Obstetrics » Infertility
Couples may be considered infertile if they have been unable to conceive after having intercourse without the use of birth control for 12 months or longer. Infertility may be caused by more than one factor. Some factors are easily identified and treated successfully while many times the reasons for infertility are unknown. The decision to go through infertility work up is usually dependant on the age of the couple and amount of time they have been trying to conceive.

TESTING

Physical exam
Medical history
Semen analysis
Check for ovulation
Check tubal patency
Check times of cycle and frequency of intercourse


There are 2 methods to check ovulation:

Basal body temperature charts- keep daily recording of first morning temperature

Ovulation predictor kit- ovulation is determined through morning urine sample by measuring the luteinizing hormone (LH) in the urine. When LH levels rise, it means one of your ovaries is about to release an egg. (this is the easiest way)

Semen analysis- Looks at size and shape of individual sperm sample. Checks ability of sperm to move. Mobility is one of the most important factors in the sperm’s ability to fertilize the egg.

Post coital test also called the Huhner test. Cervical secretions are obtained after intercourse and analyzed under a microscope to discern problems with the interaction of sperm and cervical mucus.

Clomid- Used to treat ovulatory disorders. Helps non-ovulating women conceive by stimulating the ovaries to produce an egg.

HSG (hysterosalpingogram)- An x-ray study in which dye is injected into the uterus to show the body of the uterus and whether the fallopian tubes are opened.

PCOS

PCOS (Polycystic Ovaian Syndrome) has been found to be the most common cause of anovulation and infertility. Women with PCOS do not ovulate (release eggs) on a regular monthly basis and therefore have irregular menstrual cycles. On ultrasounds, it is common to see several small cystic structures which gives the ovaries a "polycyctic" (many cysts) view on the ultrasound.

Making the diagnosis:
  1. symptons and physical findings
  2. hormonal testing
  3. ultrasound
Treatment:

Glucophage 500mg twice a day for 3 months. After taking the medication for three months, you will come in for an evaluation and a liver enzyme functioning test. If at that time, the liver enzymes are elevated the glucophage will be discontinued and you will be referred to an internist for further evaluation. If the lab work is normal, you will continue taking the medication with further follower up.