Initial Evaluation

Infertility & Reproductive

Medicine of South Broward

Kenneth M. Gelman M.D. F.A.C.E.

Dr. Kenneth Gelman and Channel 10 News investiages the miscarriage mystery!

“I feel that Dr. Gelman and his staff is the best when it comes to fertility in South Florida”

-Darlene Swaffar-Kearns

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Glossary

The Woman's Initial Evaluation

In order to establish pregnancy naturally, a woman must have at least one functioning ovary and fallopian tube, a uterus and a cervix. The following are factors that may contribute to infertility. May include these tests and others.

Ovulation

The ovaries may not develop and release an egg (ovulation) at the proper time. A wide variety of fertility drugs are now available to induce ovulation. Use of these medications is carefully individualized based on factors such as cost, ease of use, and success rates. Fallopian Tubes The fallopian tubes may be prevented from functioning properly because of tubal disease or factors surrounding the tubes (e.g. adhesions, endometriosis). Adhesions This is scar tissue resulting from inflammation and the healing process that follows an infection or prior surgeries. Once formed, adhesions must be surgically removed. Endometriosis This is a condition where portions of the lining of the uterus are found outside the uterus in the abdomen. It can grow in and on the ovaries, fallopian tubes, bladder, bowel and peritoneum, and can be treated with surgery and drugs. Cervix Sperm and mucus may not interact normally at the cervix. Uterus Disease (fibroids, polyps, infection) inside the uterus may prevent sufficient room for growth of the pregnancy or the lining of the uterus may not mature sufficiently to support implantation and maintenance of pregnancy.

Diagnostic Procedures for Women

Ultrasound
Ultrasound is a non-invasive procedure used to examine the abdominal contents including pelvic anatomy and pregnancy. As sound waves pass through the body, they reflect echoes at varying intensities which are displayed on video. Ultrasound is used to examine the development of eggs within the ovaries. It also can reveal the number of eggs, particularly when fertility drugs are used. It can be performed by placing an instrument, called a transducer, on the abdomen, when the bladder is full. However, the most common procedure involves the use of a vaginal transducer inserted into the vagina to examine the ovaries and uterus. This usually takes about five minutes and is painless.

Hormone Analyses
Hormone levels are measured to detect ovarian reserve. This typically includes a F.S.H. level. However, a more accurate test called AMH (Anti-Mulleran Hormone) level is routinely drawn to detect a women’s true ovarian reserve. Dr. Gelman has been researching this test well over two years and finds it to be a true indicator of a women’s reproductive status.

Saline Hysterograms
This is where saline is infused into the uterus to delineate the uterine cavity in more details. Problems such as polyps, fibroids and uterine anomalies are all assets by this procedure before women undergo any infertility treatment.

Endometrial Biopsy
During this procedure a small amount of tissue from inside the uterus is taken to evaluate the timing of ovulation, maturation of the lining of the uterus (endometrium), and any other abnormalities of the endometrium. It is performed in the office during the pelvic examination on day 23 or later of your cycle. You may experience mild to moderate uterine cramping, but it is usually lasts for only a short time. You will have some spotting the day of the test and, perhaps, for the next couple of days. The sample of tissue is sent to the pathology laboratory where it is prepared for microscopic study. Results are available in 4-5 days. To enable us to accurately interpret this test, the day of ovulation should be determined as well as the day your next period begins. A more definite test called the “EFT test is very commonly performed to evaluate uterine receptivity.

Hysterosalpingogram (HSG)
This is an X-ray of your fallopian tubes and uterus that shows if your tubes are open and if any uterine abnormalities exist. A physician performs the test in the radiology department. The ideal time for this test is after menstrual bleeding has stopped and before ovulation. For this procedure you will be asked to lie on the examining table for a pelvic examination. A speculum is inserted into the vagina, then an instrument is placed in the cervix that injects dye into the uterus and fallopian tubes to make them appear on the x-ray. You may experience abdominal cramping during the procedure. Vaginal spotting may occur for a couple of days after. Because of the minor discomfort and cramping, you should not eat a full meal prior to the procedure, and plan to have someone drive you home.

Dr. Gelman performs a sonohystogram in and our office setting this is a very similar procedure to the standard HSG but is much easier to perform less painful and demonstrates tubal patency using ultrasound.

The Man

Evaluation of the man begins with a thorough history. Important events such as previous genital or hernia surgery, exposure to potential sperm toxins, recent illnesses and family history of reproductive difficulties can give important clues to potentially reversible causes of infertility. Physical examination of the testicles, penis and prostate and evaluation of urine and prostatic fluid can give us insight into the possible causes of infertility. After the history and physical examination are completed, a semen analysis is done. The remaining portion of the basic evaluation includes hormonal assessment. Blood taken from a vein in the arm or hand provides information regarding the ability of the testes to produce sperm. In some cases, other testing may be indicated, including biochemical tests for antibodies to sperm. Information gathered during the history, examination, and blood evaluation is interpreted and explained to you so that a plan for further diagnostic tests or treatment can be outlined.

Semen Analysis
A microscopic analysis of sperm is the cornerstone of laboratory evaluation for the male. The test is performed on a sample of semen freshly collected by masturbation. Abstinence is advised for a minimum of two days and no more than seven days prior to the sample collection. The entire ejaculate must be collected in a clean, wide mouth container (preferably one provided by the clinic or hospital) and delivered to the laboratory within one hour for analysis. If you live a long distance from the hospital, which does not permit immediate delivery of the specimen, arrangements are made for you to produce the specimen at the office, in a private area.

The semen analysis will evaluate:

•volume of semen (amount)
•number of sperm
•sperm activity (speed and movement)
•quality of movement
•sperm morphology (shape of sperm)
•presence of abnormal constituents in specimen
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Results of the analysis are available within two days. Usually we need to obtain between one and three specimens for a complete picture of a man's sperm producing capacity. The results of the semen analysis give information regarding the likelihood of achieving a pregnancy with a normal partner. There is a wide range of variability in semen characteristics and only rarely is it possible to say, definitely, that a man is infertile based on the semen analysis.

Initial Evaluation