Everything You Need to Know About The Latest in Fertility Testing in 10 Minutes

Today if you experience shoulder pain and go to the doctor then you’re likely given a battery of tests to determine what’s causing it and what the best course of treatment is.

Can you imagine if your doctor told you to come back in a year for treatment? Would you go home with a hurt shoulder and just tough it out? It’s a pretty ridiculous thing to imagine, right?

Well, it’s EXACTLY what happens with women and their fertility. We’re told to keep trying and to see our doctor in a year if we don’t get pregnant. Yet by doing that we are potentially wasting precious time, and fertility does not get better with age.

Why does this happen?

We don’t think of fertility as a disease. Instead, we think of it in unscientific ways. We relate it to religion or our culture. It’s also something that just about everyone has an opinion about — our mothers, mother-in-law, neighbors, and friends.

There is no better time to be a fertility patient

I want to encourage you to ask questions about your fertility. Just because you ask questions does NOT mean you have to move forward with any type of treatment.

I am here to guide you.

The latest technology gives patients the greatest chance for pregnancy

We can do a hysterosalpingogram (a tube test), a pelvic ultrasound to look at the uterus and ovaries, and we evaluate sperm. Testing sperm has never been easier as you can do it in an andrology lab or get a kit sent you at home.

We also check hormones. We look at preconception labs and infectious disease labs. We do all the blood tests around cycle day number three (the time we check fsh and estradiol levels). We do some of the following genetic tests: Chromosome analysis, carrier screen including one for cancer genes, fertility genes through phosporus.com.

All of these tests and their results can be assembled in a single month. The semen analysis can be done at any time.

Here’s an example of the timing of these tests:

Cycle day 8–10: Plan to get your HSG hormone levels checked at a lab.

Cycle day 20: This is when your results from testing should come back and give you a picture of your fertility health. At this point, you can confidently create a personalized fertility care plan with the help of your doctor.

If you take these simple steps then you can get a complete fertility diagnostic evaluation to set a focused and specific treatment plan. You’ll never be that patient that tells me you went to your OB-GYN and asked for a semen analysis and were asked to wait one year before they’d do it for you.

We don’t need to wait a year for fertility knowledge

Image for post
Image for post

Knowledge is power. The first part of your power is reading this post or watching this show. The second part is taking what you learn and putting it into action. Remember, all of this will help you know more about your fertility now vs. later when you’ve potentially wasted precious time or money trying to get pregnant.

This is a new era. We are living in a time when we solve problems quickly and with the help of technology. We no longer blame women for fertility issues.

It takes two to tango. Men are an equal part of the fertility equation when it comes to creating a healthy pregnancy.

According to a study published in The Journey of Human Reproduction, there has been a 52% decline in sperm concentration and a 59% decline in total sperm count in men over a 40-year period.

Image for post
Image for post

So if you’re someone that’s done the sperm testing and you’ve found your sperm counts are lower than you need them to be, then I want to tell you everything you need to know.

What I tell my patients about sperm

Think about anatomy. A history of an undescended testicle, groin surgery (from a hernia repair) and a varicocoele could be reasons for having a low sperm count. An exam by a male fertility specialist is important when understanding the different anatomic causes of a low sperm count. Talk to your doctor about whether a varicocoelectomy makes sense for you before you start your treatment.

Lifestyle. Studies continue to show how lifestyle affects sperm counts. Avoid hot tubs, saunas, and steam rooms. Drink alcohol in moderation. Avoid marijuana use. Don’t get your sperm drunk and dizzy. Your sperm cells are dying because of it.

Review any medications you’re taking with your doctor and make sure they aren’t interfering with your fertility. For example, a calcium channel blocker (taken for high blood pressure) can inhibit fertilization. If you’re taking steroids like testosterone, you should know it can inhibit sperm production.

Overall, talk to your doctor about the lifestyle that you’re leading and ask them if your BMI is too high. Get into the best shape of your life so that you make the eggs look really good.

When it comes to labs for guys we check FSH, estradiol, the thyroid, prolactin, hemoglobin, ac1, and testosterone levels. A low testosterone level can sometimes be the reason for a low sperm count. Getting those labs checked can you figure out what you can do that’s in your control to make things even better.

The last thing to think about when evaluating a low sperm count is to see if there’s any sexual dysfunction or a low sex drive. A sex therapist or urologist can sometimes help if a guy doesn’t feel comfortable talking to me about it. If they do it’s likely that I’ll write him a prescription for Cialis or Viagra.

I’ve put all of this information together in an easy to remember mnemonic. The BALLS method.

Image for post
Image for post

Background genetics, Anatomy, Lifestyle, Labs, and Sex.

These are the five things that I talk to patients in my office about if the sperm counts are low. I hope that this will help you so that you’re not feeling confused or lost or think that things are more complicated than they really should be. Now that you know what elements we use for proper diagnosis you’ll be ready to plan your IVF cycle if that’s the technology that you’re going to be using to get pregnant.

With IVF we have three options to consider:

  1. A frozen transfer
  2. A frozen transfer with genetic testing

This is a picture of a sample genetic testing report.

Image for post
Image for post

Also known as PGT-A. With PGT we can look at chromosomes of embryos and studies have shown that this might give patients a higher chance for a healthy pregnancy and a lower risk of miscarriage. It’s the murkiest crystal ball, but it’s the best we have.

It only looks at chromosomes and doesn’t look at all of the genetics of your future pregnancy. Then we look at the testing of the lining of the uterus. I do both ERA and Receptivadx. I do the ERA test to tell me the number of hours of progesterone that my patients need before she transfers. I do the receptivadx test for the bcl6 H-score. This score guides me about the best protocol.

The way I do these tests is by putting my patients on the same cycle of medication that they would use for the transfer. But instead of transferring I do something called an endometrial biopsy. I sometimes do a saline infusion sonogram or hysteroscopy at the same time.

Then we go ahead and transfer. If we put all of this together it’s called The Egg Whisperer D.I.E.T.

Image for post
Image for post

This entails getting a diagnosis through the TUSHY method and the BALLS method, IVF, endometrial testing, and then transfer.

These are the elements that I talk to my patients about. I try and be as realistic as possible about chances while giving my patients as much support as possible.

However, I think every patient needs their own fertility team.

Image for post
Image for post

The first part of the team is therapy. This can be locally in-person or online through an app like Talkspace. I talk to my patients about the importance of exercise and acupuncture. Talk to your doctor about their exercise recommendations for you. I have found that acupuncture can minimize the side effects of fertility meds (nausea, bloating, and fatigue). My patients who do acupuncture feel so much better during treatment and during pregnancy. Finally, meditation is important to do if you’re experiencing racing thoughts and can’t focus. Consider using a meditation app like Headspace or Calm.

A better diagnosis means less wasted time on treatments that don’t work. I never want to hear a patient has gone through 10 IUIs before learning her fallopian tubes were blocked.

Fertility doctors are only human. We can’t put BOTOX in your ovaries. We can’t give you more eggs when you run out. All that we can do is give patients the best chance at pregnancy by using the best technology we have. Sometimes the best technology is still considered a murky crystal ball.

Focus on getting a diagnosis before treatment (via the TUSHY and BALLS methods) and embrace The Egg Whisperer DIET, and get your fertility TEAM to support you. All of this together is The Egg Whisperer Plan.

Image for post
Image for post

I’m hopeful that all of these elements will help you no matter who you are, where you live, or who your doctor is. I want you to be able to use these as checklists for your own care so that you have the best chance at a healthy pregnancy.

I want you to have access to the latest technology that science has to offer so that you can achieve your fertility goals in the quickest, most efficient way. I want you to spend less time as a fertility patient and more time as a parent.

I hope this article was helpful to you while on your fertility journey.

As always, please comment below or send me a note if you have any questions about this show or if you have a suggested topic for a future show.

You can also catch more of me and topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!

Fertility Doctor, Reproductive Endocrinologist, Egg Whisperer: www.eggwhisperer.com

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store