First week in infertility medicine

Thursday, November 12, 2015

Today I'm giving you guys a glimpse into this rotation. If you don't want to read all about infertility medicine, I suggest skipping this post today!


If you know me at all, you know I am passionate about OBGYN and infertility medicine. So when I started PA school I knew I wanted to try to get an elective in infertility medicine. My program contacted the best infertility specialist in our area and he agreed to let me spend 4 weeks with him. I am about to finish my first week and it has been nothing short of amazing. It has been fascinating to learn so much about such a common problem that couples face when trying to bring a babe into the world.

The first step when a couple comes to see us is to have a "consultation" in the office to document the couple's medical history, length of infertility, etc. From there, we address the 3 most common reasons that couples have trouble conceiving:
1. The female's tubes are blocked, not allowed the sperm to reach the egg
2. The female is not ovulating (releasing an egg)
3. The male's sperm is abnormal

Couples tend to always think it is due to an issue with the female's body when very frequently it is due to low sperm count, decreased sperm motility, etc. Once the male has been "cleared", we usually do a hysterosalpingogram (HSG) next in addition to a progesterone level at the end of her cycle to determine whether or not she ovulated. An HSG is where dye is pushed into her uterus under live video and you can see whether the dye has problems going all the way through her fallopian tubes or not. Below is what a normal HSG looks like… you can see the white dye has filled up her uterus and fallopian tubes then is spilling out into her abdomen, which is normal. This tells us that sperm has no problem reaching the egg.

Then we measure a progesterone level. This is done after ovulation should have occurred. If it is below a certain number, she likely did not ovulate and we have to figure out why.

If she DID in fact ovulate and the male's sperm is good, the next step is likely intrauterine insemination (IUI). This is where the sperm is looked at under a microscope, spun down and made very concentrated, then placed into the female's uterus. I like to think of this scenario as a physical problem… all the "parts" are working on both ends, but the sperm just needs a little help reaching the egg.

If she did NOT ovulate, then likely the next step is oral medications to stimulate her ovaries to release a follicle. The most common medications used for this are Clomid, Tamoxifen, and Femara. While on these drugs, she comes to the office at least once a month to have an ultrasound done right before ovulation to measure her ovaries and the follicles inside them. This gives the doctor more insight into whether the dosage is correct based on how big her follicles are. Follicles are usually 20-24mm right before ovulation. If the follicles are the right size in preparation for ovulation, she is told to go home and "spend some time" with her significant other ;) If the follicles are not big enough, either her medication dosage can be bumped up or she may possibly be switched to another medication.

So, this was just a snapshot into what I learned this week! There is obviously SO much more that goes into infertility treatments but this is the "bread and butter", or the first steps. I have been so unbelievably blown away by the patience and strength these women have. Some of our patients have been trying for 2+ years to get pregnant.

Have you gone through any of these treatments or procedures? I'd love to hear any thoughts or experiences! And as always, praying for all the women that are wanting and trying for a babe of their own.


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  1. I'm so glad that you're loving this rotation and you're so invested in it. There is definitely a LOT of new information out there that people just don't know about until they go through it. Thanks for sharing so it's not as "uncommon" of knowledge!

  2. I think it's wonderful you are so passionate about this rotation. Infertility seems to be everywhere and having people like you that can help others is so important. xoxo

  3. Love that you're so passionate about this rotation! I'm so excited and happy for you to get to work with these women and learn so much. <3, Pamela Sequins & Sea Breezes

  4. Such an amazing rotation, and I love your passion for this subject! It breaks my heart that so many couples suffer from infertility, but there is such a wealth of information and help out there. I have a few girlfriends that have been blessed with miracle babies after being told their chances of conceiving and holding a child through term were very slim to none so this is one of my favorite areas of medicine as well. *Fingers crossed* for you girl to be able to continue working in this area of medicine ;-)

    Green Fashionista

  5. this is very interesting. i have some close friends that have gone through this and i've seen the battle that they've faced - it's way more common than i realized growing up! love that you're getting to work in your passion!

    xoxo cheshire kat

  6. The facts are so important here and I thank you for sharing some of what you've learned with us!! xo, Biana -BlovedBoston

  7. This post was extremely intriguing to me from the clinical aspect and also you know being a female ;-) I was initially going to go into midwifery and possible infertility when I started out. Is this clinic hiring? :)

  8. Love this post and love that you have a passion for this field! I had no clue how prevalent infertility was until I joined the blogging community. We haven't started trying yet, but it's so comforting to know that, if we do struggle, there are others going through the same thing.

  9. I love reading about your rotations. I find it all so interesting, but I know I'm not cut out for a career in the medical field.

  10. This is so interesting to me! My brother- and sister-in-law have had infertility issues, but are very hush-hush about it, so it's enlightening for me to read about it.


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