About 80% of infertility is caused by one or more of these three problems: Ovulation problems, sperm problems, or fallopian tube problems. Infertility testing is straightforward. If ovulation is OK, then the next step is usually to check the ejaculate, and if that's OK, the fallopian tubes are checked next.
The very first test is to do a spermanalysis. The next step is for her to do some blood tests, specifically the following:
Cycle Day 3
- FSH Level FSH is the acronym for follicle-stimulating hormone. 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.
Other tests often done include the following:
- Semen Analysis: The ejaculate is obtained through masturbation, placed in a sterile collection cup, and brought to the laboratory. The best results are obtained when the man 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). 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.
- 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.
- 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.
- 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.
- 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.
- 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.