Fertility evaluations for conditions such as PCOS, Endometriosis, Male Factor, and more.
Identifying the cause of infertility, the roadblock that stands between you and a baby, is the critical first step in devising a fertility treatment plan. Your Texas Fertility Center evaluation will begin with a consultation. At this time, one of our renowned fertility specialists will determine a course of action to diagnose and overcome infertility,unexplained infertility, or secondary infertility. As infertility is a medical condition that affects the couple, we always recommend that both partners fully participate in the evaluation.
Texas Fertility Center favors an organic, straightforward approach to diagnosis. For some couples, treatment will simply involve timing intercourse to maximize the chances for conception. For women diagnosed with more involved conditions such as endometriosis, pelvic adhesions, or ovulatory problems including polycystic ovarian syndrome, we will proceed with evidence-based, targeted treatments.
Precise Female Infertility Evaluation to pinpoint Fertility Treatment
- Initial Consultation
- Male Fertility Evaluation
- Surgical Evaluation
- Follow-Up Consultation
- Recurrent Miscarriage Evaluation (Special Testing)
Because infertility is a problem that affects both the male and female partners in a couple, it is very important that both members be present for the initial consultation. This meeting typically lasts 30 to 45 minutes and involves multiple components. The first component is to establish whether or not an evaluation is warranted. The physician will begin by taking a complete medical history of both the female and male partner, which will include details regarding the menstrual cycle, previous surgeries, infections and pregnancies and other health conditions that can impact fertility. These details are important in trying to establish any identifiable risk factors for infertility from either of the partner’s previous medical histories.
Another important component of the initial consultation is to educate the couple about normal reproductive function. All too often, the last exposure that many couples had to any formal instruction was during high school sex education classes, and much of their current knowledge may not be based on fact. Often times, there are many myths and misperceptions that have to be addressed and corrected in order to help a couple understand normal reproductive physiology. This also helps the couple better understand normal statistics regarding fertility, the various causes of infertility, and the rationale for treatment. Preconception counseling regarding lifestyle and health factors including smoking, alcohol consumption and exercise are also addressed at this time. Once the initial consultation has taken place, the physician will establish a plan for a diagnostic evaluation.
The goal of the fertility evaluation is to identify a specific cause or causes of infertility, and to then recommend appropriate targeted treatments. The most common cause of female infertility is a disorder in ovulation. Significant information can be obtained from a menstrual history including cycle length and variability, as well as duration of menstrual flow and age of menarche (your first period). There are several ways to determine if ovulation occurs normally, including basal body temperature charting, ovulation predictor kits, and serial ultrasonography.
The evaluation of ovarian reserve, which refers to the number and quality of oocytes remaining in a woman’s ovary, is often performed as part of the ovulation assessment. Ovarian reserve testing typically involves measurement of the hormones follicle stimulating hormone (FSH) and estradiol (E2) on cycle day two, three, or four, as well as an ultrasound evaluation of the number of follicles within the ovaries early in the menstrual cycle. The final part of the evaluation of ovulation is a determination of the length of the post ovulatory, or luteal, phase. This time frame, which includes the time from ovulation until the onset of the next menstrual bleed, should be 12-14 days in length.
The next component of the female infertility evaluation is an assessment of the uterus and the fallopian tubes. This is most commonly accomplished with a procedure called a hysterosalpingogram (HSG), which involves a radiologic evaluation performed after a woman’s flow has ceased, but prior to ovulation. The HSG involves placement of a small catheter through the opening of the cervix in order to pass dye into the uterus and the fallopian tubes. In addition to determining whether the tubes are open (patent) and normal, the HSG can also diagnose any type of structural abnormalities of the uterus, such as congenital anomalies (birth defects), polyps or fibroids.
In specific situations, such as when a woman has a history of severe or worsening menstrual cramping or a strong family history of endometriosis, your physician may recommend an outpatient surgical procedure known as laparoscopy for further evaluation of the pelvic anatomy.
Male Factor Infertility Evaluations
As with the female, the goal of the male fertility evaluation is to identify a specific cause or causes of infertility, and to then recommend appropriate targeted treatment. The basic evaluation consists of a history – during which time previous fertility, medical conditions, surgeries, sexually transmitted diseases, and lifestyle issues will be discussed. A family history, looking for infertility, miscarriages, or other diseases will also be evaluated. The primary test of male fertility is the semen analysis. This test is critical, as it evaluates the sperm concentration as well as motility (the percent of sperm that are alive and swimming) and morphology (shape). If the semen analysis is abnormal, or if there is something in the male’s history that suggests an anatomic abnormality, then we will probably refer him to a urologist for a physical examination. We may also recommend a blood test to check the hormone levels that influence sperm production, including FSH, LH, and testosterone.
In some cases, male factor infertility is the cause of the problem.. After taking a comprehensive medical history and reviewing all previous medical testing on your partner, we may recommend additional testing as well as a consultation with a urologist for a more advanced evaluation.
For more information on Male Infertility
An integral part of the female fertility evaluation is an assessment of the reproductive anatomy – specifically the fallopian tubes, the uterus, and the ovaries. If an abnormality is discovered, it is usually correctable through the performance of a relatively minor surgical procedure, such as laparoscopy or hysteroscopy. Each of these procedures is discussed in great detail in the surgical section of our web site.
If we determine that you need surgery, we will refer you to our surgical coordinator whose sole job is to handle all of the details involved in scheduling your procedure – answering your questions as well as coordinating the scheduling of the surgery between your physician, the surgery center or hospital, and your insurance company. The surgical coordinator will also arrange for a preoperative evaluation with your physician who will thoroughly discuss your procedure with you in detail, including the risks of the procedure, the expected outcome, and what you can expect following surgery. Our nursing staff calls every surgery patient following surgery to ensure that you are recovering as expected, to review the intraoperative findings with you, and to answer any additional questions that you may have. At that time, they will also schedule a postoperative visit with your physician.
Once the diagnostic portion of the fertility evaluation has been completed, the physician will typically schedule a meeting with you and your partner to review all of the results of the testing and to discuss treatment recommendations. This is another opportunity for you to discuss the success rates and risks of any recommended treatment, as well as the costs and time commitment required for each. Following your consultation, a treatment plan will be established and you will begin your fertility journey.