How do we find out what the problem is?
At Boca Fertility we promise to provide you with unparalleled commitment to clinical excellence and unrelenting attention to patient satisfaction. A comprehensive fertility evaluation will be undertaken to find out why you are not getting pregnant. The evaluation can be quickly completed within one cycle and consists of 3 simple tests:
In 35% percent of infertile couples the problem is with the man’s sperm, and in another 35% the problem is with the fallopian tubes or uterus. In 15% of the couples the problem can be traced to ovulation problems and in the remaining 10%-15%, no obvious cause can be identified (unexplained infertility).
To schedule an appointment please call us at 1.844.207.0044
What to expect at your initial consultation at Boca Fertility?
- You will meet your Boca Fertility physician and the rest of our dedicated care team members.
- Bring your partner along when meeting with your doctor for the first time.
- Your Boca Fertility physician will extensively review your medical, surgical, menstrual, sexual, and life-style history. Occupational factors, diet, caffeine, smoking and alcohol use, exercise and stress will be discussed as they may all contribute to your infertility.
- Comprehensive physical examination, including a pelvic ultrasound to evaluate the uterus and ovaries. An egg count (AFC) is performed to assess your ovarian reserve.
- The doctor will discuss with you which tests are necessary to determine the cause of your infertility and begin formulating an individualized treatment plan for you and your partner.
- Meet with your fertility nurse who will be coordinating all aspects of your treatment.
- Meet our administrative financial coordinator to learn what is or is not covered by your insurance plan.
The Semen Analysis
In this test, freshly ejaculated semen is examined under the microscope to evaluate the number and quality of sperm and several other characteristics of the semen. The most current World Health Organization (WHO) guidelines for normal semen analysis include the following criteria:
- Count - (the number of sperm): sperm concentration is the number of sperm per milliliter. Average concentration is about 60 million per milliliter. A sperm concentration of over 15 million per milliliter is considered normal
- Motility - (the percentage of moving sperm): Motility is considered normal when at least 40% of observed sperm, show good forward movement. These are the strongest sperm, swimming fast in a straight line (Grade 4). Some of the sperm may be moving slower in a circle or in crooked lines (Grade 3). Other sperm move their tail but have no forward motion (Grade 2) or fail to move at all (Grade 1).
- Morphology - (the size and shape of the sperm): Morphology is considered normal if 4% or more of the observed sperm have normal shape.
- Volume – greater than 2.0 milliliters is considered normal. A low volume may reflect complete or partial blockage of gland secretions contributing to the seminal fluid. If the volume is less than 1 milliliter, the semen may not be in close enough proximity to the cervix to allow sufficient sperm to swim up to the uterus and fallopian tube
- White cells – Their presence in the semen may indicate an infection. A semen culture is typically ordered. If the culture is positive for bacterial infection, antibiotic treatment for the husband and a repeat semen analysis usually follow.
- PH level – normal pH range is 7.2 – 8.0. Too little or too much acid in the semen is detrimental to the sperm
- Liquefaction – It normally takes less than 20 minutes for semen to change from a thick gel into a liquid. An unusually long liquefaction time may indicate an infection.
- Fructose level – absence of fructose in the semen may indicate blockage of the seminal vesicles which secrete a significant amount of the fluid of the ejaculate.
THE FEMALE EVALUATION
The hysterosalpingogram (HSG):
HSG is an x-ray procedure performed to determine whether the fallopian tubes are open and to see if the shape of the uterine cavity is normal. It is an outpatient procedure that takes less than 10 minutes to perform. It is done after menses have ended, but before ovulation (between days 5-9 of cycle).
- Anti Mullerian Hormone (AMH) - correlates with the ovarian egg count (AFC). The higher the AFC the higher is the AMH level. A low level of AMH suggests that the ovary may be depleted of eggs, and is predictive of low egg production (poor response) during Vitro Fertilization (IVF). There is a gradual decrease in AMH levels as a woman gets older. This decline has been attributed to a decreasing number of eggs within the ovary
- Follicle Stimulating Hormone (FSH) level - FSH is an important hormone that regulates the development of your eggs. In general, if you are under age 40, a FSH level less than 10 indicates good quality of eggs. A high level of FSH suggests that there is a reduction in both the number and quality of eggs remaining in your ovaries. However, the most reliable indicator of egg quality is your age. If you are 44 years old and you have a normal FSH level, you can not assume that the quality of your eggs is good. In fact, your chance of conceiving with IVF is only 2%. Likewise, young women with a mildly elevated FSH level may have fewer eggs remaining but their egg quality may still be good with reasonable IVF pregnancy rates. High FSH levels are typically seen in older women, women with history of ovarian surgery, chemotherapy, radiation or endometriosis. Generally speaking FSH levels lower than 10mIU/ml are reassuring, while FSH levels in the 12-15 mIU/ml range indicate lower egg quality and poorer IVF success rates. Women with FSH levels greater than 20mIU/ml rarely benefit from treatment utilizing their own eggs and they should be advised to consider donor egg IVF.
- Estradiol (E2) level - High estrogen levels on day 3 of menstrual the cycle indicates diminished ovarian reserve (DOR) even if the FSH level is completely normal. It is very important to measure both day 3 FSH and estrogen (E2) levels because high levels of either one is equally predictive of a decrease in both the number and quality of the eggs. Ideally, day 3 estrogen levels should be less than 50 pg/ml. Day 3 estrogen level greater than 100pg/ml is considered abnormal.
- TSH (thyroid stimulating hormone) - an elevated TSH level indicates that your thyroid gland may be underactive. This condition can cause the prolactin level to rise, preventing ovulation. The American Endocrine Society defines hypothyroidism as present when the thyroid stimulating hormone is over 2.5µIU/ml. Hypothyroidism is treated with thyroid supplement to keep the TSH level between 1.0 and 2.5.
- Prolactin - an elevated prolactin (over 100ng/ml) can indicate a benign pituitary tumor (adenoma) or prolactinoma. Pituitary MRI will be necessary to make a diagnosis and monitor treatment. Elevated levels of prolactin can interfere with the ovulation process and may require treatment with a prolactin lowering medication such as Bromocriptine (Parlodel) and Cabergoline (Dostinex). High prolactin level is seen in women with Polycystic Ovary Syndrome (PCOS). Other causes of high prolactin include hypothyroidism (low thyroid), pregnancy and medications such as tranquilizers and anti hypertensive agents.
- Progesterone level - A single blood progesterone level, measured seven days after ovulation, can help determine whether or not ovulation is the problem. A progesterone level over 15 is an indication of a normal ovulatory process.
- Antral Follicle Count (AFC) - This is an ultrasound evaluation to determine the number of antral follicles (small immature eggs) present within the ovary. Low numbers of antral follicles (less than 6) is suggestive of Diminished Ovarian Reserve (DOR) and less favorable IVF outcome. The ultrasound can also determine if there are any uterine abnormalities are such as fibroids, polyps or uterine malformations.
To schedule an appointment please call us at 1.844.207.0044