QuestionHello,
First off, I'm from NY. My husband and I are both 32 and we've been trying to get pregnant for a little over a year now. My husband had a semen analysis and they found a problem with his motility and shape. I had blood work done as well as a sonogram and my results came back with no issues. My gyn is sending me to get a HSG next month. Depending on the results of this test, what would be the next step? Should my husband get another semen analysis? - his urologist recommended that he does. I just want to prepare myself for whatever is next, or try to get ahead of the game if my husband should be going for another test.
AnswerHello Alicia from the U.S. (New York),
Your gynecologist is certainly taking her sweet time doing the evaluation. I usually can do a complete evaluation within one month. The full infertility evaluation is as follows:
1. Cycle day #2 or 3 hormone panel (Estradiol, FSH, LH, TSH, Prolactin)to check the ovaries, thryoid, hypothalamus and pituitary
2. Hysterosalpingogram (HSG) to check for tubal patency
3. Hysteroscopy or Hysterosonogram to check the endometrial cavity.
4. Laparoscopy (optional) to check the pelvis for endometriosis or scar tissue.
5. Pelvic ultrasound to check for uterine abnormalities, ovarian cysts, tumors or large abnormalities.
6. Progesterone level on cycle day #20,21 or 22 to verify ovulation.
7. End of cycle (CD#25,26 or 27) endometrial biopsy to check for luteal phase defect
8. Semen analysis.
9. Cervical cultures for myocplasma and/or ureaplasma.
If the first semen analysis is abnormal, the proper course would be to repeat the semen analysis to verify. If the second one is abnormal, then the treatment recommendation will depend on how bad the semen analysis is. Treatment options include IUI or ICSI/IVF. If the abnormal parameters are only minimally abnormal, then sometimes a 3 month course of treatment with Clomid and Proxeed or Fertility blend can raise the parameters to normal. It has to be taken for a minimum of 3 months because that is the production cycle for sperm.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
