Infertility Testing usually consists of several stepwise tests to detect and then treat causes of infertility. It usually takes less than 6 weeks to find out the causes of infertility.
About 80% of infertility is caused by one or more of three problems.
- Ovulation problems: Is she ovulating regularly and are her eggs OK?
- Sperm problems: Does he have enough and good sperms?
- Fallopian tube problems: Are her fallopian tubes open?
- Infertility and fertility testing should answer which of these may be responsible for the couple's inability to get pregnant, and most of these tests can be completed within 5-6 weeks. If no specific cause is found, and that happens in about 1 in 7 couples, then the diagnosis is unexplained infertility.
Infertility Testing Step 1: HIS Fertility
A male fertility test is the sperm analysis or sperm count and this test should be the very first step in fertility testing. This is a test done usually in a male infertilty clinic or a urologist. It should be done even before the womnan has any specific testing done.
The ejaculate is obtained through masturbation, placed in a sterile collection cup, and brought to the laboratory. The best results are obtained when the husband abstains for three days, and the sample arrives at the lab within an hour of ejaculation. The sample is then evaluated for volume, sperm count, motility (how many are swimming) and morphology (how many are a normal shape). Here is more information on how to obtain the semen.
Although normal values vary between laboratories, a normal count is typically >20 million/mL and normal motility and morphology are >50%. This test is done to rule out male causes for infertility, and to see if the couple might benefit from treatment such as artificial insemination.
Infertility Testing Step 2: Ovulation Detection
The first question that must be answered is whether she is ovulating normally. Are there typical signs of ovulation?. Are the eggs of good ennough quality and has the couple made love regularly during the 5-6 fertile days before and the day of ovulation.
There are several ways to find out if and when you ovulate:
- Calculation: Ovulation and Fertility Charting and Calculator
- Temperature charting
- Cervical mucus changes
- OPK Ovulation Predictor
Infertility Testing Step 3: Egg Quality and Hormones
Cycle Day 3:
- FSH Level FSH is a pituitary-gland hormone that normally increases as menopause approaches and the ovary begins to show signs of aging. Blood is drawn as close as possible to day 3 of the cycle. A high level suggests that the ovaries are not responding well to brain signals and do not develop follicles for ovulation. A high FSH may mean that chances for achieving pregnancy are poor.
- Prolactin is a pituitary-gland hormone that may go up in women with small benign growths of the pituitary gland and those on certain medications.
- Thyroid tests help to determine if there may be a problem with the thyroid, wthere there is not enough or too much thyroid hormone.
- Testosterone, DHEAS, and 17-hydroxyprogesterone are androgens (male hormones) that may be useful to check in women who also have excessive hair growth (hirsutism)
7-10 Days after Ovulation
- Progesterone Test This is a blood test drawn about 7-10 days after ovulation at a time when progesterone levels peak. A good level of progesterone (usually above 10 ng/ml) usually confirms ovulation.
Infertility Testing Step 4: Fallopian Tube Patency
Testing the fallopian tubes is essential when checking fertility. This can be by with an HSG or a laparoscopy.
- Hysterosalpingogram (HSG): The HSG is an X-ray test in which dye is injected through the cervix and up into the uterus and fallopian tubes, while the doctor watches on a video screen. The HSG is usually done in the first half of the menstrual cycle, between the end of the menstrual period and before ovulation. The HSG is useful in determining if the fallopian tubes are open and if the cavity of the uterus is a normal shaped. There is a slight increase of fertility after this test.
- Laparoscopy: A laparoscopy is a surgical procedure in which a telescope is inserted into the abdomen, usually in the area around the belly button, and the pelvic organs are examined. This is usually done under general anesthesia, but in some instances is done under local anesthesia only. A laparoscopy is 'diagnostic' if used only to look at the organs, and it's 'therapeutic' when additional surgery is done as treatment.
- Sonohysterogram: A sonohysterogram is similar to an HSG except it is done in the doctor's office with ultrasound rather than an X-ray machine. Saline is injected through the cervix into the uterus, and the uterus and fallopian tubes are examined with ultrasound on a monitor.
Infertility Testing Step 5: Other Tests
- Postcoital Test (PCT, Huhner Test): The PCT is not dissimilar from a Pap smear, but it requires a couple to have intercourse 2-8 hours beforehand. The PCT is done at the time of ovulation when the cervical mucus is thin and receptive to sperm. A small sample is removed, placed on a slide and examined with the microscope. If good, it suggests that the cervix is not a barrier to fertilization. If the test is poor, the couple may benefit from artificial insemination.
- Endometrial Biopsy: A small sample of the lining of the uterus (endometrium) is obtained in the latter part of the cycle to see if the endometrium has properly matured, under the influence of the hormone progesterone. If there is a "lag" (that is, the endometrium has not reached the proper stage), the condition is known as a Luteal Phase Defect, which can be treated with hormones.
- Transvaginal Ultrasound (TVS): A plastic ultrasound probe is inserted into the vagina so that the uterus and the ovaries can be seen on a monitor. The TVS is used to look for such things as fibroid tumors of the uterus and ovarian cysts, as well as to follow patients on fertility medications and in early pregnancy.
- Hysteroscopy: During a hysteroscopy a telescope is inserted through the cervix into the uterus. The inside of the uterus can then be examined, and surgical procedures such as removal of a fibroid tumor, polyp, or scar tissue can be performed. When done for diagnostic purposes, this can often be done in the office under local anesthesia.