EVALUATION OPTIONS

1. Evaluation of ovulation.

1. Physical exam.

   1. Physical exam is performed in office at initiation of treatment to ensure there are no physical limitations of conceiving. If there any concerns, these will be discussed with you.

2. Body changes, due to hormones and ovulation.

   1. Cervical mucus changes and temperature changes are important signs of ovulation to monitor for.

3. Cycle evaluation

   1. Monitoring your menstrual cycle can show optimal days to attempt conception and help point out possible concerns of conceiving.

   2. Menstrual diary (aid to monitoring both menstrual changes and cervical mucus changes)

4. LH surge

   1. Using an ovulation predictor can help with timing of intercourse or insemination. The LH kit changes color (usually blue) just prior to ovulation, usually 24 to 36 hours before (clear blue and easy is an example of an ovulation kit).

5. Blood laboratory testing

   1. Can help evaluate ovarian and endocrine function and/or problems.

6. Ultrasound evaluation of ovulation

   1. Can be used to monitor healthy follicle development and timing of treatments.

2. Evaluation of male effect on infertility.

(Occurs in one half of couples)

1. Semen analysis. If instructed to do so please follow these instruction.

   1. Obtain a sterile specimen cup from our office or the lab, and call the main TriCities Lab on Grandridge in Kennewick to schedule a time to drop off specimen. 7131 Grandridge Blvd (509) 736-0100

   2. Provide a sample by ejaculating into the cup. Don’t use a condom for collection since some of the lubricants or condoms contain spermicidal in them and may effect the results.

   3. Keep close to body temperature by keeping close to your body.

   4. Present specimen to lab within an hour of producing.

3. Evaluation of female physical means of infertility.

1. Physical exam

2. Hysterosalpingogram (HSG) A (HSG) is a special kind of x-ray. An HSG is an outpatient procedure, which takes no longer than a half hour. It involves placing an iodine-based dye through the cervix and taking x-rays to help evaluate the shape of the uterus and whether or not the fallopian tubes are open or blocked. If necessary we will give you an order to have completed at the radiology center. You will need to call and schedule the procedure and afterwards we will review to determine if any further testing/treatment should be done.

3. Laparoscopy. Due to your history and physical exam, a laparoscopy may be necessary to evaluate and treat concerns affecting your ability to become pregnant. If necessary follow the instructions under Laparoscopy in our Hospital Surgeries of our Procedures section of our web site.

4. Ultrasound.

TREATMENT OPTIONS

1. Timing and frequency of intercourse

1. a. Optimal timing of intercourse is the 2 days prior to ovulation and the 2 days following.

   b. Frequency of intercourse increases your chances of becoming pregnant. The week of ovulation, it is optimal to have intercourse 4 times. 3 times is ok and 2 or fewer times during that week make it difficult to conceive. It is of no benefit to abstain before trying or to have a break between attempts.

2. Ovulation monitoring and induction.

1. a. If we cannot clearly determine if you are ovulating from home testing we may proceed with evaluation in office, by lab testing, physical exam and ultrasound.

   b. Ovulation may need to be augmented with cycling and stimulation of ovulation. Medications used include

   1. i. Clomid ii. Femara iii. Glucophage

3. Intrauterine insemination (IUI).

4. Fertility center treatments. If your care requires more intense monitoring and treatment we may refer you to a Fertility center. These include.

1. a. IVF/endocrine centers

   b. Napro fertility centers

FERTILITY AIDS

a. Basal Body Temperature Chart

b. Ovulation calculator - http://www.marchofdimes.com/pregnancy/ovulation-calendar.aspx?gclid=CNGFrpuOmL0CFYdFMgodEw8AZg#

c. IUI

d. Clomid/Femara. These medications are oral medications that help increase the likelihood of ovulating. If you are prescribed these medications we will have you take them once a day for days 3-7 or 5-9 after the first day of your menses. After taking these medications we will monitor your ovulation and determine your optimal time of attempts of conception. Concerns with clomid use are increased risk of multiples, such as twins and triplets and increased risk of ovarian cancer with prolonged use of. These medications may give you menopausal symptoms, such as hot flushes, vaginal dryness and mood changes.