Approximately 40% of infertility is related to the female, 30% to the male – in 20% there may be a combined problem (10% of infertility is unexplained). For that reason patients are encouraged to come in as a couple to review both partners’ history. The female history will focus on the menstrual cycle, which gives a good idea as to whether ovulation may be the issue, as well as surgical and infectious disease history that may point to an anatomic problem. The male history will focus on problems that affect sperm production, i.e. surgeries, infections, adverse environmental exposures. A good history from both partners will go a long way in identifying a probable cause(s).
Generally, a physical exam is not performed on the first visit unless there is something which clearly points to an anatomic problem, i.e. fibroids tumors, ovarian cyst, or very low sperm count. In the case of a female anatomic problem most often a vaginal ultrasound will be performed to visualize the uterus and the ovaries. If a male anatomic problem is suspected, an exam of the testicles and phallus will be performed.
If ovulation is a problem, most often an endocrine panel will be drawn to determine the cause. This will help determine the most appropriate fertility medication. If the female history points to an anatomic problem most often a hysterosalpingogram or laparoscopy will be ordered. A hysterosalpingogram is an outpatient procedure performed in radiology whereby the physician injects a radio opaque dye through the cervix and can look at the contours of the uterine cavity as well as determine tubal patency. A laparoscopy is an outpatient surgical procedure performed under general anesthesia. If pathology is found laparoscopic operating instruments can be introduced to correct the problem.
If a couple has already had a complete work-up and there is a clearly identified cause(s) for infertility an immediate treatment plan will be outlined. At the Florida Institute for Reproductive Medicine we will review costs of tests and treatments and will check with your insurance company to determine coverage.