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Infertility Cubby

Infertility Workup For Women

In general, if attempts at pregnancy have failed for a full year, it is reasonable to seek the advice of a fertility expert. Earlier intervention may be warranted if one of the partners has a history of injury or illness that could affect fertility, or if the woman is over age 35, since female fertility declines with age.

A Word About Weight
Being too thin or too heavy can reduce fertility. Very low body fat stores can result in hormonal imbalances that cause menstrual cycles to be irregular or absent. Ovulation can also be adversely affected when a woman accumulates too much body fat. Achieving and maintaining a healthy body weight is important in preparing for a pregnancy. Discuss any eating disorders with your health care provider.

A Word About Exercise
Being physically fit prior to becoming pregnant helps a woman's body prepare for the challenges of pregnancy. However, excess amounts of strenuous activity can affect ovulation and reduce fertility. Endurance exercise, or any exercise routine that causes the body fat levels to fall too low can reduce estrogen levels, and even cause menstruation to stop. So, exercise regularly, but moderately.

A Word About Stress High levels of stress can temporarily decrease fertility. Stress can cause hormonal disturbances that may result in irregular menstrual cycles or skipped menstrual cycles. Infertility itself can cause stress to mount. Be sure to find time to rest and relax and have fun. Individual therapy, and couples counseling can be beneficial in dealing with stress.

The Medical Workup
A full workup to evaluate the woman may take place over several visits. The following table describes the most common tests that are performed.

Name of Test
Purpose
Considerations
Physical Exam
Certain physical characteristics imply hormonal imbalances.

A pelvic exam is done to detect obvious physical abnormalities to the reproductive organs.

May reveal reasons for infertility without costly or invasive tests.

Basal Body Temperature Charting

Tracking the body's temperature with a special thermometer can help to determine the date of ovulation and the length of the monthly cycles.

Inexpensive.

Must be done every morning before rising.

Cervical Mucus Observation

Checking the texture and fluidity of the cervical mucus helps to predict ovulation. The cervical discharge is usually white and sticky, but during ovulation the mucus becomes smoother, clearer and stringy so that the sperm can swim through it better.

No costs.

The woman checks her own cervical mucus everyday at home to help track ovulation.

Ovulation Prediction Kit

To determine the date of ovulation based on urine levels of LH.

Noninvasive.

Reasonably inexpensive.

Ultrasounds

An ultrasound can take a picture of the ovaries to see if eggs are maturing normally.

Noninvasive.

Postcoital Test

After intercourse the couple goes to the clinic. The cervical mucus is examined under a microscope to view quality of the cervical mucus and the ability of the sperm to live and swim through the mucus.

Requires pelvic exam.

Some couples find the test embarrassing.

Hysterosalpingogram

Dye is injected into the fallopian tubes and an X-ray is taken to view the tubes. Tubal blockages and some uterine abnormalities can be diagnosed.

Occasionally this flushing of the tubes can improve their function.

On the other hand, there is a slight risk of the procedure causing an infection.

Hormone Tests

Blood levels of FSH, LH, progesterone, estrogen and prolactin are obtained. These hormones are instrumental in the normal menstrual cycle and ovulation. Abnormal results can indicate the reason for infertility.

Test results may reveal the need for further testing with a hormone specialist. (Endocrinologist).

Endometrial Biopsy

A sample of the lining of the uterus (endometrium) is examined to see if the uterus is properly preparing for pregnancy. This test also helps to indicate if ovulation is occurring normally, as the hormones involved in ovulation play a role in uterine lining preparation.

Obtaining the sample may cause pain and cramping.

Hysteroscopy

A scope is passed through the cervix to view the interior of the uterus. This procedure can detect fibroids and adhesions, or other uterine abnormalities.

Non-surgical procedure. Local anesthesia.

Small growths and abnormal tissue can be removed with the hysteroscope.

Laparoscopy

A thin scope is inserted through the abdominal wall (often at the site of the navel). This allows the surgeon to view the external side of the reproductive organs. This test can diagnose endometriosis, adhesions to the tubes, and other pelvic abnormalities.

Surgical procedure requiring hospitalization and anesthesia.

Minor repairs can be made using the laparoscope, thus avoiding more invasive surgical procedures.

Expensive. Risk for infection or other damage due to the procedure.

 
Excerpted From Nutrition For You, Nutrition For Two

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