An infertility evaluation is an important first step to help your provider guide you to the most effective treatment options.
Our team seeks to guide you to the most effective treatment options for starting a family and the first step is a fertility evaluation. Our evaluations are thorough, and we walk you through the process to help you understand the “why” for the course of treatment advised.
Your first step will be to complete a questionnaire describing your medical history and previous infertility evaluation and treatment. A copy of your medical records relating to infertility, including doctor's notes, operative reports, and laboratory tests, is extremely helpful. Links to request external records are available on the main web page. A doctor then will interview you to assess your specific infertility needs.
You should have a complete physical exam, including breast exam and cervical cancer screening (Pap smear or HPV testing) per the American College of Obstetrician and Gynecologist’s guidelines. You should also start taking prenatal vitamins containing folic acid, which has been shown to reduce the risk of birth defects of the spine. Women over 40 should consider having a mammogram for preventive health maintenance.
Blood Tests
Your physician may require you to complete blood work as part of your initial evaluation. As part of the prenatal labs recommended before pregnancy, we confirm your blood type, and screen for antibodies that could affect the health of a fetus. We also perform infectious disease testing to include syphilis, HIV, Hepatitis B and C.
Documentation of immunity to rubella (German measles) and varicella (chicken pox) may also be required. Rubella and varicella infection during pregnancy can cause serious harm to the fetus – you may need to get vaccinated or have a booster prior to becoming pregnant.
We may also recommend specific fertility blood tests to evaluate your ovarian reserve such as FSH (a hormone that regulates ovarian function) and AMH (a hormone released by the resting egg sacs in your ovaries). The FSH test must be performed on the second, third or fourth day of the menstrual cycle. These tests can reveal abnormalities in ovarian function (ovarian reserve) that can affect the success of fertility treatments, especially in women over 35 years of age. Other hormones, such as thyroid (TSH) and prolactin, may also be checked based upon your history.
Semen Analysis
A semen analysis should be performed within the past year. Changes in sperm quality may occur over time, which could affect the success of fertility treatments and may be a marker of male urologic health. In some cases, we may recommend additional semen testing. For example, we may test for the presence of anti-sperm antibodies or evaluate the sperm for DNA fragmentation. These abnormalities may impair fertility.
Uterus Exams
We recommend evaluating the anatomy of the uterus prior to ART. We may suggest an x-ray procedure (hysterosalpingogram, HSG), ultrasound procedure (saline infusion sonohysterogram, SIS or SHG), or hysteroscopy.
An HSG is performed by injecting a special liquid (X-ray contrast) through the cervix into the uterus. The liquid is visible on x-ray films and outlines the internal anatomy of the uterus and tubes. This is performed in a radiology suite and requires no anesthesia.
An SHG is performed by injecting sterile saline into the uterus during transvaginal sonography. This procedure is performed in the office without anesthesia.
Hysteroscopy involves insertion of a small telescope and light source through the cervix into the uterus to look for abnormalities. We may also perform this procedure in the office using local anesthesia.
During the evaluation and treatment of infertility, transvaginal ultrasounds may be performed for multiple different reasons (baseline evaluation, ovarian reserve testing, ovulation monitoring, etc.). Ultrasounds are performed exclusively by the physicians of the Fertility Center at UT Health San Antonio, not by ultrasound technicians.