Infertility/Reproduction Overview
Infertility is when you cannot get pregnant after having unprotected, regular sex for six months to one year, depending on your age.
The main symptom of infertility is not getting pregnant. You may not have or notice any other symptoms.
Symptoms can also depend on what is causing the infertility. Many health conditions can make it hard to get pregnant. Sometimes no cause is found.
Infertility Symptoms in Women
In women, changes in the menstrual cycle and ovulation may be a symptom of a disease related to infertility. Symptoms include:
Abnormal periods. Bleeding is heavier or lighter than usual.
Irregular periods. The number of days in between each period varies each month.
No periods. You have never had a period, or periods suddenly stop.
Painful periods. Back pain, pelvic pain, and cramping may happen.
Sometimes, female infertility is related to a hormone problem. In this case, symptoms can also include:
- Skin changes, including more acne
- Changes in sex drive and desire
- Dark hair growth on the lips, chest, and chin
- Loss of hair or thinning hair
- Weight gain
Other symptoms of disorders that may lead to infertility include:
- Milky white discharge from nipples unrelated to breastfeeding
- Pain during sex
Many other things can lead to infertility in women, and their symptoms vary.
Infertility Symptoms in Men
Infertility symptoms in men can be vague. They may go unnoticed until a man tries to have a baby.
Symptoms depend on what is causing the infertility. They can include:
- Changes in hair growth
- Changes in sexual desire
- Pain, lump, or swelling in the testicles
- Problems with erections and ejaculation
- Small, firm testicles
When to See the Doctor
If you are under 35 and have been trying to get pregnant without success for a year, see your doctor. Women 35 and older should see their doctor after six months of trying.
Blood, urine, and imaging tests can be done to discover why you are having trouble getting pregnant. A sperm analysis can be done to check a man’s sperm count and the overall health of the sperm.
Your doctor may refer you to a reproductive endocrinologist. That’s a doctor who specializes in infertility. You will be asked questions about your infertility symptoms and medical history.
Before you go to the doctor, write down the following information and take it to your next doctor’s appointment:
- All the medications you take, including prescriptions, vitamins, minerals, supplements, and any other drugs bought without a prescription
- How often you have unprotected sex, how long you have been trying, and the date of the last time you tried to get pregnant
- Body changes or other symptoms you have noticed
- Dates of any surgeries or treatments in the past, especially those involving the reproductive tract
- Any radiation or chemotherapy you have had
- How much you smoke, how much alcohol you drink, and any illegal drug use
- Any history of sexually transmitted diseases (STDs)
- Any genetic disorder or chronic illness, such as diabetes or thyroid
disease, in you or your family
Listen to your body. Tell your doctor any time you notice a symptom. Early diagnosis of an infertility problem may improve your odds of getting pregnant.
If you and your partner are trying to have a baby but haven’t been able to, you may start to wonder if you should get fertility tests. Experts say it’s time to check with a doctor if you’ve had regular sex without birth control for 12 months if you are under the age of 35 and for 6 months if you are over 35.
It’s important for the two of you to go for testing together. When you see your doctor, he’ll probably start by asking questions about your health and lifestyle. He’ll want to know things about you and your partner like:
- Medical history, including any long-term conditions or surgeries
- Medicines you take
- Whether you smoke cigarettes, drink alcohol, eat or drink things with caffeine, or use illicit drugs
- If you had contact with chemicals, toxins, or radiation at home or work
He’ll also want to know about your sex life, such as:
- How often you have sex
- Your history of birth control use
- If you’ve had sexually transmitted diseases
- Any problems having sex
- Whether either of you had sex outside the relationship
Your doctor will also have questions about things connected with your periods, such as:
Have you been pregnant before?
How often have you had periods over the last year?
Have you had irregular and missed periods or had spotting between periods?
Did you have any changes in blood flow or the appearance of large blood clots?
What methods of birth control have you used?
Have you ever seen a doctor for infertility, and did you get any treatment?
Infertility Tests for Women
There is no single best test for infertility. Doctors use a variety of ways to identify any problems that might help cause fertility trouble.
You may get a Pap smear. It can detect cervical cancer, other problems with the cervix, or sexually transmitted diseases. Any of these can interfere with getting pregnant.
To get pregnant, you need to release an egg each month — called “ovulation.” You may need tests that check for that.
Your doctor may ask you to take a urine test at home for luteinizing hormone, or LH. This hormone shows up in high levels just before you ovulate.
Your doctor also may check levels of the hormone progesterone in your blood. Increases in progesterone show that you are ovulating.
On your own, you can check your body temperature each morning. Basal body temperature rises a bit just after ovulation. By checking it each morning, you’ll learn your pattern of ovulation over several months.
Your doctor may also run tests on your thyroid, or check for other hormonal problems, to rule out conditions that might cause missed or irregular ovulation.
Tests of Reproductive Organs
Before you can get pregnant, your uterus, fallopian tubes, and ovaries all need to work right. Your doctor may suggest different procedures that can check the health of these organs:
Hysterosalpingogram (HSG). Also called a “tubogram,” this is a series of X-rays of your fallopian tubes and uterus. The X-rays are taken after your doctor injects liquid dye through the vagina. Another method uses saline and air instead of dye and an ultrasound.
The HSG can help you learn if your fallopian tubes are blocked or if you have any defects of your uterus. The test is usually done just after your menstrual period.
Transvaginal ultrasound. A doctor places an ultrasound “wand” into the vagina and brings it close to the pelvic organs. Using sound waves, he’ll be able to see images of the ovaries and uterus to check for problems there.
Hysteroscopy. Your doctor puts a thin, flexible tube — with a camera on the end — through the cervix and into the uterus. He can see problems there and take tissue samples if needed.
Laparoscopy. Your doctor makes small cuts in your belly and inserts tools, including a camera. This surgery can check your entire pelvis and potentially correct problems, such as endometriosis, a disease that affects the uterus.
Other Infertility Tests
A doctor may order other tests to check for fertility problems.
You may get a blood test to check your levels of follicle-stimulating hormone, or FSH, which triggers your ovaries to prepare an egg for release each month. High FSH can mean lower fertility in women. The FSH blood levels get checked early in your menstrual cycle (often on day 3).
Clomiphene citrate challenge testing can be done with the FSH test. You take a pill of clomiphene citrate on the fifth through ninth days of your menstrual cycle. FSH gets checked on day 3 (before you take the medicine) and on day 10 (after). High FSH levels suggest you have lower chances of getting pregnant.
Your doctor may also suggest a blood test to check for a hormone called inhibin B. Levels may be lower in women with fertility problems, but experts are divided about whether the test can predict infertility.
Another exam is called postcoital testing. Your doctor examines your cervical mucus after you’ve had sex. Some studies suggest it may not be so useful.
Your doctor may also recommend an endometrial biopsy. In this procedure, he takes a sample of tissue from the lining of your uterus. But evidence is mounting that endometrial biopsy is not helpful in predicting or treating infertility.
You may not need to have all these tests. Your doctor can discuss with you which ones are best in your situation. After the testing is done, about 85% of couples will have some idea about why they’re having trouble getting pregnant.
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