Getting pregnant can be an exciting time. For some, getting pregnant seems to happen simply by talking about it. For others, getting pregnant takes patience and perhaps a bit of luck.
Understanding when you’re most fertile can make getting pregnant easier. It’s also important to consider simple do’s and don’ts of conception. For example, maintain a healthy weight and have sex regularly, especially near the time of ovulation. Don’t smoke or drink alcohol. Of course, healthy sperm counts, too.
With frequent unprotected sex, most healthy couples conceive within one year. If you have trouble getting pregnant, don’t go it alone. A fertility specialist or gynaecologist might be able to help. Infertility affects men and women equally and treatment is available.
Evaluating your infertility
If you’ve tried unsuccessfully to get pregnant, your doctor will help you decide your next steps. First, you’ll have an evaluation that determines whether there’s something besides endometriosis affecting your fertility. Other factors can include:
- Problems with producing and releasing an egg (ovulation)
- Uterus abnormalities
- Cervix abnormalities
- Sperm abnormalities in men
What is Endometriosis?
A disorder in which tissue that normally lines the uterus grows outside the uterus.
Symptoms of endometriosis
Some women experience mild symptoms, but others can have moderate to severe symptoms. The severity of your pain doesn’t indicate the degree or stage of the condition. You may have a mild form of the disease, yet experience agonizing pain. It’s also possible to have a severe form and have very little discomfort.
- Pelvic pain is the most common symptom of endometriosis
- painful periods
- pain in the lower abdomen before and during menstruation
- cramps one or two weeks around menstruation
- heavy menstrual bleeding or bleeding between periods
- pain following sexual intercourse
- discomfort with bowel movements
- lower back pain that may occur at any time during your menstrual cycle
You may also have no symptoms. It’s important that you get regular gynaecological exams, which will allow your gynaecologist to monitor any changes. This is particularly important if you have two or more symptoms.
Understandably, you want quick relief from pain and other symptoms of endometriosis. This condition can disrupt your life if it’s left untreated. Endometriosis has no cure, but its symptoms can be managed.
Medical and surgical options are available to help reduce your symptoms and manage any potential complications. Your doctor may first try conservative treatments. They may then recommend surgery if your condition doesn’t improve.
What Is Infertility?
A diagnosis of infertility means you haven’t been able to get pregnant after a year of trying. Or, if you’re a woman over 35, it means you haven’t been able to get pregnant after six months. Women who are able to conceive but not carry a pregnancy to term may also be diagnosed with infertility.
Being diagnosed with infertility doesn’t mean that your dreams of having a child have come to an end. It may take some time, but a significant number of infertile couples will eventually be able to have a child. Some will do so on their own. Others will need medical assistance.
According to the Centers for Disease Control and Prevention (CDC), almost 11 percent of women have difficulty conceiving and carrying a child to term. Six percent of married women are infertile.
What Are the Risk Factors for Infertility?
Infertility is not just a woman’s problem. Men can be infertile, too. In fact, men and women are equally likely to have a fertility problem. About one-third of infertility cases are attributable to female infertility. However, men’s problems account for another third of all infertility cases. The final third may be a combination of male and female infertility or may have no known cause.
Risk factors for infertility include;
- older age
- history of sexually transmitted infections (STIs)
- very high or very low weight
- heavy alcohol use
Once the interview is out of the way, your infertility workup will likely begin with a physical exam and blood tests to check levels of female hormones, thyroid hormones, prolactin, and male hormones, as well as for HIV and hepatitis.
The physical exam may include a pelvic examination to look for chlamydia, gonorrhoea, or other genital infections that may contribute to the fertility problem.
The male partner may also need to be evaluated for genital infections. Your doctor will suggest a complete semen analysis for the male partner to check the number, shape, and motility of the sperm.
Your doctor may schedule other blood tests around the woman’s menstrual cycle. For example, tests for follicle stimulating hormone (FSH) and luteinizing hormone (LH) must be done on day two or three of your cycle. Luteinizing hormone surges in the middle of your menstrual cycle, in the mid-luteal phase, so you may need to come in for more tests then, and again about seven days after you begin ovulating. After you’re ovulating, your doctor will also test your estradiol and progesterone levels and compare them with the levels taken on day two or three of your cycle.
Hormones are fundamental to your reproductive function, so you will want to make sure that your body is correctly producing everything you need to conceive. Some hormone levels can give your doctor an idea of how your ovaries are working and an indication of your ovarian reserve. Your fertility expert may order some or all of the following hormone tests.
Thyroid levels (TSH blood test): Thyroid disorders, including hyperthyroidism (an overactive thyroid), hypothyroidism (an under-active thyroid) or thyroid autoimmune diseases can have a cascading effect on many other important hormones in your body. A dysregulated thyroid will cause many problems, especially related to fertility. A quick check of your thyroid levels can offer your doctor a lot of valuable information about potential fertility issues.
Anti-mullerian hormone (AMH blood test): AMH is a hormone produced in your ovaries by tiny early-stage follicles as they grow to a stage where they can potentially produce eggs for ovulation. While taking an AMH level won’t tell you much about the quality of the eggs you are producing, it can give an idea of whether or not there is still a significant number of growing follicles. From there the doctor can make a judgement on whether you are still likely to produce viable eggs.
Follicle-stimulating hormone (FSH blood test): Produced by your pituitary gland, this is one of the most significant hormones related to ovulation. Its job is to stimulate growth and maturity in your ovarian follicles so that an egg is produced and released during ovulation. FSH production is ongoing until you ovulate, and if you don’t ovulate, the FSH levels will continue to rise. When tested early in the menstrual cycle, an FSH level can indicate how much effort your body is putting in to help you ovulate. High levels are a sign of diminishing ovarian reserve.
Luteinizing hormone (LH blood test): LH works alongside FSH and regulates both the menstrual cycle and ovulation. Levels of LH rise quickly just before ovulation, about halfway through your cycle, which is known as an LH surge. Depending on the stage of your cycle, and LH test can tell whether you have ovulated, or indicate issues with menstruation or ovulation. High LH levels outside of the LH surge are correlated with problems such as polycystic ovary syndrome (PCOS), suggest premature menopause and diminished ovarian reserve or a genetic or congenital condition that affects the production of hormones. Low LH levels are associated with irregular or absent menstruation or problems with the pituitary gland.
Estradiol (E2 blood test): Secreted by maturing follicles, estradiol is a form of estrogen, the major female reproductive hormone. High levels of estradiol are another sign that your body is having to work especially hard to produce eggs, and can mean your ovarian reserve is getting low, or they could be pointing to an issue with the thyroid. Elevated levels can also interfere with the function of FSH and the ovulation process. Low levels of estradiol can point to PCOS or pituitary issues.
Prolactin (Prolactin blood test): Prolactin is related to your thyroid and pituitary function. It is a hormone which regulates and inhibits FHH and (FSH) and gonadotropin-releasing hormone (GnRH). If your prolactin levels are elevated, you may have problems with ovulation. High levels can indicate hypothyroidism or problems with your pituitary gland and is sometimes related to PCOS.
Antral follicle count (ultrasound)
Your ovarian follicles hold all the immature eggs awaiting their chance to mature, and are present in various stages of growth. Antral follicles are just large enough to be seen and counted with the help of an ultrasound. The more antral follicles you have, the more microscopic primordial follicles (holding immature eggs) you are likely to have. A high follicle count indicates a healthy ovarian reserve, while a low count suggests that the reserve is diminishing.
Diagnostic fertility tests for women
For many women, the above tests are enough to determine the state of their ovarian reserve and their current level of reproductive function. If the tests do indicate a problem, your fertility specialist is likely to order further testing to get you a clear diagnosis and help you formulate a plan of treatment or fertility preservation. These are some more advanced fertility tests which can give your fertility specialist valuable information about your reproductive health.
Cervical mucus test
Problems with cervical mucus can get in the way of conception. Issues with consistency can make it difficult for sperm to reach the egg at all, while hostile antibodies in cervical mucus can actually kill sperm before they have a chance to fertilize the egg. A cervical mucus test allows fertility experts to examine a sample of cervical mucus to ensure that everything is in order.
A hysterosalpingogram is a special type of x-ray conducted with a radio-opaque dye to allow your doctor to see whether there are any blockages in your uterus or fallopian tubes which could affect your ability to get pregnant or carry a pregnancy to term.
A hysteroscope test uses a small camera inserted through the cervix into the uterus. If an HSG test shows that there may be an issue with your uterus, a hysteroscopy can be used to allow a fertility specialist to look for scarring, growths, or other abnormalities and take pictures of any findings.
Saline hysterogram (SHG)
Also known as a saline infusion sonogram (SIS), water ultrasound, or sono-hysterogram, this test takes place during a transvaginal ultrasound. Saline solution is injected into the uterus using a tiny catheter inserted through the cervix. This expands the walls of the uterus and allows the fertility expert to check for fibroids, polyps, or other growths in the uterine wall.
A laparoscopy is an exploratory procedure performed under general anaesthesia, where a tiny fibre optic camera is inserted into the abdominal cavity. This camera allows the surgeon a clear view of the ovaries, fallopian tubes, and uterus, and can be used to look for problems such as scarring, adhesions, and endometriosis deposits. Often, the surgeon can remove these abnormalities during the laparoscopy using a laser.
An endometrial biopsy is performed when doctors suspect that the lining of your uterus may not be thick enough to allow a fertilized egg to implant. The procedure takes place just before the start of menstruation. A tiny sample of tissue is scraped from the lining (endometrium) to check whether hormones are working to thicken the lining. It can also reveal the inflammation or infection of the endometrium.
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