Struggling to get pregnant? What to know first

July 12, 2021

By Dr. Katie Shannon, OB-GYN with Clark Just for Women Health Solutions

Infertility in opposite-sex couples may be caused by many factors. Female factors are the cause of infertility about one third of the time, and male factors about a third of the time. For the remaining couples, infertility may be caused by a combination of factors in both partners or an unknown cause. 

The most common cause of female infertility is a problem with ovulation; for men, it’s a problem with sperm cells. Other factors may include:

  • Age: For healthy couples in their 20s or early 30s, the chance that a woman will get pregnant is about 25 to 30 percent in any single menstrual cycle. This percentage starts to decline in a woman’s early 30s. By age 40, the chance of getting pregnant drops to less than 10 percent per menstrual cycle. 
  • Lifestyle: Women who are underweight, overweight, or exercise too much may have a harder time getting pregnant. Smoking, drinking alcohol, and using marijuana can affect fertility in both men and women.
  • Health problems involving reproductive organs, hormones, and the thyroid or pituitary glands.

Dr. Katie ShannonWhen to consider an infertility evaluation
Experts recommend an infertility evaluation if you have not gotten pregnant after 1 year of having regular sexual intercourse without using birth control. If you are older than 35, an evaluation is recommended after 6 months of trying. If you are older than 40, talk with
your OB-GYN now about an evaluation.

At Clark Just for Women Health Solutions, we can initiate fertility testing for women who are having difficulty becoming pregnant. We may refer you to a specialist, but we can do much of the initial workup right here at Clark.

Seeing a specialist and testing
The first visit with a fertility specialist usually involves a detailed medical history and a physical exam. You will be asked questions about subjects including your menstrual period, any pelvic pain, medications, birth defects in your family, and use of tobacco, alcohol and other drugs. You and your partner also will be also asked about your sexual history, including methods of birth control and any difficulties you’ve experienced during sex.

Your specialist may recommend testing for infertility, which can include laboratory tests, imaging tests, and certain procedures. The infertility evaluation can be finished within a few menstrual cycles in most cases, and some health insurance plans may cover its cost.

Basic testing for men
Testing for a man often involves a semen analysis (sperm count), in which a semen sample is collected by masturbation or by using a special condom during intercourse. Blood tests can also be done to measure hormone levels, and other tests such as an ultrasound may be performed to look for problems in the reproductive organs.

Basic testing for women
In general, blood tests for women are done first. If no answers are found, imaging and other testing may be done.

Common ways to assess fertility in women include the following:

  • Urine LH test (ovulation predictor kits) — This test determines when and if you ovulate by detecting an increase in the levels of the hormone LH in your urine. A surge in the level of LH triggers the release of an egg. If the test result is positive, it suggests that ovulation will occur in the next 24 to 48 hours. This gives you an idea of the best time to have sex.
  • Progesterone test — A sample of blood is taken about 1 week before you expect your menstrual period to measure your progesterone level. An increased level shows that you have ovulated.
  • Thyroid function tests — Problems with the thyroid gland may cause infertility issues. If a thyroid problem is suspected, levels of hormones that control the thyroid gland are measured to see if it is working normally.
  • Prolactin level test — This blood test measures the level of the hormone prolactin, which can disrupt ovulation if it’s too high.
  • Tests of ovarian reserve — This term refers to a woman’s supply of eggs. Blood tests are used to check the remaining number of eggs in the ovaries.
  • Tracking basal body temperature (BBT) — A woman’s temperature rises around the time of ovulation. You can track this at home by taking your temperature by mouth every morning before you get out of bed. Record it on a chart for two or three menstrual cycles. Some women also monitor their cervical mucus while charting BBT. Just before ovulation, a woman’s cervical mucus is thin, slippery, and stretchy.

Imaging tests and procedures for women 
Different imaging tests and procedures can be used to look at the uterus, ovaries, and fallopian tubes to find problems. Common imaging tests for female infertility can include a regular or special type of ultrasound (sonohysterography), X-ray (hysterosalpingography), or procedures that use a camera and thin light source inserted through the cervix or abdomen to examine the reproductive organs (hysteroscopy or laparoscopy).

Next steps
Infertility can be treated in many ways. Treatments may include lifestyle changes, surgery, treatment of hormone problems, ovulation stimulation, intrauterine insemination (IUI), and assisted reproductive technology (ART).

The best thing to do is to talk with your OB-GYN or specialist about the best options for you and your partner. The OB-GYNs at Just for Women are here to help you start your family sooner. Give us a call at 812-280-7063 to schedule an appointment.