Conception
For healthy, young couples, the odds are about 20 percent that a woman will conceive (become pregnant) during any one menstrual cycle. This figure starts to decline in a woman's late 20s and early 30s and decreases even more after age 35.

Testing
Infertility may be caused by more than one factor. Some causes are easily found and treated, while others are not. In some cases, no cause can be found in either partner.

The basic workup of an infertility evaluation can be finished within a few menstrual cycles in most cases. Ask your doctor about the costs involved. Find out whether they are covered by your insurance.

Basic Workup for the Man
A semen analysis is a key part of the basic workup. It may need to be done more than once. The sample is obtained by masturbation.

Basic Workup for the Woman
The workup begins with a physical exam and health history. The health history will focus on key points:

• Menstrual function
• Pregnancy history
• Sexually transmitted disease (STD)
• Birth control

Tests. There are many ways to see if ovulation occurs. Some tests are done by the woman, and others are done by the doctor.

• Urine Test. A way to predict ovulation is by using a urine test kit at home. This test measures luteinizing hormone (LH), a hormone that causes ovulation to occur.

   

• Basal Body Temperature. After a woman ovulates, there is a small increase in body temperature.

   

• Blood Test. After a woman ovulates, the ovaries produce the hormone progesterone. A blood test taken in the second half of the menstrual cycle can measure progesterone to show if ovulation has occurred.

   

• Endometrial Biopsy. The lining of the uterus (endometrium) changes at ovulation. Sometimes a biopsy (a sample of the tissue) is done in this area to find out whether and when ovulation has occurred.

Procedures. Other tests may be done to look at a woman's reproductive organs.

• Hysterosalpingography (HSG). This test is an X-ray that shows the inside of the uterus and fallopian tubes.

   

• Transvaginal Ultrasound. Ultrasound uses sound waves to produce images of pelvic organs.

   

• Hysteroscopy. A thin telescope-like device, called a hysteroscope, is placed through the cervix. The inside of the uterus may be filled with a harmless gas or liquid to provide more information.

   

• Laparoscopy. A small telescope-like device, called a laparoscope, is inserted through a small cut (about 1/2 inch or less) at the lower edge of the navel. The doctor can look at the tubes, ovaries and uterus.

Treatment
Infertility often can be treated with lifestyle changes, medication, surgery or assisted reproductive technologies. It depends on the cause.

Finally …
If you have not been able to conceive after 12 months of having sex without the use of birth control, you may want to think about having an infertility evaluation.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.