If you have been trying to get pregnant without success – you are not alone. Ten to fifteen percent of couples have difficulty conceiving.

Infertility is defined as not being able to get pregnant despite having frequent unprotected intercourse for one year. There are many reasons why a couple may not be able to get pregnant. These include female factors and male factors. Additionally, there are times when a reason is not found. Roughly, one-third of infertility is female related, one-third is male related and one-third is unexplained.

Fortunately, many couples (even with unexplained infertility) are able to become pregnant with a little assistance with our infertility treatment and testing assistance. When it comes to family planning, we have many safe and effective options available. 

Metro OBGYN Infertility Treatment Services


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Cases of Infertility

As mentioned earlier, there are many reasons a couple may have difficulty getting pregnant. Female reasons can include problems with ovulation, the reproductive organs, or hormones. Male reasons are frequently related to the health and amount of sperm. 

Additionally, age is a factor in getting pregnant. As you get older your chances of getting pregnant each month decline. This decline occurs more rapidly after the age of 37. Age also affects a male's fertility but is not as clearly associated.

The first step in getting pregnant is to have an evaluation. At Metro OBGYN we understand this can be a stressful and difficult process and we are here to support you and work with you.


In general, we begin evaluating a couple for infertility treatment and testing if you have not conceived after one year of frequent, unprotected intercourse. You may think about being seen sooner for family planning if:

  • You are 35 or older and have not gotten pregnant after 6 months of frequent unprotected intercourse
  • You are 40 years old
  • You have a history of infertility or needed fertility assistance in a prior pregnancy
  • You have irregular or infrequent periods
  • You have previously been treated for cancer

Your partner may consider being evaluated if:

  • He has had prior scrotal surgery
  • Has a known fertility problem
  • Has previously been treated for a cancer

Lab Tests

Day 3 labs:

Performed on the 3rd day after your period starts. Performing the test on day three lets us evaluate the hormones the ovary produces. Other, tests are evaluated at this time that do not depend on where you are in your cycle.

  • Thyroid stimulating hormone
  • Prolactin
  • Follicle stimulating hormone
  • Estradiol
  • Antimullerian hormone – evaluates ovarian reserve. This helps evaluate the quality and quantity of eggs available for ovulation.
  • Sexually transmitted disease testing.

Day 21 labs; progesterone:

Assesses if you are ovulating

Ultrasound – Evaluates the uterus and ovaries for fibroids or cysts

Hysterosalpingography – An x-ray study that evaluates if the fallopian tubes are healthy and open as well as evaluating the inside cavity of the uterus.

Semen Analysis – Evaluates the quality and quantity of semen.

The evaluation you have is individual. You may have some or all of these tests performed. Occasionally, additional testing is performed. If you are interested in testing for genetic conditions, i.e. cystic fibrosis or sickle cell disease this is a very good time to perform these tests. Talk with your doctor if you are interested.


There are many treatment options and treatment depends on the cause of infertility. For women treatment usually involves stimulating ovulation with fertility drugs, intrauterine insemination or surgery to treat a structural problem like an endometrial polyp or a uterine septum. Male factor infertility frequently involves the semen – either a low volume of sperm or the sperm does not move well. Intrauterine insemination can overcome these issues. Occasionally, men may need a surgical procedure to correct a problem like a varicocele.

Fertility Drugs to Stimulate Ovulation

Chlomid and Letrozole are two medications that may be used to stimulate the release of an egg. Additionally, injectable medications may be used. We will then check a blood test on day 21 of your cycle to see if you have ovulated. If you have not ovulated the dose of medication may be increased or we may add an injectable medication.

Intrauterine Insemination

This is when the sperm is placed directly into the uterus. This bypasses the cervix and allows the most sperm to meet with an egg. Intrauterine insemination may be performed by itself or in combination with a medication to stimulate ovulation.

In Vitro Fertilization

This is a procedure where the sperm and an egg are collected and the egg is fertilized outside the woman's body. Once fertilized it is then placed into the uterus. For this procedure, we will refer you to a reproductive specialist.


It is important that women seeking out assistance with fertility understand the risks of the procedures. With medications that stimulate ovulation like Clomid or Letrozole there is approximately a 10% chance of multiple gestations. Twin pregnancies are higher risk and have a higher rate of preterm labor and preterm birth.

Additionally, there is a risk of ovarian hyperstimulation syndrome. The symptoms of this condition include abdominal distention, enlarged ovaries and abdominal pain.

It is important to talk with your doctor about potential risks and side effects of medication prior to starting treatment.

Preparing for Your Visit

There are things you can do to help prepare for your visit and speed up the initial workup.

Begin taking a prenatal vitamin – it is important to begin a prenatal vitamin a few months before you become pregnant.

Bring a list of medications and vitamins you take daily.

Track your cycle – The first day of your period is the 1st day of your cycle. Count from day 1 to day 1 of the next cycle. This will tell us how long your periods are. Additionally, if you do this for a few months we can determine if you have regular monthly periods which helps determine if you are ovulating.

Ovulation predictor kit – With this test you check your urine every morning. It also is a way to asses if you are ovulating.

If you are overweight or underweight this is a good time to try and improve your overall health. Weight can affect your chances of getting pregnant – so being at a healthy weight will optimize your chances of becoming pregnant. Additionally, quit smoking if you currently smoke and avoid alcohol and street drugs.

Call your insurance company to see if and what coverage you may have for an infertility. This can include coverage for workup tests and procedures as well as treatment medication and procedures.

Consider if preconception carrier screening is right for you – This is testing that evaluates for conditions like cystic fibrosis, sickle cell disease, fragile X disease and spinal muscular atrophy. It may be worth talking to family members to see if any genetic conditions run in your family.