Women who are planning pregnancy should schedule a preconceptional gynecology visit to review health factors that may affect fertility and prenatal care.
A general health overview and a gynecologic exam will be done. Birth defects and health problems in newborns can be significantly reduced by improving the mother’s nutrition and medical status well before pregnancy. Family history is reviewed as it relates to certain diseases and hereditary factors. Alcohol misuse, tobacco and drug use and certain medications should be discontinued. Folic acid supplements should be taken in preparation and throughout pregnancy. Other vitamins, iron and omega 3 fish oils are also important for good maternal and fetal health. Specific laboratory tests may be recommended such as blood type, Rubella, Hepatitis B, HIV and other sexually transmitted diseases. Sometimes, genetic testing is advised.
If attempts at conceiving are unsuccessful or there are existing fertility factors, then an infertility evaluation can be initiated by the gynecologist. Most couples do not require IVF or high tech treatment by a fertility specialist (Reproductive Endocrinologist). Abnormal menstrual cycles, pelvic pain or a history of gyn problems suggest not delaying a work up. I classify fertility problems into 3 main groups. Male factors, and ovulation/hormonal factors/egg production are the first two groups we look at in otherwise healthy couples. The third group I call tubal factors, and includes things like endometriosis, fibroids, blocked tubes and other conditions that impair the fertilization of a healthy and “available” egg and sperm. Evaluation of the tubal factor group involves higher levels of testing and treatment.
The basic evaluation usually begins with a simple semen analysis or “sperm count”. If there are an adequate number of healthy sperm in the male partner and normal sexual function, then the testing focuses on the woman. After a careful medical history and gyn physical exam, we will often order lab testing to check certain hormone levels and recommend menstrual calendars and ovulation predictor kits. Regular menstrual cycles, with no abnormal bleeding, missed periods or other signs of hormone imbalance usually suggests normal ovulation or egg release. This usually happens about 12-14 days before the expected start of menses. Some women will notice a mucus discharge before ovulation and a twinge or minor pain in one side. Even if cycles and labs are normal, we will suggest a physician-performed clinical transvaginal ultrasound (TVUS). This gives a clear image of the uterus, uterine lining (endometrium), the fallopian tubes and the ovaries. Problems like fibroids, damaged tubes, uterine polyps, ovarian cysts and endometriosis can be explored with this test, especially when done “real-time” by a gynecologist. When there is pelvic pain, abnormal bleeding or an abnormal ultrasound, or even if all other testing is normal, then we recommend diagnostic laparoscopy and hysteroscopy to provide a direct look at the pelvic organs. These are surgical interventions, but are an important part of the fertility investigation for many women. These procedures offer a chance to diagnose common conditions that interfere with fertility and, more importantly, provide a chance at expert surgical treatment at the same time. Laparoscopy and hysteroscopy are used to treat endometriosis, polyps, cysts, scar tissue, tubal blockage and fibroids using special tools and lasers through small natural openings or small incisions.
In some cases, these tests and treatments are either unsuccessful or bypassed in favor of ART (advanced reproductive technology), such as in-vitro fertilization, surrogacy or high-tech fertility drugs for “superovulation”.
We work closely with several IVF specialists around the country when this approach is indicated. We have had a long standing relationship with Dr. Shayne Plosker, MD, from Shady Grove Fertility clinic in Brandon, Florida, who is highly recommended..