LOWER YOUR INFERTILITY COSTS (PART III) WHEN TO SEE AN OBGYN; WHEN TO SEE A REPRODUCTIVE ENDOCRINOLOGIST

Trying on Your Own

            At - Home Fertility Testing

$          Ovulation predictor kits (OPKs) are accurate and helpful to use to better time intercourse to ovulation. On the other hand, various over-the-counter fertility testing kits for sperm or female hormones that claim to evaluate key fertility components for men and women may be a waste of money.

$          Female home kits are available that can detect FSH on day 3 of the menstrual cycle. However, since a woman’s FSH levels fluctuate widely, and this test does not measure the woman’s estrogen level at the same time, this test is virtually useless. Estrogen and FSH must always be measured together in order to interpret the value of the FSH level!

$          Male tests measure the concentration of motile sperm but give no useful information about other important factors such as total sperm count and sperm function or morphology . . . so don’t waste your money.

$          In conclusion, with OTC testing, don’t waste your money. You should see an infertility specialist when you think there might be a problem. A fertility specialist will perform tests that are much more sensitive and accurate. They will ignore the results from the OTC at –home tests since they are not accurate.

Baby Making Sex

$          Go natural; don’t use lotion, saliva or lubricants. You may try so-called fertility friendly lubricants, which are water based.

$          The best position is the traditional missionary style. This puts the sperm as close as possible to the cervix.

$          Make love at least every other day during your fertile time if you’re not using an ovulation predictor kit (OPK) or follow the directions with the predictor ovulation kit you are using… Generally 24-36 hrs after LH change detected.

WHEN IS IT TIME FOR YOU TO SEE A DOCTOR? GYNE?

Infertility is defined as the inability to conceive after 1 year of unprotected intercourse in women under 35 or after 6 months of trying for women 35 and older. Don’t delay!

The basic infertility evaluation can usually be performed by an Ob/Gyn or a Reproductive Endocrinologist (RE) depending on circumstances. The evaluation may include:

  • Semen analysis (SA) to assess male factor problems with his sperm
  • Hysterosalpingogram (HSG) x-ray to investigate your uterus and tubes
  • Ovulation predictor kit (OPK) and serum progesterone level to assess ovulation
  • A hormone evaluation evaluating thyroid, pituitary and ovarian function. Measuring serum estrogen and Follicle Stimulating Hormone (FSH) during days 2-4 of your menstrual cycle and an ultrasound (US) to evaluate the number of follicles (egg sacs) in each ovary can determine when the ‘ovarian reserve’ of eggs is diminishing.

These important diagnostic tests (total costs $1000+) can often help you and/or your Ob/Gyn determine a treatment plan and also help decide when it may be beneficial to be more aggressive with your fertility therapy and seek the expertise of a reproductive endocrinologist (RE).

Basic infertility treatments, such as Clomiphene citrate (Clomid) for ovulation are usually initially administered by an Ob/Gyn.  For more complex treatments including IUIs or FSH injections or IVF, you should see an RE.

Clomiphene Citrate (Clomid) From Your Gynecologist

$          Clomiphene citrate (CC) fools the pituitary into producing more FSH and LH, two hormones needed for normal ovulation.

$          You should always determine if you are actually ovulating on clomiphene citrate. It is important to understand that just because you get your period does not mean you are always ovulating. Too many gynecologists order clomiphene but then don’t monitor!

$          Various methods to monitor your ovulation can involve temperature charts, or looking for additional signs of ovulation (pain) or using OPKs. Undergoing a laboratory blood test with your doctor-- checking a progesterone level 7 days post ovulation - is the most accurate confirmation.

$          Age is the most important factor determining the success of clomiphene citrate. CC is not the best choice for women in their late 30's or early 40's because their FSH levels may already be elevated…CC is too mild for them.  It is not usually very effective in these women and they may be wasting their time.

$          For women taking CC, if pregnancy is going to occur, 90% of pregnancies will occur within the first 3-4 ovulatory cycles.  So if you are ovulating on CC, but aren’t pregnant after 3-4 months, you need to move on! Women under 35 have about a 33% chance of becoming pregnant within the first 3 months of using CC.  

$          Therefore, after 4 months of ovulatory cycles, you have less than a 10% chance of achieving pregnancy, socontinuing any longer is an absolute waste of time and money! Some gynecologists make the mistake of just continuing CC and telling patients they have plenty of time to get pregnant. You need to move on and see an RE. 

$          Your gynecologist may have basic knowledge … but (s)he  isn’t a fertility specialist. They may be excellent at doing hysterectomies and delivering babies but infertility may not be their top priority.  If you have been seeing your gynecologist for over 4 months with no results, you need to move on and ask for a referral to an RE, or refer yourself.

When Is It Time to See a Reproductive Endocrinologist?

There are several infertility conditions or circumstances which may prompt you or your    Ob/Gyn to seek an RE for more advanced fertility therapies:

  • Age 38 or older or diminished ‘ovarian reserve’ at any age. The biological clock is ticking loudly, often requiring more aggressive therapies such as fertility medications + IUI … Clomid or FSH injections (gonadotropins) with intrauterine inseminations (IUI) or

      In vitro fertilization (IVF).

  • Documented tubal disease or a history of damage. Previous ectopic tubal pregnancies, pelvic inflammatory disease (PID), or Chlamydia infections will often compromise tubal function or patency.  Abnormal HSG requires aggressive therapy.
  • Pelvic disorders causing adhesions (scar tissue), such as endometriosis, or previous abdominal surgeries for conditions such as ruptured appendix or ruptured ovarian cysts.
  • Significant male factor problems (very low sperm count or motility or abnormal sperm function testing-‘strict morphology’).
  • Failed Clomiphene (Clomid) ovulation induction therapy after 3-4 attempts with Ob/Gyn. If no success, seek other causes of infertility and a more aggressive approach.
  • Recurrent pregnancy losses (miscarriages).
  • Unexplained or idiopathic infertility. (No causes identified).
  • Donor egg, donor sperm or gestational surrogacy