Infertility is defined as the inability to get pregnant after one year of unprotected sex (or six months if a woman is over age 35). If a couple is having trouble conceiving, the first step is usually to see a gynecologist who specializes in infertility. Here is an overview of what to expect during the infertility evaluation and treatment process with a gynecologist.
Medical History and Physical Exam
The first thing a gynecologist will do is take a complete medical history from both partners. They will ask about any previous pregnancies, sexual health issues, prior fertility treatments, family history of infertility, etc. The doctor will also perform a full physical exam, including a pelvic exam for the woman.
This information helps the doctor understand any underlying medical conditions or risk factors that could be contributing to infertility. It also establishes a baseline level of health before beginning any treatments.
If initial test results are normal, the gynecologist may recommend further diagnostic testing for both partners to pinpoint any causes of infertility. Common tests include:
- Blood tests to check hormones that regulate ovulation and pregnancy.
- Hysterosalpingogram (HSG) to examine the uterus and fallopian tubes.
- Ultrasounds to look at the ovaries, uterus, and testicles.
- Sperm analysis to evaluate sperm count, shape, and motility.
- Genetic testing to identify issues like chromosomal abnormalities.
For women, testing is geared towards assessing ovarian reserve, monitoring ovulation, and checking the openness of the fallopian tubes. In men, testing focuses on semen quality and production. These tests help categorize infertility issues, such as ovulatory disorders, uterine abnormalities, fallopian tube damage, or male factor infertility.
Once the root cause of infertility has been determined, the gynecologist will outline treatment options tailored to the diagnosis. Treatment plans can include:
Medications may be prescribed to regulate or induce ovulation. Common drugs include clomiphene citrate, gonadotropins, and aromatase inhibitors. Metformin may be used for infertility related to polycystic ovarian syndrome (PCOS).
Intrauterine Insemination (IUI)
IUI involves inserting prepared sperm directly into the uterus during ovulation to facilitate fertilization. It is often combined with fertility medications.
Surgery can be used to restore reproductive anatomy and function in some cases. Examples include removing uterine fibroids, repairing structural issues like a septum in the uterus, clearing blocked fallopian tubes, or varicocele repair in men.
Assisted Reproductive Technology (ART)
ART includes advanced techniques like in vitro fertilization (IVF) where eggs are harvested from the ovaries and fertilized by sperm in a lab. The embryo(s) are then transferred into the uterus. Other ART procedures include frozen embryo transfer (FET) and intracytoplasmic sperm injection (ICSI).
A gynecologist may suggest diet, exercise, stress reduction, smoking cessation,etc. to improve overall health prior to conception. For example, being overweight or underweight can affect fertility.
Sometimes gynecologists bring in other specialists like reproductive endocrinologists, urologists, or genetic counselors to assist with diagnosis and treatment. They may also require referral letters to get approvals for certain procedures like IVF from insurance companies.
The gynecologist will monitor patients throughout treatment to track progress. Follow-up tests and appointments are meant to adjust medications if needed, pinpoint optimal timing for procedures, and evaluate the effectiveness of interventions:
- Bloodwork and ultrasounds to monitor follicle development, ovulation, and uterine lining thickness during medicated cycles.
- Post-procedure checks after IUI, surgery, or embryo transfer to see if pregnancy occurred.
- HSG or saline sonogram after surgery to confirm normal anatomy.
- Semen analysis to check improvement after varicocele repair.
Follow-up testing helps inform the next steps if initial fertility treatments fail. The gynecologist may suggest adjusting the treatment plan, exploring additional testing, considering IVF or donor options, etc.
When to Seek a Reproductive Endocrinology Specialist
Gynecologists can manage basic infertility evaluations and treatments like ovarian reserve testing, IUI, and clomiphene citrate ovulation induction. However, reproductive endocrinologists specialize entirely in more complex areas of infertility and assisted reproduction.
A reproductive endocrinologist may be recommended in these situations:
- Failed cycles of oral ovulation induction drugs
- Tubal factor infertility
- Male factor infertility requiring IVF/ICSI
- Multiple failed IUI cycles
- Candidates for IVF or other advanced ART
- Recurrent pregnancy loss
- Poor ovarian reserve or premature ovarian failure
- Uterine factor infertility like fibroids/polyps, Mullerian anomalies, Asherman’s syndrome
- Unexplained infertility
Reproductive endocrinologists have specialized expertise in advanced diagnostic testing and ART procedures that general gynecologists do not typically perform. However, gynecologists and reproductive endocrinologists work closely together to care for infertility patients.
Questions to Ask Your Gynecologist
Here are some suggested questions to ask your gynecologist during infertility treatment:
|What are the most likely causes of infertility based on our test results?
|What are my ovarian reserve levels?
|Do I have ovulatory dysfunction, uterine abnormalities, tubal damage, or unexplained infertility?
|Does my partner have any issues with sperm count, motility, or morphology?
|What are our treatment options based on this diagnosis?
|What is the stepwise plan for treatment?
|How many cycles of oral medications or IUI do you recommend before moving to IVF?
|Do you think I may need a reproductive endocrinologist?
|What are the next diagnostic steps if initial treatment fails?
|Do you have any lifestyle recommendations to increase fertility?
Tracking key milestones, test results, procedures, medications, and lifestyle changes in a notebook or app can help you stay organized during the process. Don’t be afraid to be your own advocate and speak up if you have concerns.
Infertility Support Groups
Seeking emotional support during infertility is also crucial. Isolation and frustration are common experiences. Connecting with others who understand can provide hope, empathy and resources. Some support options include:
- In-person, online, or phone-based support groups
- Individual or couples counseling
- Online forums and communities for infertility
- Apps to connect with those experiencing similar issues
- Blogging, journaling, or vlogging about your journey
Support networks allow couples to share their stories, provide guidance, and trade practical tips for coping with the stresses of infertility treatment. They can make the journey feel less lonely.
Seeing a gynecologist for an infertility evaluation is the first step for couples who have been unable to conceive. The gynecologist will obtain a medical history, perform physical exams, order diagnostic testing, and offer treatment recommendations based on those results. Treatment can range from oral medications that induce ovulation to advanced assisted reproductive techniques like IVF.
It is important to monitor treatment progress closely and ask the gynecologist questions every step of the way. If initial treatments are unsuccessful, a reproductive endocrinologist may be consulted for their expertise. Seeking emotional support is also key as infertility can take a toll mentally and physically. With patience and the right medical guidance, most couples are able to build their families despite infertility.