Miami and Miramar, Florida — Fertility Evaluations at Palmetto Fertility Center

Fertility evaluations at Palmetto Fertility Center, done for both members of a couple, seek to identify the source of a couple's problems in conceiving a child. With the wide variety of tests to perform, infertility evaluation can seem overwhelming at first. However, the testing is usually completed in a short time (a month or less) and follows a logical order.

Though we see some patients who have had an initial evaluation at another physician's office, we may need to repeat some of the testing at our center in our specialized Miami fertility laboratory; this is an important step in beginning treatment.

• What are fertility evaluations?
• Male Infertility Evaluations
• Female Infertility Evaluations

What are fertility evaluations?

Infertility is related to the man, or male factors, about 40 percent of the time; it is related to the female, or female factors, about 40 percent of the time. About 20 percent of the time, it is related to problems in both members of the couple. In the infertility evaluations conducted at Palmetto Fertility Center, we examine for both male and female factors that may lead to infertility.

Male Infertility Evaluations

Male factor infertility often occurs with men who have a varicocele (enlarged veins in the left testicle), or have had surgery or some kind of trauma to the testicle. We screen for abnormalities in the male by performing a semen analysis. In this test, we evaluate the sperm count, motility (movement), morphology (appearance), and other factors. We may also perform specialized testing to identify any antisperm antibodies (ASA), which may be present in the male or in the female partner's blood. Although the couple may have had this testing done at another facility, we usually require this test to be repeated in our Miami, Florida fertility center.

Female Infertility Evaluations

Female infertility can be related to problems with the ovaries, the quality of eggs, the uterus, or the fallopian tubes. Female fertility evaluations have multiple elements because female infertility can have a variety of causes.

Background/Genetic/Infectious Screening

The most important part of the infertility work-up is obtaining a screening history and blood work so we can evaluate any potential problems before a woman gets pregnant. Most of these detect infections that may interfere with a healthy pregnancy. A PAP smear should have been performed within the previous year.

Dr. Michael D. Graubert and the rest of the team at Palmetto Fertility Center order appropriate genetic screening based on the female partner's background and family history. Examples of genetic screening tests include evaluations for sickle cell anemia, Tay-Sachs disease, or cystic fibrosis.

Ovarian Function/Ovulation Screening

Disorders of the ovaries account for about 30 percent of female-related infertility. Our main questions are:

• Are you ovulating?
• How well do you ovulate (what is the quality of eggs you produce)?

Many women have premenstrual symptoms (bloating, breast tenderness) a few days before their menses. This is a good sign that you ovulate. Some women may have regular bleeding, but may not actually ovulate. We may evaluate if this is occurring by determining your levels of follicle stimulating hormone (FSH) or luteinizing hormone (LH), which are made by the pituitary gland in order to stimulate egg development in the ovary. We also may order an evaluation of your progesterone level (progesterone is a hormone made by the ovary only after ovulation), or have you check your urine with an ovulation predictor kit (LH surge kit), which you can buy in a drugstore.

While the question of whether you ovulate is an important one, it is equally important to know how well you ovulate. Some women may have regular, monthly, ovulatory periods, but the "quality" of their eggs may be reduced. This happens naturally as women age. By testing the FSH on the third day of the cycle, we can predict how well the ovaries are making the eggs. These tests of "ovarian reserve" allows us to better predict how well your ovaries will respond to stimulation with fertility drugs, and help us to predict your potential pregnancy rate with infertility treatment.

This test, a day-three FSH, is performed on day three of your cycle and is required by all women undergoing advanced infertility treatment. Because every laboratory's FSH test is a little bit different, we require this test be done in our Miami, Florida fertility facility. We will inform you if you are a candidate for testing. Sometimes we may need to stimulate the ovaries a little to get even more information about how well the eggs are doing. In this case, we perform a clomiphene citrate challenge test (CCCT), in which we draw an FSH on day three and day 10 of your cycle, after you have taken 100 mg of clomiphene on day five through nine of your cycle. We perform this test in all women over the age of 35 and women with unexplained infertility. We can perform an intrauterine insemination (IUI) during the same cycle as your CCCT, potentially turning a diagnostic test into a therapeutic one.

We are also performing anti-mullerian hormone testing (AMH) to evaluate egg quality in women. This new testing is proving to be very useful in determining egg quality.

Uterine Evaluation

The uterus, or womb, is lined on the inside by a layer called the endometrium. This is where the developing embryo will implant. It is important to evaluate the uterine cavity, looking for potential problems such as uterine scar tissue, polyps, fibroids, or other structural defects in the uterus. These problems may interfere with a developing pregnancy, leading to miscarriage and/or infertility. The uterine evaluation will consist either of an X-ray study of the uterine cavity, a hysterosalpingogram (HSG) or a sonohysterogram, which is a special ultrasound test. If there are abnormalities on these tests, we may perform a hysteroscopy, a surgical procedure used to correct problems inside the uterus.

Tubal Evaluation

Problems with the fallopian tubes, such as tubal blockage, account for about 30 percent of female infertility problems. This is especially true in women who may have had a pelvic infection in the past. Blocked tubes and scar tissue can also be caused by abdominal infections such as appendicitis, prior surgeries, or endometriosis. We screen for problems on the fallopian tubes by performing an HSG. This test evaluates problems in both the uterus and the fallopian tubes (see above). If we find tubal blockage, we may perform a laparoscopy, a surgical procedure done to better diagnose and potentially correct tubal problems.

Endometrial Biopsy

An endometrial biopsy, or biopsy of the lining of the uterus, may be performed to look for a potential problem in the development of the endometrium called luteal phase defect. It may also be done to look for infections.

Contact Palmetto Fertility Center

If you and your partner have had trouble conceiving, the caring professionals in Miramar and Miami, Florida at Palmetto Fertility Center can help. Male and female fertility evaluations are important in identifying the source(s) of a couple's infertility so we can provide treatment. Please schedule an appointment today if you and your partner may benefit from fertility evaluations.