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As you sit across the table from your reproductive endocrinologist, your head is likely spinning with frustration and sadness that you have to be in a medical office, of all places, trying to get pregnant. You are overwhelmed with your efforts of the last few months or years—cycle charting, body temperature checking, cervical mucous changes (what isthat?). Your marriage or partnership is likely feeling the strain.

So rule number one: let us take the stress out of your hands. Period. We do this all day, every day, and we do it well. We’re here to help.

Here is the basic conversation I have with all new patients during their first visit to Reproductive Medicine Associates of Southern California:

Infertility is common, and you can actually have more than one cause of infertility within the same couple. So we typically recommend performing the complete workup to check out all the pieces and the parts. That way, we systematically check everything off and make sure we don’t go down a treatment path only to find that there is a second problem at play.

Here are the things we will check:

SPERM COUNT

At this stage, this typically means “meets or at least almost meets normal laboratory parameters.” Men make millions of sperm every day, so there is a wide range of normal. The volume of fluid should be at least 1.5 ml, there should be at least 15 million sperm per ml, at least 40% of the sperm should be swimming, and 4% or more should be shaped normally. Visit our Options for Men page for more information on male infertility.

 

SHAPE OF UTERUS

This is one of the less common causes of infertility. But your doctor should always look with an ultrasound to make sure the uterus is shaped in a specific way and to evaluate whether you might have fibroids in the muscle or polyps in the lining of the uterus. Depending on what we see on initial ultrasound, we may order other imaging, such as MRI, saline ultrasound, or hysteroscopy. Visit our Options for Women page for more information on female infertility.

 

OPEN FALLOPIAN TUBES

Fallopian tubes are delicate, flimsy organs, and if they are damaged they usually can’t be repaired. They must be functioning to make sure there is a chance of egg and sperm meeting inside your body.

The only way to evaluate the tubes is with a special x-ray called a hysterosalpingogram (HSG). Your REI or a radiologist will place a catheter in the cervix through which contrast dye will fill the uterus and spill out of the tubes into the abdominal cavity. We will then capture an image with an X-ray from above your belly. This procedure can be crampy, but is much more tolerable if you take 800 mg of ibuprofen an hour before and don’t get too stressed out about it.

 

(THE MOST IMPORTANT PART) YOUR OVARIES

Here’s how ovaries work: We all have thousands of eggs in our ovaries, but they are microscopic and “sleeping,” or in long-term hibernation. Every month a small group of eggs wakes up from sleeping and starts to mature just a little bit—these eggs make a little bit of fluid around them and we can see them on ultrasound. This is called the antral follicle count. Then, if you are cycling regularly, your brain talks to your ovaries and your ovaries talk back to your brain and one of those eggs grows, matures fully and ovulates. The rest of that group dies. The next month you’ll have a new group of eggs.

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Dr. Ellen Goldstein

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Affiliated With: CN Health

Dr. Ellen Goldstein is a board certified OBGYN and specialty trained Reproductive Endocrinologist and Infertility physician. Dr. Goldstein graduated from Brown University with an undergraduate degree with honors in biology and she received the James...

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