Infertility Evaluation

For pregnancy to occur, both male and female fertility is required. In men, healthy sperm must be adequately produced and effectively ejaculated into the vagina. In women, the ovaries should release healthy eggs, and the fallopian tubes should provide a clear path for sperm to travel to the egg for fertilization and allow the fertilized embryo to migrate to the uterus for implantation.

Infertility Diagnosis

Your doctor will ask you about your sexual habits and explain how to improve the chance of pregnancy and order appropriate infertility tests to pinpoint the cause. However, in some people, infertility may be unexplained.

Tests for Men:

Semen Analysis
In case of abnormal semen analysis, the following tests could help find the causes:

1. Physical exam including genital examination
2. Hormone testing to check the level of testosterone
3. Genetic testing to find out if there are genetic disorders
4. Testicular biopsy
5. Imaging tests such as MRI, transrectal ultrasound, and vasography

Tests for Women:

• Physical exam, including a gynecological exam
• Ovulation testing
• Hysterosalpingography to see if there is a blockage in the fallopian tubes
• Ovarian reserve testing and pituitary hormone testing
• Imaging tests of the uterine cavity and ovaries (Transvaginal ultrasound)
• Hysteroscopy
• Laparoscopy to check if there are any abnormalities of the fallopian tubes, ovaries, or uterus

The doctor will choose personalized and appropriate diagnostic modalities.

Treatment

Your doctor will consider your age, the cause of infertility, the duration of attempts for conception, and your preferences to provide a suitable treatment. If you cannot achieve spontaneous pregnancy after following the doctor’s recommendation, assisted reproductive technology may be suggested.

Treatment for men:

• Lifestyle modification can increase the success rate of pregnancy, such as beginning a regular exercise routine, increasing the frequency of sexual intercourse, quitting smoking, etc.
• Medications to improve the quality and production of sperm.
• Surgery to repair a varicocele, reverse a sperm blockage, or retrieve sperm.

Treatment for women:

• Fertility medications can help regulate and induce ovulation.
• Intrauterine insemination (IUI) facilitates fertilization by placing healthy sperm in the uterus during ovulation. 
• Fertility restoration surgery for those who have uterine problems such as a uterine septum, intrauterine adhesions, or endometrial polyps.

Assisted Reproductive Technology

In vitro fertilization (IVF) is one of the most effective infertility treatments. It may involve:

• Intracytoplasmic sperm injection (ICSI).
• Assisted hatching
• Gestational carrier
• Donor eggs or sperm

Complications of treatment

• Infection or bleeding
• Multiple births
• Ovarian hyperstimulation syndrome (OHSS)

Preparation

Coping with infertility can be challenging and emotionally exhausting. Before starting the infertility treatment journey, you and your partner should be prepared for the uncertain outcomes, decide how many fertility treatments are financially and emotionally acceptable, and consider the risk of multiple births or alternatives like adoption or having no baby. It is possible that after repeated attempts, you may have a miscarriage, or the conception may not occur.

Communicate with your doctor, friends, or loved ones who can provide support. Expressing how you feel can help lower stress. And always keep yourself healthy with regular exercise and healthy foods.

Before consulting the infertility issues with a doctor, you can:

• Take note of your attempts for conception, such as how long you have been trying and how often you have sexual intercourse.
• List the medical condition you have and the medications you are taking.
• Write down questions you would like to ask your doctor.

For example:

• What are the causes of our infertility?
• Do we need to undergo any tests?
• What treatments are suitable for us? What are the side effects?
• Are there any complications related to the treatments?
• How often should we try the treatments?

Your doctor may ask:

Questions for couples

Possible questions for couples include:

• How long have you been trying for pregnancy?
• How often do you have sex?
• Do you smoke or drink alcohol regularly?
• Are you taking any medications?
• Do you exercise regularly?
• What is your eating habit?

Questions for men

• Have you had a child before?
• Do you have any difficulties during sex or low sexual desire?
• Do you have any testicular pain?
• Do you take a hot bath or shower?

Questions for the woman

• When did you have your first menstruation?
• Is your menstruation regular or heavy?
• Have you ever been pregnant?

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