Do you have eggs? Then you need a blood test. Do you have sperm? Then a semen analysis (or access to donated sperm) is a must. Are the fallopian tubes open? An HSG or surgery should happen. Finally, is the uterus a safe place for the baby to grow? You’ll need an HSG or diagnostic hysteroscopy. Then, and only then, can options for treatments make any sense.
Here are some examples of pitfalls that most non-fertility doctors and patients fall into:
My husband had a baby with another woman so he does not need to get his sperm checked!
Men can stop making sperm in one day (maturation arrest)
I had a baby before, so I don’t need to have my eggs, uterus, or fallopian tubes checked!
Pregnancy is not like a water pump that is primed once and then keeps working. Each cycle is unique and aging impacts fertility in women and men.
Let’s try clomid and see how it works!
How does the doctor know your tubes are open or that your partner has sperm?
We were successful with IUI 10 years ago (when 30 years old) and now at 40 we want to do IUI again!
Same answer as above, as well as, men can stop making sperm at any time, also impact of age on uterus and fallopian tubes can not be underestimated… check first, treat after you KNOW what the issues are.
It doesn’t matter how old you are, try clomid first!
What about the 42 year-old that is rapidly losing her eggs? Is it worth the 6 months of failure before appropriate treatments are started?
So, what does this all mean?
Here are some decision examples:
1. 21 year-old woman: never pregnant, normal tubes and uterus, not ovulating, sperm parameters are acceptable (count, motility and shape of sperm).
a. OI – 15 % chance of success per try
b. OI/IUI – 25 % chance of success
c. IVF – 45% chance of success
d. IVF with Chromosomal Testing – 75% chance per try
2. 36 year-old woman: never pregnant, normal tubes and uterus, not ovulating, sperm ok.
a. OI – 3 % chance of success per try
b. OI/IUI – 8 % chance of success
c. IVF – 30% chance of success
d. IVF with Chromosomal Testing – 60% chance per try
3. 40 year-old woman: never pregnant, normal tubes and uterus, not ovulating, sperm ok.
a. OI – <1 % chance of success per try
b. OI/IUI – 1 % chance of success
c. IVF – 6% chance of success
d. IVF with Chromosomal Testing – 45% chance per try
There are many other factors, especially regarding sperm. If the sperm parameters demonstrate even one abnormality, then the pregnancy rates for OI alone and OI + IUI drop by more than half.