Tag: reproductive endocrinology

  • Investigating Infertility: The Most Accurate Tests for Women and Men

    1. Investigating Infertility:When Should You Get Tested for Infertility?

    Doctors recommend fertility testing if:

    • A woman under 35 has been trying to conceive for 12 months without success.

    • A woman over 35 has been trying for 6 months without success.

    • A woman has irregular or absent menstrual cycles.

    • A man has a history of low sperm count, erectile dysfunction, or hormone issues.

    • A couple experiences multiple miscarriages​.

    The choice of tests depends on age, medical history, lifestyle, and suspected reproductive health conditions.

    2. Investigating Infertility:Fertility Tests for Women

    A. Hormonal Blood Tests

    These tests assess ovarian reserve (egg supply), menstrual cycle regularity, and reproductive hormone balance:

    Test Purpose Ideal Value for Fertility

    Anti-Müllerian Hormone(AMH) Measures ovarian reserve 1.0–4.0 ng/mL

    Follicle-Stimulating Hormone (FSH) Assesses ovarian function. <10 mIU/mL on day 3

    Luteinizing Hormone (LH). Indicates ovulation issues. 5–20 mIU/mL on day 3

    Estradiol (E2) Evaluates ovarian response. 25–75 pg/mL on day 3

    Progesterone Confirms ovulation >3 ng/mL after ovulation

    Prolactin Identifies hormonal imbalances 2–29 ng/mL

    Thyroid Hormones (TSH & T4) Assesses thyroid function, which affects ovulation TSH: 0.4–4.0 mIU/L

    These tests are usually done on specific days of the menstrual cycle to get the most accurate results​.

    B. Ultrasound Tests

    Transvaginal Ultrasound helps evaluate:

    • Antral Follicle Count (AFC) – Measures how many eggs are available for retrieval.

    • Ovarian cysts or polycystic ovaries (PCOS).

    • Fibroids or uterine abnormalities that can affect implantation​.

    C. Ovulation Tracking

    Doctors may recommend tracking ovulation through:✔ Basal Body Temperature (BBT) charting – Slight increase in temperature after ovulation.✔ Ovulation predictor kits (OPKs) – Detects LH surge before ovulation.✔ Blood tests – Measures progesterone levels post-ovulation​.

    D. Fallopian Tube and Uterus Testing

    1. Hysterosalpingography (HSG) – An X-ray test using contrast dye to check if fallopian tubes are open.

    2. Sonohysterography – Uses ultrasound to detect polyps, fibroids, or uterine shape abnormalities.

    3. Hysteroscopy – A small camera is inserted into the uterus to directly examine the endometrial lining​.

    If any blockages or abnormalities are found, surgical intervention may be needed to restore fertility.

    3. Investigating Infertility:Fertility Tests for Men

    A. Semen Analysis

    A semen analysis evaluates:

    • Sperm count – Normal is 15 million or more per milliliter.

    • Sperm motility (movement) – At least 40% should be active.

    • Sperm morphology (shape and size) – At least 4% normal shape.

    • Volume – Normal is 1.5–5 mL per ejaculation​.

    B. Hormonal Tests

    Men also need hormonal evaluations:

    • Testosterone – Regulates sperm production (Normal: 300–1,000 ng/dL).

    • FSH & LH – Stimulates sperm production (Normal: 1.5–12.4 mIU/mL).

    • Prolactin – High levels may indicate pituitary dysfunction.

    • Estradiol (E2) – Important for sperm maturation (Normal: 10–40 pg/mL)​.

    C. Genetic Testing

    If a man has severe sperm issues, genetic tests may identify Y-chromosome microdeletions or chromosomal abnormalities, such as Klinefelter Syndrome​.

    4. What Happens After Testing? Treatment Options

    Based on the results, possible fertility treatments include:

    A. Lifestyle Changes

    ✔ Maintaining a healthy weight.✔ Reducing alcohol, smoking, and caffeine.✔ Managing stress and sleep patterns​.

    B. Medications for Women

    • Clomiphene citrate – Induces ovulation.

    • Letrozole – Stimulates egg production.

    • Gonadotropins (FSH, LH injections) – Used in IVF or IUI cycles.

    C. Assisted Reproductive Technologies (ART)

    1. Intrauterine Insemination (IUI) – Sperm is placed directly in the uterus.

    2. In Vitro Fertilization (IVF) – Eggs are retrieved, fertilized, and implanted.

    3. Intracytoplasmic Sperm Injection (ICSI) – A single sperm is injected into an egg, useful for male infertility.

    4. Egg or sperm donation – If natural conception is not possible​.

    5. Conclusion: Investigating Infertility:The Importance of Early Testing

    Early fertility testing can identify potential issues and help couples make informed decisions about their reproductive future.

    Women should check their ovarian reserve by age 30 if planning to delay pregnancy.

    Men should have a semen analysis if conception is unsuccessful after 12 months.

    Advanced fertility treatments exist for many causes of infertility.

    If you’re struggling to conceive, schedule a fertility evaluation today!

    References

    1. Cardim, H.J.P. Vencendo a Dificuldade de Engravidar. Editora Pensamento-Cultrix Ltda, 2009.

    2. Eekelen, R. van, et al. “Natural Conception: Repeated Predictions Over Time.” Human Reproduction, Vol.32, No.2, 2017, pp. 346–353. DOI:10.1093/humrep/dew309​.

    3. Guerriero, S., Condous, G., & Alcázar, J.L. How to Perform Ultrasonography in Endometriosis. Springer International Publishing, 2018.

    4. Barreto, N.C.N. “Predição do Sucesso de Gestação Utilizando Algoritmos de Machine Learning Após Procedimentos de Fertilização In Vitro.” Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Análises Clínicas e Toxicológicas, 2021​.

    5. Silva, G.M. et al. “Number of Antral Follicles and the Success of In Vitro Fertilization: A Multivariate Analysis.” Brazilian Journal of Human Reproduction, 2012​.

  • Can Long-Term Use of Birth Control Make It Harder to Get Pregnant?

    1. How Does Birth Control Work?

    Birth control methods prevent pregnancy by stopping ovulation, blocking sperm, or making the uterus less hospitable for implantation. The most common types include:

    Hormonal methods – Pills, patches, rings, injections, implants, and hormonal IUDs. These use synthetic hormones to prevent ovulation or change the cervical mucus and uterine lining. Non-hormonal methods – Copper IUDs, condoms, diaphragms, and fertility awareness methods. These do not interfere with ovulation but prevent fertilization or implantation. Permanent methods – Tubal ligation (for women) and vasectomy (for men) are surgical procedures that permanently prevent pregnancy.

    2. Will Long-Term Use of Birth Control Affect My Fertility?

    2.1 Birth Control Pills, Patches, and Vaginal Rings

    How they work: These methods contain estrogen and/or progestin to prevent ovulation. Fertility after stopping: Most women start ovulating within a few weeks to months after stopping. How long does it take to get pregnant? About 50% of women conceive within 3 months, and 80% get pregnant within a year (Gnoth et al., 2003).

    Birth control pills do not cause infertility, but some women may take a few months for their cycles to regulate.

    2.2 Birth Control Injections

    How it works: Depo-Provera is a shot given every 3 months that stops ovulation. Fertility after stopping: It can take 6-12 months for ovulation to return. How long does it take to get pregnant? Most women conceive within 10-18 months after the last shot (Peterson et al., 2000).

    If you want to get pregnant soon, injections may not be the best choice because it can delay fertility longer than other methods.

    2.3 Birth Control Implants

    How it works: A small rod placed under the skin releases progestin to stop ovulation for up to 5 years. Fertility after stopping: Ovulation typically returns within 3 months after removal (Hidalgo et al., 2009). How long does it take to get pregnant? Most women conceive within 6-12 months.

    Implants are long-lasting but do not cause long-term fertility issues.

    2.4 Intrauterine Devices (IUDs)

    There are two types of IUDs:

    Hormonal IUD

    How it works: Releases progestin to thicken cervical mucus and sometimes stop ovulation. Fertility after stopping: Ovulation returns within a month after removal.

    How long does it take to get pregnant? About 80% of women conceive within a year (Lira et al., 2010).

    Copper IUD

    How it works: Does not use hormones; instead, copper creates an environment that prevents sperm from reaching the egg. Fertility after stopping: Ovulation resumes immediately after removal. How long does it take to get pregnant?85% of women conceive within a year (Hatcher et al., 2018).

    IUDs do not cause infertility, and most women can get pregnant quickly after removal.

    2.5 Permanent Birth Control (Tubal Ligation & Vasectomy)

    How it works: These procedures permanently block the sperm or eggs from meeting. Fertility after stopping: Reversal is possible but not always successful. How long does it take to get pregnant? Even with reversal surgery, pregnancy success rates range from 40- 80%(Melo et al., 2008).

    Bottom line: Tubal ligation and vasectomy should be chosen only if you are 100% sure you do not want children in the future.

    3. Does Long-Term Use of Birth Control Harm My Reproductive System?

    Most research shows that using birth control for many years does not harm fertility. However, some women may experience:

    Delayed ovulation after stopping – This is more common with injectables like Depo-Provera. Thinner uterine lining – Long-term use of hormonal contraceptives may cause a thinner endometrial lining, but it usually returns to normal within a few months. Undiagnosed reproductive issues – Some women who stop birth control discover they have conditions like PCOSor endometriosis, which were masked by the pill.

    Important: If your periods do not return within 3-6 months after stopping birth control, talk to your doctor.

    4. How Can I Improve My Chances of Getting Pregnant After Stopping Birth Control?

    If you have been on birth control for a long time and want to conceive, here are some tips:

    Track your ovulation – Use ovulation tests or monitor your cycle. Take prenatal vitamins – Folic acid helps prepare your body for pregnancy. Maintain a healthy weight – Being overweight or underweight can affect fertility. Reduce stress – High stress levels can interfere with ovulation. See a doctor if needed – If you do not get pregnant after a year (or after 6 months if over 35), consult a fertility specialist.

    5. Conclusion

    Long-term use of birth control does not cause infertility, but some methods may temporarily delay the return of ovulation. Most women can get pregnant within 3-12 months after stopping birth control. The birth control shot has the longest delay, while IUDs, implants, and pills allow for a quicker return to fertility. If you are planning a pregnancy, it is important to choose a contraceptive method that aligns with your future goals.

    References