Saturday, April 24, 2010

Why can't I get pregnant

Most women spend many years of their life trying NOT to get pregnant and then a fair amount of them won't be able to conceive when they want. Don't tell my mom, but this is what happened to me. I'm not the most patient person, so when I wanted to have a baby at age 34, I wanted to conceive the first time I had sex with my husband. I was certain this would happen- afterall, I'm a Gynecologist. I know all the tricks! As you can probably guess, this didn't happen to me!! SOOOOOOOOOOOOOOOOO frustrating!!!! Especially when I do this job- with pregnant women and babies and talking about getting pregnant is what I do all day long. Even my husband and family members would tell me, "try not to think about it.... it will happen in time." Yeah right- easier said than done.

Certainly, I'm not alone in feeling this way . This is a common condition as 15 percent of the couples in the United States who are trying to conceive are not able to do so.

So, the big questions raised is why? The following is a general overview of the tests that I usually order when a patient comes to see me for infertility.

EVALUATION OF INFERTILITY IN MEN — A healthcare provider (not me ! I don't do men anymore- usually the family practitioner) usually begins with a medical history and physical of the the dad to be. I WILL give the father to be an order for a semen analysis and a specimen cup. . A man should avoid sex and masturbation for two to seven days ( do you think its possible?) before providing the semen sample. Ideally, a sample should be collected in a clinician's office after masturbation (yes, they have special rooms with magazines and movies to help ; if this is not possible, the man may be allowed to collect a sample at home in a sterile laboratory container. The sample should be delivered to the lab (usually University Pointe in West Chester) within one hour of collection. The cost of this test is about $65
If the initial semen analysis is abnormal, I will often request an additional sample; this is best done one to two weeks later.


Medical history — A woman's past health and medical history may provide some clues about the cause of infertility. I will ask about childhood development; sexual development during puberty; sexual history; illnesses and infections; surgeries; medications used; exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility evaluations.

Physical examination — A physical examination usually includes a general examination, with special attention to any signs of hormone deficiency or signs of other conditions that might impair fertility. I will also perform a pelvic examination, which can identify abnormalities of the reproductive tract and signs of low hormone levels.

Blood tests — Blood tests can provide information about the levels of several hormones that play a role in female These hormones include follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin.

Tests to evaluate ovulation — Ovulation (the release of an egg from an ovary) is essential for fertility. Abnormalities of ovulation can often be determined from a woman's menstrual history or hormone levels such LH or progesterone

Menstrual history — Amenorrhea (absent menstrual periods) usually signals an absence of ovulation, which can cause infertility. Irregular menstrual cycles can be a sign of irregular ovulation.

Basal body temperature — Monitoring of basal body temperature (measured before getting out of bed in the morning A woman's temperature usually rises by 0.5ºF to 1.0ºF after ovulation.
Hormone levels — Levels of luteinizing hormone (LH) rise abruptly approximately 38 hours before ovulation. This hormone surge can be detected using an over-the-counter home urine test. However, this kit fails to detect the hormone surge about 15 percent of the time. Therefore, sometimes I may recommend a blood test to confirm ovulation- the progesterone test.

Tests to evaluate the uterus and fallopian tubes — Uterine abnormalities that can contribute to infertility include congenital (present from birth) structural abnormalities, such as a uterine septum, fibroids and uterine polyps.

Scarring of the fallopian tubes can occur due to pelvic inflammatory disease, endometriosis or scar tissue from prior infections or surgery.

Hysterosalpingogram — Hysterosalpingogram (HSG) is used to help identify structural abnormalities of the uterus and fallopian tubes. It involves inserting a small catheter through the cervix and into the uterus. A liquid dye is injected through the catheter, which fills the uterus and fallopian tubes. An x-ray is taken after the dye is injected, which shows the outline of the uterus and tubes . An abnormally shaped uterus or blocked fallopian tube would be visible on the x-ray. I always tell patients that this test hurts- it's quick, but it hurts.

Pelvic ultrasound — This is used to measure the size and shape of the uterus and ovaries, and to determine if there are structural abnormalities (such as fibroids or ovarian cysts). If abnormalities are seen, further testing may be needed.

Laparoscopy — During laparoscopy, a thin, lighted tube is inserted through a small incision in the abdomen while the patient is asleep under anesthesia. . Laparoscopy allows me to detect damage and obstruction of the fallopian tubes, endometriosis, and other abnormalities of the pelvic structures. This is the best test for diagnosis of endometriosis or pelvic adhesions (scarring). Furthermore, endometriosis can be treated during laparoscopy, which can help to improve pregnancy rates. However, laparoscopy is not routinely done during an evaluation of infertility.

EMOTIONAL SUPPORT DURING INFERTILITY EVALUATION — The process of trying to become pregnant and the inability to do so can lead to a variety of emotions, including anxiety, depression, anger, shame, and guilt. I personally became obscessed with trying to get pregnant. It takes over all your thoughts!! Some experts suggest relaxation techniques, stress-management, coping skills training, and group support. Those options are great but what I've found is that patients and myself feel so much better when we (patient and doctor) are DOING something to help speed up this process. Because, in my experience the best way to make this all well and good is to get pregnant!!!!!