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Time to question your fertility?
Yvette Smith, MD, MPH posted:
If you've been trying to conceive for at least a year with no luck, you may be asking what's next.

The first step is basic infertility testing, which usually includes ovulation testing (e.g. ovulation predictor kits or temperature charting), and a hysterosalpingogram (HSG), or an X-ray test to make sure your fallopian tubes are open. Infertility testing may also include semen analysis for your partner, to confirm that he has a productive sperm count, that his sperm move in the right direction, and that they maintain the right shape. Testing should also include blood work to check for other issues, like thyroid dysfunction. If abnormalities are identified, treatment options can be provided that aim to address your specific issues as a couple. >

If you're like most couples who undergo infertility testing, you hope these tests tell you exactly what the problem is, so you and your medical team can work to solve it. But the truth is about half of the time fertility specialists don't find a specific reason as to why their patients aren't getting pregnant. So you may ask again, what then. Certainly, many couples continue trying to conceive on their own, with ovulation charting and timed intercourse. Other couples want to know what other options they have.

I always recommend that couples consult with a fertility specialist. I think there are great benefits to hearing about possible options from an expert. These options may include:
  • Using a mild fertility drug
  • Using injections or stronger medications for more productive ovulation
  • Insemination with your partner's sperm
  • Insemination via a donor's sperm
  • In vitro fertilization (IVF) with your own eggs
  • IVF with a donor's eggs
And more?

You might be surprised about what's involved in some of these choices, or rather, that certain processes don't work like you thought they did. But if nothing else comes from speaking with a specialist, at least you'll know what options you're discarding. It would be very hard to realize much later that you might have tried a certain option, but were unaware of its existence.

Have you looked into any additional options for successful conception?
Jjoy81 responded:
We just had our results from a fertility work up and everything came up normal. Does that mean there is nothing wrong and we just need to keep trying or does that mean there could be an additional problem but it wasn't detected? Do blood tests look at hormone levels? Do you know if your bodies PH can be a problem in the vaginal canal and killing the sperm?
Yvette Smith, MD, MPH replied to Jjoy81's response:
We come up empty in about half of couples. It's hard to say what this means. Perhaps nothing is wrong. Another possibility is that we're just not smart enough yet, we just haven't desinged the right test to explain what the problem is in your situation.

We're fortunate that frequently infertility specilaists can help you get pregnant even if we can't explain why you need our help. The blood tests do look at some of the hormone levels, but not all of them. The tests are designed to look at the areas that we know can go awry and areas that we might be able to correct.

We used to do after intercourse testing to see if sperm were being killed or being affected in some negative way. In the end, it didn't change anything we had to offer with respect to addressing fertility problems. Since it did not change the treatments recommended, we stopped doing the test.

It's hard to say what you should do next. Some couples choose to continue trying on their own for awhile longer, others are ready to move on and pursue options being offered by their fertility specialists.
klwise responded:
Hi Dr Smith! We have been ttc for about 1 1/2 years, and I was originally diagnosed with pcos. I also have hypothyroidism and have been controlling that with medication for about 8 years now. I am somewhat doubting the pcos diagnosis since they found no cysts with an ultrasound, I have no excessive hair or acne, and the only symptom I do have is a irregular period (as in every three months or so). It has allways been irregular, though. My Dr has prescribed me clomid 50mg and 100 mg and neither dosage resulted in ovulation. Next we tried femara, and I think that did work since I had a 33 day cycle with it, but I never did detect the LH surge with opk's. Dr decided I should try tamoxifen, which I did last month and did get a positive opk and a 30 day cycle, so finally some results. I am curious if there is a max number of cycles I should try witht the tamoxifen? He has discussed referring me to a specialist, but unfortunately there are not any close to where we live, so that would entail a 2-3 hour drive each way. We would rather not have to do that, but will if it comes to that. Hopefully will not have to worry if this month is the one, but I have to be realistic also! Thanks Dr Smith!
Yvette Smith, MD, MPH replied to klwise's response:
It sounds like you're working with a wonderful doctor who has been very thoughtful about your situation. Generally if we get a good result from a treatment, we give it 3 tries before moving on to other modalities. Unfortunately you may have to make the commute to see the specialist if you are not successful with this treatment.
An_191705 responded:
I am trying to have baby and I am starting to think that ovualation calendar is not working. How can I find when do I ovualate?

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For more information, visit the Duke Fertility Center