one in six people worldwide (WHO, 2023). It has been noted that infertility is caused by female factors 30% of the time, male factors 30% of the time, male and female factors 30% of the time, and the other 10% is unexplained.
Female Infertility
So, how do we diagnose infertility? Starting on the female infertility side, we look at three major areas that can impact a woman’s ability to conceive.
-
Egg Health. This is important because women are born with the number of eggs they have for their lifetime, and we start to see a decline in the quality and quantity of eggs at age 32 and an even steeper decline at age 38. To evaluate egg health, we look at four major hormones: Anti-Müllerian Hormone (AMH), also known as ovarian reserve assessment, Estradiol (E2), Follicle-Stimulating Hormone (FSH), and Luteinizing Hormone (LH). We also perform an ultrasound to evaluate the pelvic anatomy and perform a basal antral follicle count (small fluid-filled sacs in the ovaries that contain immature eggs). It is recommended to perform egg health testing between cycle days 1-4 when everything is at its baseline. The blood test and ultrasound provide helpful information regarding the quality and quantity of a woman’s eggs.
-
Ovulation Process. A woman is fertile for a period of six days, the five days leading up to ovulation (when the egg is released from the ovary) and the day of ovulation. “Ovulatory dysfunction is identified in approximately 15% of all infertile couples and accounts for up to 40% of infertility in women” (ASRM, 2021). We evaluate the ovulatory process through various methods, including checking progesterone blood levels after ovulation, ovulation predictor kits, basal body temperature (BBT), and endocrine evaluation blood tests.
-
Anatomy. Evaluating the uterine anatomy and fallopian tube patency is another crucial piece of the fertility workup. A FemVue or Hysterosalpingogram (HSG) is a procedure performed to determine whether the fallopian tubes are open and to see if the shape of the uterine cavity is normal. A FemVue is the most recommended in-office procedure at Denver Fertility Care for the initial workup. It allows for a complete pelvic assessment, immediate results, and is well-tolerated and safe. A FemVue involves inserting a small catheter through the cervix to fill the uterine cavity with saline and air, which then flows into the fallopian tubes. A transvaginal ultrasound is utilized to visualize the uterine cavity and tubes to check for blockages. A Hysterosalpingogram (HSG) is an x-ray procedure used to see whether the fallopian tubes are open and if the inside of the uterus is normal. Both methods are considered outpatient procedures and can be completed in less than 30 minutes. They are usually done between cycle days 6-12 (after menses have ended but before ovulation to prevent interference with an early pregnancy).
Male Infertility
Moving onto the male infertility side, a Semen Analysis is used to determine whether a man might be infertile. This test analyzes the health and viability of a man’s sperm. A semen analysis evaluates the semen (the fluid that carries the sperm), the number of sperm (count), the shape of the sperm (morphology), and the movement of the sperm (motility). Several factors can affect sperm count or other semen analysis parameters, including the use of alcohol, nicotine/tobacco, recreational drugs, caffeine, prescription drugs, and some herbal medicines, as well as increased heat exposure to the testicles.
Based on the information gathered from the evaluation, a diagnosis is made, and specific treatment options are recommended. Treatment options vary depending on the cause of infertility, how long you’ve been infertile, age, length of time trying to conceive, and any prior infertility treatments.
Schedule a Consultation with Denver Fertility Care
Infertility can be a challenging and emotional journey, but you are not alone. At Denver Fertility Care, our team of highly trained fertility specialists is here to guide you with personalized, compassionate care. Whether you are just beginning your fertility journey or seeking a second opinion, we are committed to helping you navigate your options with expertise and empathy.
Take the first step today—schedule an appointment at Denver Fertility Care.