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Fertility Evaluation

Video Transcription: Hello. I'm Dr. Jessica Herzberg. Here at Moreland OB-GYN, we understand the emotional and physical strain infertility has on couples. We offer a variety of fertility services for couples looking to conceive including fertility evaluations, preconception counseling, and fertility education. We also provide several services for treatment for fertility including Intrauterine Insemination or IUI which is done here in our clinic. As always, it's Moreland OB-GYN's goal to lead women to better health. 

No one expects that they will be faced with challenges getting pregnant. At Moreland OB-GYN we understand the physical and emotional strain that couples face during this difficult time. We now offer several options to help you along your fertility journey.


Who should be evaluated for Infertility?

Over the course of one year, 85% of couples having unprotected intercourse will become pregnant. You should see a doctor if you:

  • Are under 35 and not pregnant after 12 months of attempting pregnancy.
  • Are 35 or older and not pregnant after six months of attempting pregnancy.
  • Women with irregular or no menstrual cycles
  • Women with a history of known pelvic infection or endometriosis
  • History of infertility.

Learn Three Natural Fertility Options to Help You Get Pregnant 

What are the causes of infertility?

There are three categories of cause for infertility: Female, Male, and Unexplained.

Female Infertility

Female infertility is strongly correlated with the age of the woman that is trying to become pregnant. If you find yourself trying to have children later in life, your egg quantity may be diminishing.

Other common causes of infertility in women include:

  • Polycystic Ovarian Syndrome (PCOS) can result in anovulation.
  • Thyroid Disorders, known as hyperthyroidism and hypothyroidism, are known to affect ovulation. Other imbalances of hormones, such as prolactin and androgens can also affect ovulation.
  • Endometriosis is another common disease that can cause infertility in women. If you have endometriosis, this does not mean that you are infertile. In fact, nearly 15% of women are diagnosed with this disease and most of these women are able to conceive naturally. Endometriosis is when the lining (endometrium) of the uterus grows elsewhere, such as on the outside of the uterus, ovaries, fallopian tubes, or the lining of your abdomen.
  • Abnormalities with the uterus can contribute to pregnancy difficulties. These include uterine fibroids and Mullerian anomalies. Mullerian anomalies can be abnormal shapes of the uterus.
  • Roughly 30% of infertility cases result from fallopian tube blockage or damage. This is referred to as Tubal Factor Infertility and this can be caused by endometriosis, pelvic inflammatory disease (PID), scar tissue from pelvic surgery, or even a pelvic infection such as chlamydia. The function of fallopian tubes is to transport sperm to reach the egg and enable the fertilized embryo to get back to the uterus. When these tubes are blocked or damaged, there is a lower opportunity for the fertilization process to take place. These women also have a higher risk of ectopic pregnancy. This is when the embryo implants outside of the woman’s uterus.

Male Infertility

A common cause of sperm abnormalities, such as shape, lack of ability to swim (motility), or blockage of sperm, is from a condition called Varicocele, which is an enlarged vein in the testicle and present in about 40% of infertile men. Other reasons that influence the life span or mobility of the sperm come from inflammation in the testicles or having abnormally developed testicles.

Hormone imbalances, as well as reproductive organ blockages, are other common issues that can lead to male infertility. In 50% of cases, the cause of male infertility cannot be determined.

Common reasons for low sperm count or short life-span of sperm, include:

  • Having an imbalance of LH and FSH hormones
  • Blockages/damage caused by past infections or STDs
  • Immoderate exposure to radiation or poisonous chemicals
  • Wearing too tight of clothing
  • Hernia surgery repercussions
  • Having a predisposed genetic condition
  • Receiving an injury to the groin
  • Excessive alcohol, tobacco, or other drug consumption

There can also be causes of infertility for men due to problems with ejaculation such as retrograde ejaculation, premature ejaculation, and erectile dysfunctions.


On average, one in every four couples have no medical reason for infertility.

For these couples, fertility treatments may be beneficial, these treatments include:

  • Hormonal treatments
  • IUI
  • IVF treatments
  • Gestational carrier

Lifestyle changes you can make to prepare your body for pregnancy include:

  • Maintain a healthy weight
  • Cut back on alcohol consumption
  • Avoid drinking too much caffeine
  • Quit smoking
  • Reduce stress
What tests are there for fertility?

Female Fertility Test Options

Infertility Hormone Tests

Common tests your doctor may order include: thyroid testing, prolactin testing, and ovarian reserve testing. Ovarian reserve refers to the number of eggs that remain. Women are born with approximately 300,000 eggs and are used up throughout their lives. This testing does not predict if a woman can conceive but rather guide practitioners on how aggressive to treat the patient. Ovarian reserve can be evaluated with an ultrasound or blood work such as FSH (follicle-stimulating hormone), Estradiol, and AMH (Anti-Mullerian Hormone).

Based on your test results:

  • Your doctor may advise you to try on your own for a shorter period of time before investigating a more aggressive treatment plan.
  • If you are not ready to start a family but you know you want to have children eventually, your doctor may advise you to freeze your eggs now.

Fertility Imaging and Ultrasound Tests

Some common tests your doctor might use include:

  • Pelvic ultrasound test. This evaluates the shape of the uterus and ovaries.
  • Antral follicle count ultrasound test. This ultrasound test looks at the early eggs in the ovaries to get a sense of the ovary reserve and how many eggs may be left in each ovary.

A common misconception is that each month only one ovary produces an egg. This is not true. Each month, both of your ovaries are competing to create the largest egg or follicle. The largest egg or follicle will mature and be released into the fallopian tube.

As you approach menopause and start to skip periods, it is because the ovaries cannot find any eggs to send.

Another interesting fact–when a woman has an ovary removed, it doesn’t mean you will ovulate every other month, it just means your single ovary always sends the ‘winning’ egg for possible fertilization.

Hysterosalpingogram: Infertility Fallopian Tube Evaluation

If you are struggling with fertility, your doctor may suggest having a test completed that determines whether your fallopian tubes are blocked.

A hysterosalpingogram involves the insertion of a small, flexible catheter into the uterus. Dye is then injected into the uterus and x-rays are done to see if the dye spills out of the fallopian tube.

Risk factors for blocked fallopian tubes include:

  • Endometriosis
  • Past infections such as chlamydia, can cause infertility
  • Ovarian cysts
  • Scar tissue from previous surgery in the belly

Fertility Surgery

There are a few minimally invasive fertility surgical options your doctor may suggest if you are struggling with infertility.

Based on your medical history and exam, your gynecologist may offer a hysteroscopy, a procedure that looks at the inside of the uterus, or a laparoscopy, which looks into the abdomen to exam the fallopian tubes, ovaries, and outside of the uterus.

These minimally invasive fertility surgical procedures can help your doctor understand the root cause of your infertility and suggest an appropriate fertility treatment option.

Male Infertility Test Options

Infertility can have a number of causes, including male infertility.

To evaluate male infertility, a physician may:

  • Complete a full history and physical exam
  • Order an ultrasound if any abnormalities are found in the testicles
  • Semen analysis
  • Hormonal studies
  • Talk with you about hormonal or surgical treatments for male infertility depending on the cause

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