The Infertility Workup 101

Although we are very good at what we do, the diagnostic work up is pretty straight forward, for most couples.  I should add, its very important to finish this evaluation before recommending in vitro fertilization (IVF) or other advanced reproductive techniques.  IVF works well for many couples but many couples probably go through IVF who don’t really need it. The worst situation is to go through IVF and not to get pregnant, multiple times.  My first patient like this came to me having spent $25,000 (in 1989 dollars), failing IVF 3 times and still not knowing why she wasn’t getting pregnant. Turns out she had endometriosis and this story repeats itself over and over (http://ow.ly/1bJAb).

So, what I tell my patients when we first meet, is this:

There are 5 basic reasons why couples can’t conceive.

1) Male factor infertility – get a semen analysis

2) Cervical problems (rare in my opinion)

3) Blocked fallopian tubes or problems inside the uterus (get an HSG and/or sonohysterogram)

4) Ovulation problems – obtain hormone testing (TSH, Prl, FSH, estradiol, testosterone, DHEA-S, day 21 progesterone)

5) Endometriosis – consider a laparoscopy for diagnosis AND treatment of endometriosis

That’s it! Most couples will be quickly sorted out using this simple approach. Skip one of these steps and you may end up very unhappy with the results.  Case in point, see the following email I received from a doctor in Kentucky

 To: Bruce Lessey, MD


Subject: Thanks 

Dear Bruce,  Thanks so much for being so kind to my patient Ginger xxx. She is a very nice lady and is a statistics professor at one of the local universities. I wasn’t aware that she was going to call you until she brought a typed summary letter from her conversation with you, to her appointment later that day. I hope her call was not too much of an inconvenience for you. Both she and I appreciated your suggestions regarding treatment, and I thought I would give you a little follow-up on her. As she mentioned to you she has done 3 fresh IVF cycles and one FET which resulted in a biochemical pregnancy with a peak hCG of only 12. In each of her cycles she stimulated well and had good blastocysts, but never had a successful outcome.  In the cycle following her laparoscopy and ablation of endometriosis, she conceived on her own and is now 7 weeks pregnant with a viable IUP!  Needless to say, she is thrilled.

And so are we. Endometriosis Awareness Month starts March 1, please contact us with any questions you may have at fcc@ghs.org