Trying To Conceive (TTC). Are you barren? for how long? this information will guide and help you to rule out barrenness

Introduction to Trying To Conceive (TTC)

Congratulations! You’re entering an important and exciting time in your life as you try to conceive! Are you concerned about getting pregnant? Don’t worry; even if it doesn’t happen right away, the odds are in your favor that you’ll be selecting a layette set and painting the nursery soon enough. Statistics show:

• 25 percent of all couples become pregnant in their first month of trying

• 60 percent become pregnant within six months

• 75 percent become pregnant within nine months

• 80 percent of all TTC couples will be pregnant within a year

If you’ve been trying for 12 months (or six months if you are over the age of 35), you may want to consult a fertility specialist, just to make sure there is no problem. You can learn more about going to see a fertility doctor in this article.

Since 90 percent of all couples will achieve success within 18 months, odds are in your favor that there is no problem and you just need to be patient and keep trying. While you’re trying to conceive, this section will help you with tips, tricks and information about your health, nutrition, and your cycle, and how to recognize pregnancy when it happens!

Here are some articles that you may find informational:

Before Trying to Conceive

Nutrition and Trying to Conceive

Trying to conceive? If you’re not already eating a nutritious diet and exercising regularly, now is the best time to change your diet, and possibly even your lifestyle, to help insure not only a successful conception but a healthy pregnancy. By learning more about nutrition and developing good habits now, you’ll be in a good position to instill healthy eating habits in your child, too.

Pre-conception Doctor’s Appointment
You may even want to visit your doctor before you conceive. He or she can advise you on a healthy diet, evaluate your overall health, and let you know if you should lose or gain weight before you begin trying to conceive. You can find out your ideal healthy weight by calculating your BMI (body mass index). Being overweight can decrease your chances of conception by as much as 29 percent.

Eliminate Fast Food
For many people, step one toward a healthier diet is to eliminate fast food from your weekly menu. Pricey, fried, loaded with trans fats, and mostly devoid of nutrients, fast food offers few benefits beyond convenience. If you find yourself at a fast food restaurant, order a salad with grilled chicken on top, and use dressing sparingly. This is a lifestyle change that will benefit your unborn baby and your infant. Some of the benefits of breastfeeding are negated if you eat fast food more than once or twice a week while breastfeeding.

Eat a Balanced Diet
A balanced diet consists of plenty of whole grains, at least five servings of fruits and vegetables, at least three servings of non-fat or low-fat dairy products, and small portions of lean proteins, such as chicken and fish. Don’t forget the healthy fats, too, such as those found in olive oil (and other nut and seed oils) and foods like avocado.

You can find out more about the USDA Food Pyramid and smart food choices atwww.mypyramid.gov.

Pregnant women and those TTC need more folic acid (otherwise known as Folate or vitamin B9) in their diets and should be sure they are getting enough calcium and Vitamin D. Taking in no less than 400 mcg of folic acid per day can reduce the risk of serious neural tube birth defects such as spinal bifida. You can get folic acid from sources such as dark leafy vegetables like spinach, citrus fruits, and fortified breads and cereals.

The Good and Bad of Fish: DHA and Mercury
Studies show that DHA, an Omega-3 fatty acid, is important in the development of the brainsof fetuses as well as infants and toddlers. DHA can be found in foods such as flax, pumpkin seeds and avocado, but one of the best sources of DHA is coldwater fish, including tuna and salmon.

Unfortunately, fish also contain levels of mercury, which has been linked to nervous system disorders. So, what’s a woman who’s TTC, pregnant or breastfeeding to do? Eat fish shown to have the lowest levels of mercury in moderation by following the EPA guidelinesfor fish consumption in pregnant and lactating women.

As a general guideline, stay away from tuna steaks, swordfish, and shark, which are high in mercury and limit consumption of low-mercury level fish, including salmon, shrimp, chunk light tuna (not albacore) to 12 oz. per week.

Get the balance of your DHA by taking a pre-natal multivitamin enhanced with DHA or taking a separate DHA supplement.

Pre-natal Vitamins
Most people’s diets don’t contain enough Vitamin D, folic acid, or DHA, along with many other essential nutrients. Even if you eat a balanced diet, it can be challenging to get sufficient quantities of these vitamins and nutrients every day. Your doctor may prescribe a pre-natal vitamin during your pre-conception check-up, but you’ll probably find prescription pre-natals don’t differ much from over-the-counter supplements.
Pre-natal vitamins should contain:

• Vitamin A

• Vitamin C

• Vitamin D

• Vitamin E

• Thiamin

• Riboflavin

• Niacin

• Vitamin B6

• Folic Acid

• Vitamin B12

• Calcium

• Iron

• Zinc

Take pre-natal vitamins with a meal or a glass of milk, as they may cause nausea on an empty stomach. If your pre-natals are causing constipation or an upset stomach, you may want to experiment with different brands. Again, it is better to start your vitamins while you are TTC, so that you know that any side effects are caused by the vitamins and not by pregnancy.

Exercise
Most doctors will tell you that it’s safe to continue almost any exercise program you were doing with proficiency before you conceived during your pregnancy. This includes bicycling, scuba diving, aerobics, yoga, tennis, weight training and countless other sports and activities. After you get pregnant, however, is not the time to learn a new sport or skill, which is why it’s a good idea to begin an exercise program you love while you are TTC. If you were not exercising regularly before you conceived—or did not have time to grow proficient in your chosen activities before you conceived–stick with walking and swimming, or even water aerobics if swimming is too taxing on your body, during pregnancy.

Birth Control and Trying to Conceive

For many women, the very first step in their journey to try to conceive is to stop using birth control. If you’re using condoms, spermicides, a diaphragm or any other form of hormone-free birth control, you can—and it is safe to—get pregnant as soon as you stop.

If you use any hormone-based birth control methods, which offer protection from pregnancy by preventing ovulation, you should talk to your doctor before you begin trying to conceive.

Here is an explanation of what it takes to conceive after using many common forms of birth control.

Oral Contraceptives (The Pill) – Most oral contraceptives (and there are many on the market!) contain estrogen and progesterone to prevent ovulation. Some women can get pregnant right away after going off the Pill. For others, it may take as long as three months for their menstrual cycle to return to normal. Fertility rates for former Pill users are about the same as the national average; 90 percent of all women get pregnant within one year of coming off the Pill. Most doctors recommend waiting one or two cycles before trying to conceive after you come off the Pill, because of a very small risk of birth defects if the hormones are still in your system.

According to NuvaRing, there is no need to wait one cycle before TTC with this hormone-based, insert-able ring. A clinical study indicated that most women’s cycles return to normal quickly, with ovulation occurring within 13 to 28 days after the ring is removed.

Mirena and other IUDs – This intrauterine contraceptive (IUC) is estrogen-free and, as with any IUD, you can begin trying to conceive immediately after its removal. Your fertility should return fairly quickly.

Permanent Birth Control

Tubal Ligation (Tubes Tied) – This is the most “permanent” of any birth control method for women and is not easily reversed. Chances of a successful reversal range from 20 to 70 percent, depending on the type of tubal ligation and the health of your fallopian tubes.

A tubal ligation reversal is major surgery, where the surgeon rejoins the remaining sections of the fallopian tubes. If both fallopian tubes are at least four inches long and are equal in diameter, the chances of a successful reversal are higher. IVF, or in vitro fertilization, is another option for women who want to get pregnant after having their tubes tied.

Vasectomy – The success rate of a vasectomy reversal for your partner is even lower than tubal ligation reversal. You’ll only want to consider permanent forms of birth control if you both feel fairly certain you do not want to conceive any more children.

Trying to Conceive

Natural Fertility Signs

One way to increase your odds of conceivingquickly is to make sure you are having sexduring the most fertile part of your cycle — the days just before, during and after ovulation.

Because sperm can live in the body for up to five days, but an unfertilized egg dies after 24 hours, you increase the odds of having sperm and egg meet by having sex just prior to ovulation. But how do you know when you are ovulating?

If your periods are very regular, and come consistently anywhere from 21 to 35 days apart, you can also use our ovulation calculator to predict when you are fertile.

But by tracking the physical signs of fertility, you will get more exact results, even if your cycle varies slightly each month. You can track your fertility by charting your Basal Body Temperature (BBT), Cervical Fluid, and Cervical Position.

Basal Body Temperature
BBT is the temperature of your body before any activity—your body’s baseline temperature. Your BBT rises slightly on the day of ovulation and remains elevated until just before your next period starts. To track your BBT, take your temperature orally with a BBT thermometer(they sell for about $10 at any drug store) every morning before you get out of bed and chart the results. A BBT thermometer only registers temperatures between 96 to 100 degrees F. and can detect very slight changes in your temperature. Most women have a BBT of 96 to 98 degrees normally before ovulation and 97 to 99 after ovulation.

Cervical Fluid 
Cervical fluid, sometimes called cervical mucus, is produced by the lining of a woman’s cervical canal and varies in consistency, color, and amount based on where you are in your monthly cycle.

As you get closer to your time of ovulation, your cervical mucus will change in order to better permit the transfer of sperm into your cervix.

To get a good sample of your cervical mucus at any time, place your fingers (make sure they are clean) inside your vagina. When you pull your fingers out, examine the sample you’ve obtained, noting its consistency and color.
Immediately after menstruation, you will have several “dry days,” where there is very little fluid at all.  What is there may be white or opaque and thick and sticky. As you approach mid-cycle, you will note more moistness, and the fluid will be thin, and possibly cloudy. If you hold some between your fingers, it will be slightly stretchy.
In the few days just before ovulation, which is when you are most fertile, your cervical fluid will be copious, thin and transparent. It will be very stretchy, almost the consistency of egg whites.

Just as your cervical fluid changes throughout your cycle, so does the position of your cervix in order to facilitate the transportation of the sperm and fertilization of the egg during your fertile time. Monitoring the position of your cervix is another way to track your ovulation times. Using these three methods combined will give you the most accurate results.

Begin by checking your cervical position at the end of your period, and check it daily until you reach your time of ovulation. You should do this at the same time each day, and in the same position each time. You can check your cervical position while sitting on the toilet, or it may be easier to place on foot on the toilet and keep one on the floor. Move your middle finger all the way up into your vagina until you hit your cervix, which will feel like a rounded cylinder.

At the beginning of your cycle, your cervix will be low and easier to reach. During ovulation, it will rise to a higher position, and may even be difficult to reach with your middle finger. It will drop back down to a place where it is easier to touch after you ovulate.

Ovulation and Trying to Conceive

Ovulation occurs when a woman’s ripened egg, or ovum, is released from one of two ovaries, making the journey down the respective fallopian tube and into the uterus. By this time, the uterus lining has thickened to prepare to protect the egg if it becomes fertilized and turns into an embryo. If the egg is not fertilized, it is absorbed into the uterine lining and then expelled along with the lining during menstruation.

If an egg is fertilized by a sperm, it implants into the uterus and pregnancy begins! Some women experience implantation bleeding: light bleeding that occurs when the egg implants. This often happens 6 to 12 days after fertilization, sometimes right around the time a woman would be expecting her next menstrual period, and is nothing to be concerned about.

Women are born with 1 to 2 million follicles, or immature eggs, in the ovaries. By puberty, only about 400,000 remain. With each menstrual cycle, approximately 1,000 follicles are lost, with only one maturing into an egg.

In healthy women, both ovaries can release eggs, but they do not alternate consistently, with the right ovary releasing an egg one month and the left releasing an egg the next month. Even healthy women can occasionally have cycles in which they don’t ovulate, and they will still get their period on schedule. This can be caused by stress, rapid weight loss or gain, illness, change in diet or exercise routine, or medications.

Having sex a few days before, during and directly after ovulation is the best way to try to conceive. Because you can ovulate without a menstrual period, or have a menstrual period without ovulating, calculating from period to period is not always reliable, but it is one easy and free method. There are several different methods that can be used to predict when you are ovulating and to determine your next ovulation date.

• Ovulation Calculator

• Natural methods to track your fertility, which include charting your basal body temperature, cervical mucus and cervical position

• Over-the-counter or prescription ovulation predictor kit.

Finally, some women can actually feel themselves ovulate. They will experience a sharp pain on one side of their abdomen, or experience a feeling similar to menstrual cramps. This is called “mittleschmerz,” literally translated from German to mean “middle pain.” For some, this pain is fleeting, for others it can last a few hours.

Using one or any combination of these methods will help you predict your time of ovulation

Ovulation Predictor Kits

Many methods exist for tracking your dates of ovulation. Some, such as tracking changes in your cervical mucus or using an ovulation calculator, are free. But many women rely on over-the-counter ovulation predictor kits, which can be purchased at drugstores like CVS, Rite-aid and Walgreens, and at retailers like Wal-mart, K-Mart, and Target. You can also find ovulation calculators online at Amazon.com. They run about $15 to $40, and you can save money by purchasing in bulk online.

Two types of ovulation predictor kits exist – those that measure the luteining hormone in your urine and those that measure estrogen in your saliva. This article explains how to use both and evaluates some of the more popular brands.

Ovulation Predictor Test Strips

Ovulation predictor test strips measure the amount of LH (luteining hormone) in your urine. LH peaks right before you ovulate, giving most women a 36-hour window to try to conceive before they ovulate, and another 24 hours while they are ovulating. While you may get pregnant up to 24 hours after you ovulate, because an egg lives for 24 hours, the best time to try to conceive is the few days prior to ovulation.

Many fertility specialists say that Ovulation Predictor Kits (OPKs) are more reliable than other ways of tracking your fertility. Your results may vary, though, if you have an irregular cycle. Additionally, if you have a long cycle, using an OPK every day until you ovulate, starting on day 10 of your cycle, gets expensive.

Additionally, OPKs only detect the hormone surge that precedes ovulation; they can’t tell if you will actually release an egg during your cycle.

To get the best results, follow the directions in the package for your specific test precisely. Keep in mind, polycystic ovarian syndrome (PCOS), a common cause of infertility, may affect the results of the test, as will certain fertility drugs, including Clomid.

How to Use an Ovulation Predictor Kit

Much like an over-the counter pregnancy test, you simply urinate (mid-stream) on the test strip. In most tests, you will see a control line and then a line that indicates the amount of LH in your urine. If the test result line is the same color or darker than the control line, you are experiencing the hormone surge that indicates you will ovulate soon—usually within 12 to 36 hours of the surge.

Unlike a pregnancy test, you don’t use an OPK with your first-morning urine. Instead, wait until about 2 PM – anytime after noon may be okay. You may have a hormone surge in the morning, but it takes 4 hours to show up in your urine. You may also want to test twice a day, once in the afternoon and once in the evening, to make sure you don’t “miss” the surge.

Since ovulation times vary, you should begin testing on day 10 of your cycle, which is approximately five days after the start of your period. These numbers may vary if you have an exceptionally long or exceptionally short cycle. Continue testing until you detect the LH surge.

Ovulation Kits That Measure Saliva

The QTest, Ovuscope, MaybeBaby and Fertile-Focus saliva ovulation test kits are just a few examples of kits which test for estrogen, rather than LH, to determine time of ovulation. Most of these kits are about $20 to $30, although others exist that are much more expensive.

A saliva ovulation test kit is essentially a small, re-useable 40X to 60X microscope. Some kits work with a supply of slides, while others, which are more expensive, let you test right on the lens. Tests are approximately deemed 98 percent accurate and capable of detecting ovulation up to 72 hours in advance.

As your body nears the time of ovulation, in addition to an LH surge you will experience an estrogen surge. This surge manifests in saline in your saliva. Saliva Ovulation Predictor Kitsdetect this saline, which shows up as a fern-like pattern on the microscope slide.

How to Use a Saliva Ovulation Predictor Kit

You can use the test first thing in the morning, or anytime during the day, as long as you have not eaten or drank anything, brushed your teeth or smoked for at least two hours before testing.

Use fresh saliva to test; swish your saliva around in your mouth and apply fresh saliva from under your tongue to the test slide.

If you are near the time of ovulation, you will see a fern-like pattern on the slide. During the transition phase, the slide will contain a mixture of ferns and small bubbles. You are not ovulating or in transitions if you see only tiny bubbles.

Keep in mind, smoking, eating, drinking or brushing your teeth up to two hours before taking the test could affect the results. Pregnancy, recent pregnancy, menopause, hormone-based birth control methods and hormone replacement therapy may also affect the test.

You may have to test for a few months before you begin to plan your pregnancy to recognize the fern pattern. Keep track of your cycle by marking every menstrual period on a calendar, too, so that you can begin testing just prior to your most likely time of ovulation. You may want to test at other times of month, too, for a comparison.

If, after several months, you are seeing ferns all the time, or not seeing any ferns around your suspected time of ovulation, check with your doctor. You may be producing estrogen all month, perhaps due to a lack of the hormone progesterone, or you may not be producing enough estrogen to conceive.

The Pregnancy Planner calculates preferred days for getting pregnant. Plans are based on the fact that ovulation happens 14 days before the next menstrual period. If you are trying for a boy or girl, the planner will also suggest some actions that many influence the sex of the child, based on the scientific research of Dr. Landrum Shettles and David M. Rorvik, who published findings in a book called "How to Choose the Sex of Your Baby: The Method Best Supported by Scientific Evidence."

As ovulation approaches your chances of getting pregnant increase. Before proceeding, there are a few things to keep in mind: Cycle lengths of more than 35 days are too long for appropriate calculations. Cycle lengths of less than 21 days are too short for appropriate calculations. This calendar cannot be used to reliably prevent pregnancy. Good Luck & Don't Forget to Have Fun! First day of last menstrual period:                  Month                  Jan                  Feb                  Mar                  Apr                  May                  June                  July                  Aug                  Sept                  Oct                  Nov                  Dec                                  Day                  1                  2                  3                  4                  5                  6                  7                  8                  9                  10                  11                  12                  13                  14                  15                  16                  17                  18                  19                  20                  21                  22                  23                  24                  25                  26                  27                  28                  29                  30                  31                    200920102011           Length of cycle:                  21                  22                  23                  24                  25                  26                  27                  28                  29                  30                  31                  32                  33                  34                  35                 days Desired Sex of baby:                  Any                 Boy                 Girl                Show me:                  1                 2                 3                 4                 5                 6                Months

The Best Positions to Get Pregnant

When a couple is trying to conceive, thoughts of ovulation dates, cervical mucus (isn’t that a romantic term?), andpre-natal vitamins often over-ride the most fun aspect of making a baby: having regular sex!

Couples can—and do—conceive in any position imaginable. There is no medical evidence to support the fact that certain sexual positions encourage conception. With millions of sperm approaching the cervix after every ejaculation, barring any medical problems the most tenacious one will eventually reach the egg regardless of whether or not you are “helping it out” by lying down, standing on your head or propping your hips up on a pillow.

However, certain positions do keep semen from leaking out of your vagina and also keep sperm in your cervix longer. They might even encourage the flow of sperm into your fallopian tubes. If you are trying to conceive, why not give gravity a helping hand?

Old Wives’ Tales say that standing on your head or lying with your legs up over your head immediately following intercourse will help the sperm travel up your body. This hasn’t been medically proven, but it couldn’t hurt, either. Then again, if you are not physically agile enough to successfully execute the maneuver, it could hurt.

Lying down for 15 minutes after sex offers the same benefit of keeping more sperm in your body. Besides, why jump up right after sex? If anything, it’s a good excuse to cuddle for 15 minutes and bask in the afterglow.

Additionally, intercourse with a pillow beneath your hips will tilt your cervix in such a way that it might “help” the sperm travel to their destination.

Keeping gravity in mind, positions that could make it harder to get pregnant include:

• Standing

• Sitting

• Any position with the woman on top

These positions cause semen to leak out of the vagina, meaning that less sperm will embark on the journey up to the egg.

Ultimately, timing has a lot more to do with getting pregnant than position does, but trying out new positions under the guise of “helping the sperm reach the egg” might keep baby-making sex interesting if it begins to feel like a chore.

Another Old Wives’ Tale says that if the woman has an orgasm during sex – particularly after or while her partner ejaculates — she is more likely to conceive. Uterine contractions that take place during an orgasm help “push” the sperm toward the fallopian tubes.

In reality, painless uterine contractions occur involuntarily all the time, and are more pronounced during ovulation, so your body is already giving the sperm some help. Again, having an orgasm in hopes of conception can’t hurt. In fact, striving to achieve orgasm every time you make love is a worthwhile endeavor, whether or not it results in pregnancy.

Don’t be afraid to experiment with different positions, strive for orgasm, and help those little swimmers by staying horizontal after sex, but remember that timing is far more important than position when trying to conceive.

Predetermining The Sex of Your Child

Is it really possible to pre-determine or, more accurately, to select, the gender of your child? Several medical experts say that it is.

These are a few methods currently used for gender selection.

The Ericsson Method – This medical procedure can be pricey, but it is effective about 75% of the time when selecting a boy and about 70% to 72% of the time if the couple is trying for a girl. The use of the fertility drug Clomid increases the odds of bearing a girl if sperm bearing the X chromosome are used for insemination.

The Ericsson Method entails artificial insemination, where the sperm are first separated and those bearing the male (Y) chromosome or bearing the female (X) chromosome only are used to fertilize the eggs, depending on the patient’s choice.

PGD (Preimplantation genetic diagnosis) – PGD combines in vitro fertilization with the Ericsson Method of sperm selection, so that only embryos fertilized with sperm bearing either the X or Y chromosome, depending on the patient’s choice, get implanted into the mother. Because the embryos are first fertilized with selected sperm and then checked for gender prior to implantation, this combination yields even higher success rates than the Ericsson Method alone.

If you are using gender selection to avoid passing on gender-related genetic diseases, or if you feel you absolutely could not accept a child of the gender not of your choosing, this medical method has the most proven track record, according to many accounts.

Intercourse -Timed Gender Selection – In the 1970s, two doctors released two different books offering directions on how to conceive a baby with the gender of your choice. In 1971, Dr. Landrum Shettles and David Rorvik wrote “How to Choose the Sex of Your Baby,” and revealed that sperm with male (Y) chromosomes move faster than sperm with X (female) chromosomes but do not live as long.

To conceive a boy, have intercourse on the day of ovulation or one day after. To conceive a girl, have sex two to four days prior to ovulation.

Use any number of methods, such as:

• tracking your natural fertility signs such as: basal body temperature, your cervical mucus, and your cervical position

• using an ovulation predictor kit

• using an ovulation tracker/calculator

Shettles offers other tips for tipping the scales when it comes to conceiving a baby boy, too.

• Have sex in a position that encourages deep penetration to deposit the weaker “boy” sperm closer to the cervix

• When a woman orgasms, it changes the pH level in the vagina to be more alkaline, an environment where the Y-chromosome sperm thrive

• Create an alkaline or acidic environment for the sperm by douching with a special solution prior to intercourse

• The prospective father-to-be should drink coffee prior to intercourse

Elizabeth Whelan’s method – outlined in her mid-seventies book “Boy or Girl,” contradicts the Shettles Method. She says that biochemical changes in a woman’s body prior to ovulation make the environment more friendly to Y-chromosome sperm. To conceive a boy, she says, have sex six to four days prior to ovulation, and to have a girl, wait until two or three days prior to ovulation.

Whelan’s technique, however, has lost validity over the years, while many people still rely on the Shettles Method. The Shettles Method, when done correctly, offers a 75% success rate for both genders, making the technique as reliable as medically-assisted methods. The Whelan’s method offers only a 68% success rate for boys and 56% for girls; only 6% higher than the natural 50% odds of having a girl without doing anything prior to or during conception to influence the gender.

GenSelect Gender Selection Kit – Kits such as the Genselect Gender Selection Kit also consider the pH level of the vagina, and offer special douching solutions to create an acidic or alkaline environment, friendly to x- or y-chromosome sperm, respectively.

This kit, which touts a 96% success rate, combines intercourse timing with diet and all-natural nutriceutical supplements with douches to adjust the acidity of the vagina.

Diet – A recent study suggests that women who eat a high-calorie diet tend to conceive boys more frequently – specifically, in a sampling of 740 women, 56% of the women who ate a diet high in carbohydrates and who consumed more calories conceived a boy, compared with 45% who ate a lower calorie diet. Additionally, starting the day with a bowl of cereal increased the odds of having a boy. 59% of women who ate cereal daily had boys, compared to 43% who ate cereal less frequently than once a week.

Experts attribute the increase in males conceived by women who eat a healthier, heartier diet to an increase in blood sugar levels. Also, the study seems to lend credence to the old belief that a diet high in salt increases the odds of conceiving a boy. In the study sample, a higher intake of sodium, potassium and calcium seemed to favor conceiving a boy.

It’s important to note, however, that a change in diet alone only increased the odds by a mere 9% (at best) over the natural 50-50 chance of having a boy.

Many people view the ideal family as “one boy, one girl.” And parents with two children of the same gender often get the question “Are you going to try for a boy/girl?”

These ideas may help you conceive your gender of choice. But let’s be honest: When all is said and done, most people don’t really care whether they have a boy or girl, so long as the baby is healthy. Even if you are hoping against hope for one or the other, as soon as you see that wonderful baby you created, the gender probably won’t matter.

Fertility Issues

Causes for Infertility

Infertility has several different causes. Many couples may experience more than one cause. Some infertility causes can be overcome through lifestyle changes, hormone therapy and/or medical intervention such as in vitro fertilization, while other couples may need to take other measures, such as a surrogate mother or even adoption.

Whatever your choice, remember that if you and your partner want a baby, there is one for you, just waiting to be chosen or conceived, taken home and loved.

This article outlines several common causes for infertility and possible treatments. It explains the concepts without jargon so you can have an educated discussion with your doctor about your challenges in trying to conceive.

* Ovulation Factors

Ovulation – the release of an egg into the fallopian tube – is required for conception. Most women ovulate about once a month or approximately every 28 to 31 days.

Oligoovulation means a woman ovulates irregularly. If you suffer from oligoovulation, it will be hard to predict your ovulation by tracking your menstrual cycle, but measuring basal body temperature along with tracking cervical mucus changes may be more effective, as will over-the-counter ovulation predictor kits.

Anovulation means a woman isn’t ovulating at all – either permanently or temporarily. Drastic changes in diet or eating disorders such as anorexia and bulimia can cause temporary anovulation, as can excessive exercise, stress, and breastfeeding. Amenorrhea, also caused by these factors, refers to a lack of a menstrual cycle. Every so often, a woman can get her period but not release an egg during that cycle. This is called an anovulatory cycle.

Some diseases also cause anovulation. These include:

• Pituitary problems

• Polycystic ovarian syndrome (PCOS)

• Hypothalamic dysfunction

• Luteal phase defects

• Pituitary gland, adrenal gland or ovarian tumors

Hormonal imbalances are the number one cause of anovulatory cycles.

Replacement hormones and drug therapy can often induce ovulation, but in some cases, lifestyle changes – such as stress management, reducing strenuous exercise, or stopping breastfeeding – will bring back a normal menstrual cycle complete with regular ovulation.

* Cervical / Uterine Factors

If a woman is diagnosed with cervical infertility – usually done by means of a cervical exam – it means sperm is unable to pass through the cervix and into the uterus. Cervical infertility may be caused by:

• Cervical mucus too thick to allow sperm to pass through;

• A lack of cervical mucus to transport sperm;

• A narrow cervix, also called “stenosis”;

• A cervix infection, sometimes caused by sexually transmitted diseases;

• A sperm “allergy,” where the woman’s immune system attacks the sperm as a foreign body.

Uterine abnormalities are not a common cause of infertility; they are more closely associated with recurrent miscarriages. However, a number of uterine abnormalities may contribute to infertility. Often, these are not the primary cause of infertility but a factor to consider during in vitro fertilization to avoid pre-term pregnancy or miscarriage.

Abnormalities your doctor may check for include:

• congenital malformations;

• leiomyomas (fibroids);

• intrauterine adhesions (scarring)

• endometrial polyps.

* Tubal & Peritoneal Factors

• Completely blocked fallopian tubes

• One blocked tube

• Tubal scarring

• Tubal damage

• Tubal ligation (performed intentionally as permanent birth control)

A tubal blockage located close to the uterus is called “proximal” tubal blockage, while a blockage locating further away is called distal tubal blockage.

Making up about 25 percent of all infertility cases, tubal damage or blockage is one of the most prevalent causes of infertility. It is often caused by pelvic infections, including pelvic inflammatory disease (PID) or pelvic endometriosis, but can also be caused by scar tissue that forms after pelvic surgery. Some STDs, including gonorrhea and Chlamydia, cause pelvic infections that lead to tubal blockages.

Since tubal damage is such a common cause of infertility, most doctors will test for it using a special X-ray called a hysterosalpingogram (HSG) and/or a diagnostic laparoscopy.

Most blockages can be treated with surgery – even in the case of previous tubal ligation patients – but if surgery doesn’t work, in vitro fertilization remains an option for women with tubal infertility issues.

The peritoneum is a thin membrane that lines the pelvic cavity. Problems with this membrane, sometimes caused by endometriosis, ruptured appendicitis, pelvic inflammatory disease and scar tissue, can contribute to infertility.

*Immunological Factors

Several immunological factors may lead to infertility. They include anti-sperm antibodies present in the male or female partner.

These anti-bodies can:

• immobilize sperm;

• make them clump together;

• limit their ability to pass through the cervical mucus or

• stop them from binding to and penetrating the egg.

In vitro fertilization using ICSI (injecting a sperm directly into an egg) has the highest success rate of any current treatments;

A woman’s body rejects the fetus as foreign tissue.

Clinics report a 70 percent success rate when treating this form of infertility by injecting the partner’s white blood cells into the woman prior to conception. When successful, the woman’s body begins to “recognize” the cells, and therefore, later identifies the fetus as “friendly.”

Antibodies in mother produce blood clots.

The prospective mother-to-be produces antibodies that cause clotting in blood vessels that lead to the fetus. Deprived of nutrients, the fetus dies in utero, triggering a spontaneous abortion or miscarriage.

* Endometriosis

Endometriosis afflicts more than 5.5 million American women and girls, and contributes to 25 to 50 percent of all infertility cases. Thirty to 40 percent of women suffering from endometriosis are infertile, so this is an important factor to look at if you have been trying unsuccessfully to conceive.

The Endometriosis Association lists several symptoms of the disease, but the disease may be asymptomic in mild cases.

• Pain before and during periods

• Pain during sex

• Infertility

• Fatigue

• Painful urination during periods

• Painful bowel movements during periods

• Other Gastrointestinal upsets such as diarrhea, constipation, nausea.

What exactly is endometriosis? The Endo-Association defines it as a chronic disease that occurs “when tissue like that which lines the uterus (endometrium) is found outside the uterus, usually in the abdomen on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and rectum; the outer surface of the uterus; and the lining of the pelvic cavity.”

The tissue develops into growths or legions that—like the uterine lining—builds up, breaks down and sheds during a woman’s menstrual cycle. Since this lining has no way to leave the body, it results in internal bleeding, breakdown of the blood and tissue and painful inflammation.

*Treatment of Endometriosis

Although endometriosis has no cure, several different treatment options are available to reduce pain and symptoms, slow or shrink growths and preserve or restore fertility.

Medication: In mild cases, over-the-counter pain relievers such as aspirin and acetaminophen (Tylenol) and prostaglandin inhibitors such as ibuprofen (Advil and Motrin) can relieve pain and slow growth.

Hormone therapy: Stopping ovulation through oral contraceptives or other hormone therapy will also stop the build up and break down of legions. Obviously, this isn’t a desirable treatment option for women trying to conceive and may also cause side effects.

Surgery: Surgery – usually laparoscopy, an outpatient procedure in which surgery occurs through the belly button – can remove or destroy the growths and relieve pain. Pregnancy can often occur after such surgery. A more extensive procedure with a longer recovery time – laparotomy – involves a full incision, but is still considered “conservative” surgery, versus the alternative of a hysterectomy with removal of all growths and the ovaries.

Alternative / Natural Medicine: As with most diseases, alternative and natural treatments also exist. These can be used with traditional Western medicine treatments or alone and may include:

• nutritional changes

• homeopathic treatments

• immune therapy

• allergy management

• traditional Chinese medicine such as acupuncture and acupressure

* Pelvic Inflammatory Disease

Most infertility causes are not preventable, but Pelvic Inflammatory Disease, a bacterial infection in the upper genital tract, can be prevented by preventing STDs, including Chlamydia and Gonorrhea. A PID typically affects the uterus, fallopian tubes and ovaries and can lead to infertility. It is also the most important risk factor for ectopic pregnancies leading to miscarriages.

Since Chlamydia and Gonorrhea are transmitted through unprotected sex, use of a condom in any non-monogamous relationship can prevent the diseases and help prevent PID. If you are in a monogamous relationship, both partners should be tested to make sure they are free of STDs before they begin having unprotected sex.

Symptoms of PID include:

• fever;

• chills;

• lower abdominal and pelvic pain

• vaginal discharge or bleeding.

Symptoms may begin a few days after the start of your period.

When symptoms are present, doctors can diagnose PID through a bacterial culture of cervical discharge and a white blood cell count test. (Elevated levels may indicate the infection.)

PID is sometimes confused with appendicitis or a ruptured ovarian cyst, in which case a laparoscopy can confirm PID. It can be cured with antibiotics.

Only 10 to 25 percent of all single cases of PID (that is, not a recurring infection) result in damage to the fallopian tubes that cause infertility, and prompt treatment increases the odds that there will be no enduring side effects.

* Polycystic Ovarian Syndrome

The single-most common cause of female infertility, according to Women’s Health, the Federal Government Source for Women’s Health Information, is Polycystic Ovarian Syndrome. PCOS afflicts one in 10 women of childbearing age, although it can begin in young girls as early as age 11.

The syndrome occurs due to high levels of androgens (male hormones, although females also produce them in smaller quantities) in the body, leading to missed or irregular periods, baldness, excessive facial and/or body hair, cysts in the ovaries, and often, infertility.

A number of other symptoms and disorders are linked to the disease, including:

• obesity

• pelvic pain

• sleep apnea

PCOS also carries with it an increased risk of:

• Type 2 diabetes

• high cholesterol

• high blood pressure

• heart disease

Why DOES PCOS cause infertility?

The follicles within a woman’s ovaries contain fluid and multiple eggs, which begin to mature each month. Usually only one egg matures fully, and the follicle breaks open to release the egg, which travels down the fallopian tube ready to be fertilized. This process is called ovulation.

PCOS prevents the ovary from making all the hormones it needs for an egg to fully mature. Instead, follicles grow and build up fluid, remaining as cysts. Without ovulation, the woman’s body doesn’t produce progesterone, and the menstrual cycle become irregular or non-existent (called anovulation). Obviously, without ovulation, pregnancy cannot occur by natural methods.

Treatments for PCOS

No cure exists for the syndrome but treatment and lifestyle changes designed to manage the illness can reduce the risk of complications, minimize symptoms and also increase the chances of a successful conception and pregnancy.

Unfortunately, one of the most common forms of PCOS treatment is the use of birth control pills to regulate menstrual cycles and reduce the presence of male hormones. This is not a permanent fix, however, and lasts only as long as the woman is on the Pill, so is not a desired treatment for women trying to conceive.

Diabetes medications: Diabetes medications, including Glucophage (metformin) lowers testosterone production and controls the way the insulin controls blood sugar levels. PCOS is linked to insulin production, making this an effective treatment. Glucophage, according to an article in the New England Journal of Medicine, was recently found safe for pregnant women to treat gestational diabetes, and so may be a good option to discuss with your doctor if you trying to conceive with PCOS.

Fertility medications: Since anovulation causes infertility – and is a common symptom of PCOS – medicines designed to stimulate ovulation may help a woman with PCOS become pregnant. Clomiphene citrate, under the brand names Clomid or Serophene, usually works. Sometimes metformin will be added, which may help a woman ovulate with on a lower dose of both medications. Gonadrotropins – a fertility medicine taken by injection – may also be used, but carries a greater risk of multiple births. Finally, in vitro fertilization remains an option for women trying to conceive with PCOS.

Surgery: When fertility medicines don’t work, “ovarian drilling” – a laparoscopic procedure – may be used as a last effort to stimulate ovulation. The surgeon punctures an ovary with a small needle and uses an electric current to destroy a small portion of the ovary. There is a risk of scar tissue developing on the ovary, but the surgery may lower male hormone levels, stimulating ovulation. Effects may last a few months, creating a small window during which a woman may conceive naturally or through artificial insemination. The treatment typically doesn’t help with cosmetic symptoms of PCOS, such as baldness or body and facial hair growth.

Lifestyle modification: Often, women can manage the symptoms and risks of PCOS with lifestyle changes, including regular exercise and a healthy diet rich in fruits, vegetables and whole-grain products. By following a diet similar to what a diabetic should eat, a woman with PCOS can improve her body’s use of insulin and normalize hormone levels, which may stimulate ovulation and even create regular menstrual cycles, leading to the possibility of a healthy pregnancy.

*Premature Ovarian Failure

According to the International Premature Ovarian Failure Association, approximately one to four percent of the female population suffers from Premature Ovarian Failure, sometimes called premature menopause.

More information about PCOS

Premature Ovarian Failure typically occurs in women under 40; it can happen as early as the teen years. POF may be caused by certain syndromes, diseases, genetic disorders or even radiation treatment or chemotherapy, although in many patients, doctors can’t identify a specific cause at all.

If you are not pregnant, breastfeeding or menopausal and your periods have stopped or become irregular, it could be due to POF. You may also experience other symptoms of menopause, including:

• Hot flashes

• Vaginal dryness

• Lack of sex drive

• Painful sex

• Bladder control problems

• Mood swings

• Energy loss

Unfortunately, only about six to eight percent of women with POF will be able to successfully conceive. No treatments exist to restore fertility in women with POF, but you should still seek treatment for the disorder, because it carries several other health risks including an increased risk of osteoporosis, and heart disease.

A doctor may diagnose POF with two FSH tests done approximately a month apart. If FSH (Follicle Stimulating Hormone) levels are normal, it typically indicates the ovaries are working correctly. Women with POF will show FSH levels in the post-menopausal range.

According to the International POF Association, many doctors misdiagnose POF or blame the symptoms on stress. Insist on diagnostic testing to either rule out or diagnose the disorder so that you can begin treatment promptly. Treatment may include hormone replacement therapy and lifestyle changes to manage symptoms and decrease the health risks of complications associated with POF, such as osteoporosis and heart disease.

More information on Premature Ovarian Failure (POF)

* Fibroid Tumors

Fibroid tumors by themselves are a primary cause of fertility in only three to 12 percent of women who have them. If fibroid tumors block the fallopian tubes, they can cause infertility.

However, treatments for fibroid tumors, including myomectomy – a surgical procedure in which fibroids are removed but the uterus remains intact – and hysterectomy can cause permanent infertility. In many cases, fibroid tumors return after a myomectomy and the surgery must be repeated. This repeated procedure can cause uterine scarring leading to infertility. If conception occurs, however, 85 to 90 percent of all women will have a successful pregnancy without complications.

Female Alternative Surgery, which uses lasers to remove the fibroid tumors without damaging the uterus or ovaries and preserving fertility, should be discussed with your doctor, as well.

What are Fibroid Tumors?

Fibroid tumors are benign masses which grow in the uterus. They can be hard and stony or soft and rubbery. Nearly 25 percent of all women of childbearing age have fibroids. They are typically identified during a gynecological exam when a doctor may feel a mass in the uterus; this diagnosis may be confirmed by an ultrasound.

Some women won’t have any symptoms from fibroid tumors and, chances are, without any symptoms, the fibroids also won’t create problems with conception. However, if you are having fertility issues and have any of the following symptoms, fibroid tumors blocking the fallopian tubes may be a cause.

Symptoms of Fibroid Tumors

• Pelvic Pain

• Increased menstrual cramps

• Increased menstrual flow

• Clots

• Irregular or painful periods

• Increased urinary frequency

• Constipation

• Bloating

* Hyperprolactinemia

A hormonal disordered characterized by unusually high levels of prolactin in the blood in non-pregnant, non-breastfeeding women or in men.

This disorder occurs in approximately 10 percent of the population and can result in infertility in males or females. In women, it can cause irregular or non-existent menstrual periods.

Stress, sex, exercise, sleep, nipple stimulation, certain prescription drugs and even eating certain foods can also increase prolactin levels temporarily. If one blood test shows elevated levels of prolactin, a follow-up test should be ordered to confirm the diagnosis.

If hyperprolactinemia is causing infertility, it can be treated with prescription drugs.
* Luteal Phase Defect

The luteal phase of a woman’s menstrual cycle begins immediately after ovulation and continues for approximately 12 to 14 days. If the luteal phase lasts 10 days or less, it is considered a Luteal Phase Defect. Some doctors believe any luteal phase shorter than 12 days can cause problems. This shortened time period may not allow the uterine lining to develop enough for the embryo to fully implant, and often leads to an early miscarriage or a failure to conceive.

LPD occurs because of inadequate progesterone stimulation; it is a hormonal imbalance. You may discover a Luteal Phase Defect while charting your fertility. A time frame between ovulation and menstruation of less than 12 days may indicate an LPD. A doctor can discover an LPD with a simple blood test that detects progesterone levels in your body seven days after ovulation.

It is often treated with vitamin B6 and progesterone cream, which help lengthen the luteal phase.
If over-the-counter treatments don’t work, a reproductive endocrinologist may prescribe Clomid or progesterone suppositories.

* Other Causes of Infertility

Several other causes of infertility exist. A reproductive endocrinologist may explore some of these possible causes with you.

Anything that effects your menstrual cycle, including stress, rapid weight loss or gain, travel, and intense exercise can cause temporary infertility. These are all factors to consider when you are trying to conceive.

Additionally, some medical conditions can lead to infertility. Some diseases associated with infertility, pregnancy complications or miscarriage include:

• Diabetes

• Lupus

• Thyroid Disease

Going To See The Doctor

If you have been trying to get pregnant without success for more than a year, or for more than six months if you are over the age of 35, it may be time to visit a fertility specialist.

Before you see a doctor, however, make sure you have done everything in your power to get pregnant.

• Are you tracking your menstrual cycles and using some method to ensure you are having sex at or around your time of ovulation?
• Does an ovulation predictor kit show that you are ovulating normally?

If this is the case, a fertility specialist should be able to help you pin down the reason you have not been able to conceive and discuss methods that will help you conceive or make a pregnancy possible. Statistics show that 85 percent of all infertility cases are curable.

Testing for Him

The doctor first will take down your medical history. Testing typically begins with the male, because his test involves a simple semen analysis. The analysis will look for sperm count, healthy movement of the sperm, and the shape and maturity of the sperm cells to determine the quality. The semen’s consistency and volume will be analyzed – approximately one teaspoon is considered normal. The pH balance will be tested – it should be slightly alkaline to survive in the environment of the cervix.

If the test results show abnormalities, a doctor specializing in male infertility will repeat the exam two times over the next three months. Many different factors – from a fever or illness to sexually transmitted diseases – can affect sperm count. Additionally, intense physical activity – and especially bicycle riding – can reduce sperm count, as can high temperatures, such as those experienced in a hot tub. Even wearing briefs instead of boxers can create a warm environment in the testes that can lower sperm count.

If the next two exams bring abnormal results, your partner will be referred to a urologist, who will perform the following tests:

• A sperm antibody test

• Hormonal blood tests

• Testicular biopies to determine if he is sterile

• Vasography which checks for any obstructions

• Fructose test

• Bovine cervical mucus test which checks the sperm’s ability to penetrate cervical mucus from cows

• Hamster egg test which determines sperm penetration strength. This test is important, because if his sperm can’t penetrate the egg, in vitro fertilization will not be successful.

Testing for Her

If your partner’s semen analysis results are normal, or if all of the tests performed by the urologist show no problems, testing begins for you. A gynecologist specializing in reproductive endocrinology can take you through this stage of fertility testing.

The doctor will first view both of your charts and review your medical history, paying particular attention to past surgeries such as appendicitis, myomectomies or fibroid surgery, and any STDs on record. He will ask about your menstrual cycle – if you’ve ever had irregular periods, etc., and he will ask about your contraceptive history. He will then conduct interviews with both of you, either together or separately.

He will ask you both questions about previous pregnancies and their outcomes, as well as how long you’ve been trying to get pregnant. He will also ask many lifestyle questions including:

• Frequency of sex

• Do you use any recreational drugs?

• Do you smoke?

• How often do you drink alcohol?

• How healthy is your diet?

• Do you exercise regularly? How often and what activities?

• Have you experienced any stressful events recently, such as a death or new job?

It may be tempting to lie when you answer some of these questions but your honest answers will help your doctor discover the cause of your infertility and make changes that will help you get pregnant.

Your exam includes a complete physical, including an internal, when the doctor will examine your ovaries for signs of problems such as PCOS (polycystic ovarian syndrome),endometriosis, and PID. An ultrasound may be performed to check the condition of the fallopian tubes and ovaries.

Additionally, blood work will be done or scheduled to check reproductive and thyroid hormone levels and to test for STDs.

A visit to a fertility specialist can be a stressful experience, but knowing what to expect and being prepared can help alleviate some of your concerns, as well as make your visit go smoothly.

How can you prepare?

• Bring a list of questions you and your partner want to ask

• Be prepared with your families’ medical histories and your own medical histories

• Be prepared with information about your menstrual cycle, including ovulation dates from charting your cycle for at least three months.

Diagnostic Procedures

Several tests performed by your doctor or reproductive endocrinologist will help diagnose the cause for your infertility. We already covered the tests your partner will go through in the section titled “Visiting Your Doctor.”

The tests for you range from very simple in-office tests no more invasive than a PAP smear or ultrasound to surgical procedures.

Post Coital Test
During the Post Coital Test the doctor takes a sample of your cervical mucus. The doctor will examine the cervical mucus under a microscope to determine if it is hospitable to sperm.

Timing is everything with this test; it must be performed four to 10 hours after sex when just prior to, during, or immediately following ovulation (i.e., your fertile period, or the time of your cycle when you should be able to conceive.) Use an ovulation predictor kit to be certain, although you can certainly use other timing methods, including tracking BBT (Basal Body Temperature) and cervical mucus.

Do not:

• Use lubricant during sex

• Douche after sex

• Bathe or swim after sex (a shower is okay)

The doctor will take a small sample of cervical mucus and examine it for:

• Quantity – There should be more plentiful amounts during your fertile period;

• Consistency and clarity – It should be very thin and clear and also very stretchy, almost rubbery;

• Ferning – Under a microscope, the doctor should see a fern-like pattern in the dried cervical mucus, indicating the presence of estrogen without progesterone hormones;

• Cellularity – Few cells, other than sperm, should be present.

If any of these factors show problems, this could be the reason you are having difficulty conceiving. The doctor may recommend artificial insemination by means of intrauterine insemination in order to bypass the cervix all together.

However, the number one reason this test fails is poor timing; if the test was not done four to 10 hours after intercourse or was not done while you were ovulating, then the cervical fluid may not show a favorable environment for sperm to survive, swim and fertilize an egg. If this is suspected to be the case, a second test should be performed at the time of ovulation.

Other causes for an unfavorable cervical environment include:

• Infection or irritation. If this is the cause, testing will show white blood cells in the mucus.

• Procedures performed on the cervix to treat an abnormal Pap smear, such as freezing or laser treatment.

• Medications. Clomid (generic: clomiphene) a fertility drug used to treat infertility caused by anovulation, can have adverse affects on cervical mucus. If your doctor prescribes the drug or increases your dosage, he should perform a post-coital test to be sure the cervical environment is still hospitable to sperm.

Ultrasound
Most people think of ultrasounds as a non-invasive, painless procedure performed on pregnant women in order to see the unborn baby. True, an ultrasound can determine the gender, size (give or take 2 pounds), and often the general health of a fetus, but it can also give a doctor information about why you haven’t been able to conceive yet.

Your doctor will use an ultrasound to evaluate the condition of your ovaries and fallopian tubes, and check for cysts, tumors and uterine fibroids. He will be looking for Polycystic Ovarian Syndrome, endometriosis, and anything else that may be impairing your ability to get pregnant. An ultrasound can show the doctor if your eggs are developing properly and are being released from the ovaries and if the endometrial lining thickens sufficiently to permit implantation.

An endometrial biopsy is used to detect cancerous cells, precancerous cells, infections or any abnormalities that may be affecting your ability to conceive. The doctor inserts a thin catheter, called a pipelle, into the uterus and uses it to draw out cells for testing.

You may experience mild to intense cramping during and after the test. The doctor may recommend you take ibuprofen, such as Motrin or Advil, before and after the test to minimize cramping, or he may offer a prescription painkiller. You may have minor bleeding following the test.

You should take a pregnancy test prior to an endometrial biopsy since the procedure may terminate a very early pregnancy.

Hysteroscopy
A hysteroscopy is an out-patient procedure performed that will allow your doctor to spot abnormalities in the uterus such as:

• fibroid tumors

• polyps

• scar tissue

A hysteroscope is a very thin telescope with a camera on the end that can enter the cervix with no dilation. The uterus is expanded by means of saline solution or carbon dioxide, permitting the doctor to view the inside on a television monitor in the office. Minor cramping may result from the introduction of saline or carbon dioxide into the uterus, but the procedure is not considered especially painful.

Falloposcopy
Cleared by the U.S. FDA (Food and Drug Administration) in 1997 for use to diagnose fallopian tube blockages in women trying to conceive, falloposcopy is regarded as a relatively new and complicated procedure. However, since nearly 35 percent of all female infertility cases are related to fallopian tube damage, this procedure may be invaluable in determining the cause of infertility. Your doctor will probably order less invasive tests first, however, including an ultrasound.

Because the fallopian tubes are located so deep within the reproductive system, past diagnostic procedures carried a 40 percent rate of false diagnoses. The STARRT Falloposcopy procedure, patented by Conceptus, Inc., shows a much greater accuracy rate.

The procedure takes about 45 minutes and is performed with local anesthesia or intravenous sedation. Another benefit of the test is that tubes can be repaired at the same time, with the same equipment, if the doctor finds any abnormalities. Tubal repair can take as long as two hours and your doctor will use a general anesthesia. If abnormalities are found but the tubes cannot be repaired, your doctor will discuss the possibility of in vitro fertilization with you and your partner.

Similar to a hysteroscopy, a falloposcopy views the inside of the fallopian tubes by means of a camera inserted into the body. It enters through a catheter that travels through the cervix and uterus and finally, into the fallopian tube. A fiber optic endoscope with a camera on the end is then inserted through the catheter, so the doctor can view images on a television monitor in the office.

Risks include infection and bleeding, so your doctor may prescribe an antibiotic as a preventative measure.

Laparoscopy
Laparoscopic surgery is an advance in medical technology which permits diagnostic surgery through a very small incision, into which a thin instrument (laparoscope) is inserted in order to take pictures of the abdomen. Carbon dioxide is used to expand the abdomen, permitting the doctor with a clear view of the uterus, cervix, and ovaries and fallopian tubes on a television monitor in his office or in the operating room.

Doctors in the late 20th century commonly recommended this diagnostic procedure in couples trying to conceive. Today, however, other procedures are recommended first. Although laparoscopy is simpler and safer than traditional surgery with a full-size incision, it is still surgery, and often performed under general anesthesia. Rarely does a laparoscopy turn up any abnormalities not spotted by other fertility screening tests.

Hysterosalpigogram (HSG)
According to the Advanced Fertility Center of Chicago, a hysterosalpigogram is a common infertility diagnostic procedure that is helpful in detecting tubal infertility. Since 25 percent of all infertility is caused by tubal abnormalities, this test may be an important one. Less invasive than a laparoscopy, top fertility clinics makes it part of its basic fertility screens.

The test is performed in the radiology department of the fertility clinic, hospital or medical center between days six and 13 of the patient’s menstrual cycle.

Dye is injected into the uterine cavity, through the vagina and cervix. If the fallopian tubes are normal, the dye should spill out into the abdominal cavity. If there is a tubal blockage, the dye will stop at that point. The X-rays will be available for evaluation that day.

An HSG test also detects:

• uterine anomalies

• polyps

• fibroid tumors

• uterine scar tissue

• tubal defects

• scar tissue around the fallopian tubes

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