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Infertility DiagnosisCouples 30 years old or younger who have been trying to conceive without success for one year may consider having a fertility evaluation. Some couples may choose to have an earlier evaluation (after six months), because early treatments are associated with improved outcomes. These include couples where one partner is older than 30, or has one or more of the infertility causes listed earlier. Preliminary evaluationA couple's infertility problems may be due to one partner or both. As a result, both partners are usually evaluated. The preliminary evaluation typically starts with a complete physical examination and a questionnaire for each partner, which includes: - Female: Gynecological examination.
- Male: Examination of the male genitals.
- Both partners: Medical history including diseases, injuries, medications, sexual habits, and surgeries.
Based on an evaluation of the results, the couple may decide to be treated by their general practitioner or by a specialist who treats infertility problems. Fertility TestsThe preliminary evaluation determines which fertility tests are most suitable for a couple. Infertility testing may take several months as different causes are investigated and test results are evaluated. Doctors typically work jointly with couples to decide on the choice and order of the tests. Female TestsFemale fertility tests focus on ovulation, uterine, and fallopian tube problems. Common female fertility tests include:Basal body temperature (BBT)Until recently BBT was used to identify ovulation phases. This test has been replaced by blood tests, which are more reliable. Blood testsTwenty-five percent of female fertility problems are due to the woman's inability to ovulate (release an egg). Although regular menstrual cycles indicate a woman's ability to ovulate, some women do not ovulate regularly. Female blood tests identify the levels of the following hormones, which influence ovulation include: - Estradiol
- Follicle stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Progesterone
- Prolactin
- Thyroid-stimulating hormone (TSH)
Clomiphene citrate challenge test (CCCT) CCCT evaluates a woman's ovarian reserve (the number and quality of the eggs stored in the ovaries). The test measures follicle-stimulating hormone (FSH) levels on day 3 of the menstrual period. The woman then takes 100 mg of clomiphene citrate (brand names: Clomid, Serophene) on days 5 through 9 and FSH is measured again on day 10. Abnormal FSH levels signify a poor ovarian reserve, which helps determine which fertility treatment to use. Hysterosalpingography (HSG)HSG is a process that uses ionizing x-rays and a radio-opaque material for greater contrast. The doctor or technician uses HSG to examine a woman's uterus and fallopian tubes. Any abnormalities identified can then be treated with medication or surgery. HysteroscopyDuring this procedure, the doctor or technician uses a hysteroscope (a uterine speculum with a reflector) to look through the vagina and cervix to examine the interior of the uterus. Fibroids, polyps, intrauterine devices (IUDs), and abnormalities can be viewed. Any abnormal tissue is then removed. HysterosonographyAlso known as sonohysterography, this test is a minimally invasive ultrasound technique used to view the interior of the uterus. This transvaginal ultrasound technique provides real-time imaging of the uterus, which enables the doctor to view any uterine abnormalities, such as atrophy, defects, fibroids, polyps, or scarring. LaparoscopyLaparoscopy is a surgical procedure that requires general anesthesia. A small amount of gas is inserted through a small slit in the abdominal wall. A laparoscope (an illuminated fiber-optic tube attached to a viewing device) inserted through the slit enables viewing of uterine, fallopian tube, and ovary to identify any problems. If any abnormalities are identified, the doctor may be able to repair them using instruments inserted through additional small incisions made in the abdominal wall. Laparoscopy is now commonly used instead of a more invasive laparotomy procedure, which requires abdominal surgery and a hospital stay. Male TestsMale testing focuses on the quality and quantity of his sperm and semen. Common male fertility tests include:BiopsyIn rare cases, a biopsy of testicular tissue is used to identify problems such as inadequate sperm production or reproductive organ defects. Blood testsMale blood tests identify the levels of the following hormones, which influence sperm levels: - Follicle stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Testosterone
Post-ejaculation urinalysisThis test helps identify diseases implicated in male infertility, such as kidney disease and urinary tract infections (UTI). Postcoital Sims-Huhmer testAlso known as the sperm-mucus interaction test, this test examines the sperm's ability to move through the female reproductive tract. Semen analysisThe semen analysis tests the sperm as well as the semen. This analysis is often the only male test performed. The semen is tested for its: - Color
- Consistency
- Sperm antibodies
- Volume
The sperm is tested for its: - Concentration
- Count
- Function
- Morphology (shape)
- Motility (movement)
- Quality
- Size
Sperm penetration assay (SPA)Also known as the sperm-oocyte interaction test, SPA examines the ability of the sperm to penetrate the egg. SPA provides useful information about the true functional state of the male's sperm. Unexplained InfertilityFertility tests are not always able to identify the reason for a couple's infertility. Approximately 10% to 20% of couples undergoing fertility testing are given a diagnosis of unexplained infertility. The likelihood of an unexplained infertility diagnosis increases in women 35 and older, and could be due to problems with egg quantity and quality. A diagnosis of unexplained infertility doesn't mean that a couple will never conceive. The diagnosis does, however, complicate treatment decision making, and may cause frustration and uncertainly for couples. Some couples decide to take further tests, either at their current clinic or a new clinic. Other couples decide to begin fertility treatments or turn to other options, such as adoption.
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