When you arrive at your appointment, you and your partner will meet with your physician and usually first discuss what has led you to seek out an evaluation. This discussion will often include a review of your medical history, the details of your attempts so far to get pregnant, and an overview of the tests and procedures which will help diagnose or rule out causes of infertility. Oftentimes the doctor will also give you a brief summary of the treatment options available if you are diagnosed with infertility so you are aware of what the next steps are should you be diagnosed.

The Basic Infertility Evaluation

The infertility evaluation can seem to be a daunting experience, but it is usually painless, and might be quite fascinating, and probably stressful. Both partners are being tested and there are feelings of "pass or fail" and a real sense of despair should a test come back showing questionable or undesirable results. It helps to know what to expect, to be informed and aware of how it will feel and what the doctor is hoping to find.

Continue on to read about the male and female workup, and what to expect after your evaluation appointment.

The Female Work-up

After your medical history has been thoroughly reviewed, you can expect a full physical examination. The doctor will be looking for signs of unrecognized hormone or medical problems. You can also expect a pelvic examination. The doctor will be looking for signs of pain, infection, masses, or scar tissue that may be present in your pelvis. It is also very common to receive a vaginal ultrasound examination of the pelvis as well. Many abnormalities cannot be felt, and the ultrasound probe works like "x-ray vision" to look into and measure all the important pelvis structures. Unless you have endometriosis or bad scar tissue, this examination should be painless. You can also expect to have blood drawn for numerous blood tests. The doctor will want to make sure you do not have any underlying conditions that are hurting your fertility. Some of these blood tests need to be taken on the second to third day of your menstrual cycle (that is, during your period). Do not be surprised if they wish you to come to the office at this time of the month.

If abnormalities are found in your pelvis, the doctor may suggest that you have a surgery called a laparoscopy. This will be discussed elsewhere on this website in much greater detail. If your pelvic organs appear to be normal, the doctor may assume that your reproductive parts are working normally and no more physical tests may be needed for the time being.

The doctor may also suggest that you make sure that your tubes are open and the "plumbing" is all open and shaped normally. The most common way to test this is through an x-ray dye study test called a hysterosalpingogram (HSG). This test is done in the radiology departmant or in a special radiology (lead lined) room in the clinic. This test cramps a bit, but it is generally not too bad and usually only lasts about 10 - 15 seconds. The doctor puts a little nozzle in the cervix (the opening of the uterus) and slowly injects a liquid dye that blocks x-rays. X-ray films are then taken as the dye flows through the reproductive system, and pictures then show if the dye flows through the tubes freely. The dye is rapidly absorbed and leaves the body very quickly. The test also has the effect of washing the tubes open. Sometimes mucous or other debris can block normal tubal function and prevent the eggs, sperm, and embryos from moving freely through the system. The HSG can wash the tubes open and make them function to their best capacity for a year or more after the test.

The Male Work-up

If the man is able to have sexual intercourse, then the most important part of the male evaluation is the semen analysis. The fresh sperm must be evaluated under a microscope by an experienced professional to see if there are enough, if they swim properly, and if enough of them are shaped normally. Most clinics are fairly flexible in the manner you collect the specimen. If you live close to the lab, you can frequently make the sample at home. Sometimes special private areas are available in the clinic for this purpose. You should try not to be embarrassed about this part of the evaluation. This is where babies come from and the professionals at the medical office will not bat an eye. You need to realize that at fertility clinics, people are making and processing semen and sperm samples all the time. "Putting it in a cup" just goes with the territory.

Most clinics will suggest that you abstain from any type of sexual, activity for two to five days before you make the specimen. If you wait too long, a large number of old, bad sperm will build up in your system. If you have sex the day before analysis, your volume and count may be lower. Your doctor will tell you what they want you to do for their testing facility.

If semen abnormalities are discovered, then additional blood tests for the man may be ordered. Occasionally, referral to a urologist will be made. Do not be surprised if mild or moderate abnormalities are discovered. Most men nowadays have some type of abnormality. Have no fear if borderline issues are found: almost all of these conditions can be easily overcome with simple, common procedures (such as insemination).

After Your Appointment

Following your appointment, you may already have a diagnosis or your doctor may have some strong suspicions with regard to your situation. You may need to wait for test results which will provide additional information. No matter what, this is the time to relax and unwind, acknowledge the stress of the appointment, and know that whatever the findings, infertility can almost always be effectively treated.

Once you have a firm diagnosis, you can then review your options and begin to think about how you want to proceed. You doctor will probably have a lot of information for you to read and think about, so take your time and carefully consider your treatment options. As you move forward, remember to take good care of yourself and be aware of the emotional impacts an infertility diagnosis can have.