infertility

infertility

At Gwinnett Ob-Gyn Associates, we offer testing to evaluate infertility. About 10% of couples battle infertility, so you are not alone. If you have not been able to conceive after 6-12 months of having intercourse without using contraception, you may have an infertility issue. A woman’s age is an important factor in problems with infertility. Talk with your doctor about how long to wait before seeking an infertility evaluation.

In order to achieve a successful pregnancy, there are many processes that have to be working together. It all starts when a woman’s ovary releases an egg. This is called ovulation. It usually occurs about 14 days before the first day of your menstrual cycle. So, if you have regular monthly cycles, ovulation is about half way between the first day of your cycle and the first day of the next cycle. After ovulation occurs, there is a small time window that you have for the egg to be fertilized, usually about 12-24 hours. This is why timing of intercourse is important. When the man ejaculates during intercourse, his semen travels up through the vagina, into the woman’s cervix and then into the woman’s uterus. Semen contains the sperm that will then fertilize the egg when it meets it in the fallopian tube. The sperm can live in those tubes for about 3-5 days. When the sperm and the egg combine, it is called fertilization.

Once fertilization occurs, the fertilized egg moves down the tube and into the uterus where it attaches within the uterine lining and starts to grow.

Infertility issues can occur if there is a problem with any of the above steps.

Infertility testing looks at each of the steps in the process of getting pregnant to test whether or not there is a problem with any of those steps.

Your Testing for Infertility May Include:

  • Medical history – includes menstrual, pregnancy, and sexual history of both partners
  • Physical exam- including testing for sexually transmitted diseases (STDs)
  • Bloodwork to check various hormones including thyroid hormones. Some of these lab tests are done on certain days of your cycle.
  • Testing for ovulation- we recommend both ovulation predictor kits (OPK)s as well as a blood test in the office
  • Semen analysis- your partner will need to contact his primary care physician or we can refer him to a urologist to perform this test. Please have the results sent to our office.

Tests to check to make sure the uterus is normal and the fallopian tubes are open- this can include ultrasound and a hysterosalpingogram (HSG)- this is a radiology procedure that checks to see if your tubes are open. We ask you to call the office on the first day of your cycle to schedule this procedure for around cycle day # 7. It is very important that once your cycle starts, you do not have intercourse until this test is completed. On the day of the procedure, you will come by our office for a urine pregnancy test, then check in at admissions at Eastside Hospital. One of our doctors will meet you in the radiology suite at the hospital. We will place a speculum in the vagina and insert a long thin tube into your uterus through the cervix. Dye is then injected through the thin tube in order to see if the uterine cavity looks normal and to see if your tubes are open.

Laparoscopy- an outpatient surgery where a small camera is placed into your belly in order to directly visualize how the inside of your abdomen and pelvis looks.

We will work with you to develop a treatment plan for infertility based on your test results. Some ways to help may include lifestyle changes, medication, surgery, or referral to a reproductive endocrinologist (doctor who specializes in assisted reproductive technology). We do offer the oral medication Clomid in our practice to induce ovulation in women with ovulation issues. Here is further information about Clomid.

Clomid

Clomid is used in doses of 50, 100 or 150 mg. We start with the smallest dose and then gradually increase depending on the patient’s response. The goal is to help the ovary release an egg. Most women tolerate the side effects of this medication well, but you may experience bloating, cramping, pelvic pain, weight gain, acne.

There is a small increased risk of multiple pregnancy (twins, triplets). There is also a small increased risk of ovarian hyperstimulation, so we encourage you to report any sudden pelvic pain or increasing abdominal size to your doctor.

Clomid is taken for 5 days in the early part of your cycle, on the days as directed by your doctor or nurse practitioner. We then test to see if you have ovulated that cycle with a blood test that checks your progesterone level. If you do not get pregnant that cycle, we see you back in the office to review what happened and do an exam.Once you have ovulated, we continue that same clomid dose for three total cycles.

If you don’t get pregnant after three ovulatory cycles, we then discuss the next steps, which may include seeing a reproductive endocrinologist. We have several local groups that we have a relationship with to whom we can refer.

We know infertility can be challenging and emotionally draining. We hope you will let us know if there are any questions or problems along the way. 

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