Understanding Infertility: What to Do After a Healthy Exam

Question
hi i was wondering if you could help me, I've been for a transvaginal examination today and she said that my womb was fine and heathy and my ovaries looked fine. But I've been with my partner for 3 years and I'm not getting pregnant I'm still having all my periods. is there anything you could suggest or what might it be? thanks

Answer
Hello Joanne,

You need to have an infertility evaluation done.  There are 9 steps that your body goes through in order to become pregnant.  All you know at this point is that you ovulate (because you have regular periods), but know none of the other 8 steps.  The ultrasound has ruled out major abnormalities like fibroids or dilated fallopian tubes, but does not help with know if the endometrial (uterine) cavity is normal.  

If you doctor doesn't do infertility evaluations, then I would recommend that you see a fertility specialist.

The testing usually performed are:

1.  Blood test for hormone levels.
2.  Hysterosalpingogram - checks if your tubes are open or blocked
3.  Hysteroscopy or Hysterosonogram - checks the uterine cavity
4.  laparoscopy - checks for pelvic abnormalities such as scar tissue or endometriosis or positional abnormalities of the tubes
5.  Luteal phase progesterone - checks for adequate progesterone levels and confirms ovulation.
6.  Endometrial biopsy - checks for malformation of the endometrial lining.
7.  Semen analysis - checks to see if there are adequate numbers, adequate motility and adequate normally formed sperm.
8.  Ultrasound - you've already done this

I hope this is helps,

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.