Family Centre The Family Centre strives to build healthy families

Infertility Evaluation

About 10% of couples in the United States are infertile. Couples may be infertile if the woman has not been able to conceive after 6–12 months of having sex without the use of birth control. The number of months depends on many factors, such as your age, your partner's age, and how long you have been trying to get pregnant.

If you and your partner are trying to have a child and you have not gotten pregnant, you may want to have an infertility evaluation. Tests can be done to find the cause of the problem. Based on the results of these tests, treatment may be needed. This pamphlet explains: What an infertility evaluation involves, Testing for infertility, Treatment options.
Conception
The process of becoming pregnant starts with ovulation, the release of an egg from a woman's ovary. In an average 28-day menstrual cycle, ovulation occurs about 14 days after the first day of your last period. Once an egg is released, it can be fertilized for about 12–24 hours. Fertilization can occur if you have sex during or near the time you ovulate.

When the man ejaculates during intercourse, his semen releases into the vagina. Semen is the fluid that carries the sperm. Sperm travel up through the woman's cervix and out into the fallopian tubes. Sperm can live in the tubes for 3 days or more. If a sperm and egg join, fertilization occurs.

The fertilized egg then moves through the fallopian tube into the uterus. It attaches there and begins to grow. All these events must take place for pregnancy to occur. If there is a problem in this chain of events, infertility may result.

Causes
Infertility may be caused by more than one factor. Some are easy to find and treat, while others are not. The factor may relate to the woman (65%) or the man (20%). In some cases, no cause can be found in either partner (15%).

The couple's age can be a factor. For healthy, young couples, the odds are about 20% that a woman will conceive in 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 years. A man's fertility also declines with age, but not as early. For this reason, older couples may not want to wait 6–12 months to seek care if they are having problems conceiving.

Male factors most often involve problems with the amount or health of the sperm. Abnormal hormone levels may be a cause. Infection or scarring from a sexually transmitted disease (STD) also may be a cause. Female factors also may involve abnormal hormone levels. The ovaries may not produce enough eggs at the right time. Scarring or blockages in the cervix or tubes also may be a cause.

Lifestyle factors, such as poor nutrition, anorexia, and obesity can play a part in infertility. Exposure to a drug called diethylstilbestrol (DES) can cause problems.

Testing
The decision to begin testing depends on a number of factors. They include your age and your partner's age, as well as how long you have been trying to get pregnant. You and your partner will receive care as a couple. Testing involves an evaluation as follows: Physical exam, Medical history, Semen analysis, Ovulation check. Tests to check for a normal uterus and open fallopian tubes. Discussion about how often and when you have sex. 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 for a man. It may need to be done more than once. The semen sample is obtained bymasturbation. Sometimes it can be obtained at home. Sometimes it is obtained in a lab. Your doctor will give you instructions.

The semen sample then is studied in a lab. The doctor will study the sperm for:Number ,Shape,Movement,Signs of infection. The man may be referred to a urologist (a doctor trained in treating problems of the urinary tract). The urologist will perform an exam and tests may be done.

Basic Workup for the Woman
The workup for a woman begins with a physical exam and health history. The health history will focus on key points: Menstrual function, such as irregular bleeding and pain, Pregnancy history, STD history, Birth control, A Pap test and blood tests also may be done.

• Tests
  There are many tests to see if ovulation occurs. Some are done by the woman, and others are done by the doctor. Urine test. This test can be done by the woman at home with a kit. It is a way to predict ovulation. This test measures luteinizing hormone (LH), which is what makes ovulation occur. If the test result is positive, it means ovulation is about to occur. Sometimes these kits are used with basal body temperature charts.

Basal body temperature. This test can be done by the woman at home. It is a way to tell that ovulation has occurred. After a woman ovulates, her body temperature increases a bit. To measure it, a woman takes her temperature by mouth every morning before she gets out of bed (basal temperature). She records it on a chart for two or three menstrual cycles. Other tests may be done, depending on a woman's risk factors.

Procedures
 Procedures are used to look at a woman's reproductive organs. They check if the uterus is normal and the fallopian tubes are open. The tests you have depend on your factors and symptoms. Hysterosalpingography (HSG). This test is an X-ray that shows the inside of the uterus and fallopian tubes. In most cases, it is done right after a menstrual period. A small amount of dye is placed in the uterus through a thin tube inserted through the cervix. An X-ray is then taken. The dye outlines the inside of the uterus and fallopian tubes. If it spills from the tubes, it shows that the tubes are open.

Transvaginal ultrasound
This test checks the ovaries and uterus by using sound waves to produce pictures of pelvic organs. First a device (a transducer) shaped like a wand is lubricated and inserted into the vagina. A machine displays an image of the organs.

Hysteroscopy
 This procedure lets the doctor look inside the uterus. A thin telescope-like device, called a hysteroscope, is placed through the cervix. The uterus may be filled with a gas or liquid to reveal more information. During this procedure, the doctor can correct minor problems or get a sample of tissue to study. The doctor also may decide other procedures are needed.

Laparoscopy
This procedure lets the doctor view the tubes, ovaries, and the outside of the uterus. A small telescope-like device, called a laparoscope, is inserted through a small cut (about ½ inch or less) at the lower edge of the navel. Fluid is placed in the uterus to see if it spills from the ends of the tubes. This shows if the tubes are open or blocked. The doctor also can look for pelvic problems, such as endometriosis or scar tissue. You may be given pain relief for some of these procedures.

Treatment
Infertility can be treated in many ways, including lifestyle changes, medication, surgery, and assisted reproductive technologies. The choice depends on the cause. After your evaluation, talk with your doctor about the best treatment options for you and your partner. You also may choose adoption or to live without children.

Finally…If you have not been able to conceive after 6–12 months of having sex without using birth control, you may want to think about having an infertility evaluation. Certain tests may help find the cause of the infertility. If a problem is found, steps can be taken to treat it.

Read more

Breast Evaluation

A clinical breast examination (CBE) is a physical examination of the breast done by a health professional. Clinical breast examinations are used along with mammograms to check women for breast cancer. Clinical breast examinations are also used to check for other breast problems.

Medical experts disagree about the need for regular clinical breast examinations. Some studies show that mammogram tests alone reduce breast cancer deaths just as well as using mammograms and CBE. A clinical breast examination may be part of your regular checkup. Talk with your health professional about how often you need a breast examination. Breast implants do not change a woman's chance of getting breast cancer, so women with breast implants should also have regular clinical breast examinations.

Why It Is Done

A clinical breast examination is done to:
Find a lump or change in the breast that may mean a serious problem is present, such as breast cancer.
Check other breast problems that may need more treatment, such as mastitis or a fibroadenoma.

How To Prepare

Tell your health professional if you:
Have a new lump or change in your breasts. This includes a change in the way your nipples look or if you have any nipple discharge.
Some women have nipples that sink into the breast, called inverted nipples. For these women, this is normal. But if you do not have inverted nipples and notice a change where your nipple becomes inverted, tell your doctor.
Have pain in one breast, especially if the pain is not related to having yourmenstrual period.

• Are or might be pregnant.
• Are breast-feeding.
• Have breast implants.
• Have had a breast biopsy.
• Have completed menopause.
• Are taking hormone replacement therapy.
• Have a personal or family history of breast cancer.

You may want to have your examination 1 to 2 weeks after your menstrual period ends, if you are still menstruating; your breasts are less likely to be tender at that time.

Talk to your health professional about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form.

How It Is Done

A clinical breast examination is done by a health professional. You will need to take off your clothes above the waist. You will be given a gown to wear during the examination.

First, your health professional will ask you questions about any problems you may have, your medical history, and your risk factors for breast cancer. Talk to your health professional about any areas of your breasts you may be concerned about.

Your health professional will then examine each breast, underarm, and collarbone area for changes in breast size, skin changes, or signs of injury or infection, such as bruising or redness. You may be asked to lift your arms over your head, put your hands on your hips, or lean forward and press your hands together to tighten the muscle beneath each breast during this part of the examination. You may also lie flat on the table and put your arm behind your head while your health professional checks your breast tissue.

Read more