Struggling to Get Pregnant: Understanding Infertility Treatments

Anne Brown, MD, is board certified in in obstetrics and gynecology. She is currently the medical director of the Women’s Health Service Line for Inova Loudoun Hospital. Read Dr. Brown’s Profile.

The decision to start a family is usually an exciting one. But if you have trouble conceiving, that excitement can quickly turn to stress and frustration. Whether you’ve just gotten into the baby-making game or have been at it for a while, it helps to know there are options for dealing with infertility.

What Is infertility?

Officially, infertility is the failure to get pregnant after one year of regular, unprotected intercourse. How can you know if you might have trouble conceiving? As I tell my patients, you don’t know until you try.

Still, certain factors could increase the likelihood of infertility. Those factors include:

• Age greater than 35 in women or 55 in men
• A history of pelvic inflammatory disease or sexually transmitted diseases in women
• History of scar tissue from abdominal surgeries in women
• Infrequent menstruation in women, which can signal problems with ovulation
• History of mumps in men
• History of genital injury in men

Tracking and Testing

If you’ve been trying for a baby and haven’t had any luck, I recommend using ovulation predictor kits. These kits help couples time intercourse for the days when a woman is ovulating. Some women also choose to track their basal body temperature, which helps them pin down their most fertile time of the month.

Still no luck? We can perform a series of tests to identify problems. Those tests include:

• Semen analysis. We can perform a “sperm count” to examine the quantity and quality of a man’s sperm. This is best performed in the laboratory after 24 to 48 hours of abstinence.
• Hysterosalpingogram/HSG. Also known as a tubal dye study, this test looks for structural problems in a woman’s uterus and fallopian tubes.
• Hormone tests. We can measure levels of several hormones related to fertility in women, including follicle stimulating hormone (which stimulates the growth of eggs), anti-Müllerian hormone (which is produced by immature egg follicles) and luteinizing hormone (which tells the ovaries to release an egg).
• Using ultrasound during the first half of the menstrual cycle, we can count the number of small egg follicles, also known as antral follicles. These counts help us estimate a woman’s “ovarian reserve,” or remaining egg supply.

What’s Next? Exploring Treatment Options

Sometimes the tests identify a treatable problem. Many times, though, the cause of infertility remains a mystery. In either case, we often refer couples to specialists called reproductive endocrinologists (REs), who can help patients figure out the next steps.

If you need help getting pregnant, there are two common ways REs can help:

• Intrauterine insemination (IUI). Also known as artificial insemination, this involves placing sperm inside the uterus to boost the odds of fertilizing an egg. In some cases, medications are used to stimulate ovulation.
• In-Vitro Fertilization (IVF). In this procedure, doctors combine eggs and sperm in the laboratory and then transfer the embryo to the uterus.

The good news is that more and more insurance companies are covering infertility testing and treatments. Still, struggling to have a baby can be stressful for a couple, and it is important to take care of yourself and your relationship during the process.

We combine skill and sensitivity to help couples explore their options. To make an appointment, visit Capital Women’s Care (formerly Loudoun Physicians for Women).