[beginning fertility issues]

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Written by TTC Couples.

 

Low-Tech Ways to Help You Conceive - Chapter 14

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Low-Tech Ways to
Help You Conceive


14. WHEN YOU'VE TRIED EVERYTHING ELSE,
AND IT'S TIME TO SEEK MEDICAL ASSISTANCE:


I've been where you are. It is frustrating! You've probably hear the standard "one year of trying" rule, but I've also read that if you are over 30, it isn't a bad idea to have some tests done. Based on personal experience, I would seek out the best board-certified reproductive endocrinologist in your area and make a appointment. It may take a couple of months to get in to see him or her and by that time it'll be close to a year. Hopefully, things will work out by then and you won't need to see the doctor, but it'll be good to have in your back pocket. I know some OB/GYNs are good, but an RE specializes in getting people pregnant. I've heard some scary stories about OB/GYNs.


We have been trying for 2 1/2 years. I'm 36. When we got to about the point where we are, I finally asked my OB/GYN for a reference to a fertility specialist. She gave me one and I went for an appointment last November. After taking our histories, he did two fairly basic procedures. The first is a sperm count/test for my husband. The second was a test called HSG to see if my tubes were open. My tubes were open. He recommended that we try a drug called Clomid and do intrauterine insemination at the same time. (The husband's sperm is inserted directly into the uterus with a small catheter) The IUI is relatively painless, not much worse than a pap for most. I am a CPA and was very busy during tax season, so I took the drug, but never made it for the inseminations. After tax season, I began seeing the same RE (reproductive endocrinologist) again. This time, he recommended that I have a laparascopy which is an outpatient surgery where the doctor goes in through the belly button and examines the outside of uterus and ovaries and tubes. At the same time, they did a hysteroscopy which allows the doc to see the inside of uterus. They correct any problems found like endometriosis with a lazer. I had the surgery on Thursday and was back at work the next Monday. The doc corrected some small problems like a polyp, a cyst and some small amounts of endometriosis. Since he found some problems, he suggested we try IUI without drugs for 3 months. I am now on the third month and should know by Monday whether it worked this month of not. I use ovulation kits to detect my surge and then go in the next day for the procedure. My husband provides the sample for me at home (we are close to doctor's office and lab). I will move on to IUI with drugs next month if no success this month. My first suggestion to you is to find a good board-certified reproductive endocrinologist.


What is an RE?

An "RE" is a Reproductive Endocrinologist. We are physicians with special training and certification in the area of the endocrinology of reproduction and infertility. All RE's are first OB/GYN's who then do an additional two or three years of training and research. During this time, physicians are trained in the assisted reproductive technologies (ART's), microsurgery, and operative laparoscopy. Board certification in this subspecialty is very difficult and there are only ~500 certified RE's in the United States. Hope this has enlightened you, Dr. G.


My original post should have read "I've also read that if you are over 30, it isn't a bad idea to have some tests done after six months of trying." (I forgot to type the six month part!) I've read some of the posts from people who are in the same situation as [name] and many are questioning whether to see a reproductive endocrinologist or just their OB/GYN.

From my own experience (I've seen my regular OB/GYN, two GYNs who are "infertility specialists" but not REs and now a board-certified RE) I would definitely go right for the board-certified RE. When I first called RESOLVE after about a year of trying, they suggested that I find a board-certified RE, but I thought that I didn't need the "big guns" and would start with a local guy. My regular OB/GYN totally misinterpreted my husband's semen analysis, telling us he had a big problem. I know some OB/GYNs are good, but they just don't have the training of REs.

You've only got about 12 chances a year to get pregnant. An RE can get to the bottom of the problem (if there is one) by running the right tests and suggesting the proper treatment (not just clomid pills month after month after month without proper testing - which has happened to several people I know.)


Although you didn't state how long you have been trying or your age, most causes for women with past successful pregnancies is a low sperm count in the partner. This can be due to his age, diet, clothing, and exposure to tobacco, alcohol, drugs and workplace contaminants.

Your initial exam should include a thorough discussion of these factors for you and your partner. A physical exam should include a Pap smear, DNA testing for Chlamydia and Gonorrhea, and HPV virotypes as well as a viginal culture for Staph and Strep, if indicated. A wet mount slide may be done to rule out yeast and bacterial vaginosis (BV). You should begin to take your morning "Basal" temperature. That is, your body temp after at least [three] hours of sleep. Regardless of other instruction, you should take your temperature at the same time every day and should be taken vaginally. It takes a special thermometer that is easily found at any pharmacy. You will probably come back after 3 monts of temp taking.

[RAH -Oral temperature-taking is usually fine, unless you see a pattern of erratic temperatures, or you just prefer vaginal or rectal temperature-taking -- see Sec. 9.3). - RAH]

If you have a lot of money to spend, you can also have a hormone workup as well as using ovulation predictors but I think that these are premature before your partner gets a sperm count and you get your baseline tests done.

The fix to all this should be fairly simple. Please don't panic. Take your time and don't jump to advanced testing and drugs until the basics have been done correctly. By the way, the most accurate sperm count is obtained by using a special polyethylene condom that can be obtained from Milex company. This allows natural intercourse for collection rather that by masturbation. The volume of the condom samples is closer to the normal amount.


Unexplained Infertility is often caused by sperm that do not fertilize. This is all too often found out too late. After failed IUI cycles or more cancelled IVF cycle, quality eggs are retrieved only to lose them due to sperm fertililization problems.

Routine Semen Analysis will miss many subfertile and infertile males. Repeated IUI failures may be undetected male factors especially low sperm function.

New sperm function tests ( Capacitation and Acrosome test) are available to pre-test sperm samples prior to IUI, GIFT or IVF. Low test scores predict male factor infertility or subfertility and will result in successive failed IUI or IVF therapy. Acceptable test scores and a sufficient quantity of motile sperm will verify sperm fertilizability.


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