Fertility Testing

Fertility_Testing

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When a couple first goes to their doctor with concerns of infertility, the doctor will want to do some fertility testing. This testing will help to uncover the causes for the fertility problems and determine if the couple truly is infertile and what treatments are necessary. Most times you will initially be seeing an OB/GYN (obstetrician/gynecologist) who will do your initial testing and refer you to an RE (reproduction endocrinologist) if some sort of infertility is found. The RE will do the actual treatments, assuming that the condition(s) are serious enough for treatment and treatments are available. The following is an outline of a routine fertility workup. This may vary slightly by doctor.

During your first appointment, which should be during the first week of your cycle, the doctor will take baseline levels of FSH (follicle stimulating hormone) and LH (lutenizing hormone) in the female. Some doctors may also do routine screening of both partners for AIDS, hepatitis, etc. Also during this time, the doctor will take medical histories for both partners. To help this process along more quickly, you should try and keep track of your menstrual cycles for several months prior to seeing your doctor. Also, charting your Basal Body Temperature (BBT) and using home Ovulation Predictor Kits and recording your results of both can give your doctor some insight. Many doctors will automatically order a test of the male's sperm in the very early stages of testing before putting the female through the more complicated and in depth tests. This test checks the number of sperm present as well as their motility and structure, to ensure that they are healthy and capable of fertilizing the egg.

Your second appointment should be scheduled on the day of the woman's LH surge...BEFORE ovulation. You can detect a surge by using home ovulation predictor kits and you can then call for an appointment on the day you detect a surge. At this appointment your doctor will most likely do a Cervical Mucus Test which will include a post-coital test to see that sperm can penetrate and survive in the cervical mucus. Also included in the cervical mucus test will be a bacterial screening. Also during this time the doctor should do an Ultrasound Exam which will assess the thickness of the lining of the uterus, monitor follicle development and check the condition of the uterus and ovaries. This test can also detect fibroid tumors, abnormalities of the shape of the uterus and cysts on the ovaries, sometimes it can even detect endometriosis. Many doctors will order a second ultrasound two or three days after the first. This would confirm that the follicle actually did release and rule out the possibility that the woman's eggs are ripening but not releasing. In addition, your second appointment should include Hormone Tests which will check the levels of LH and FSH again as well as Estradiol and Progesterone. Also tested at this time should be Prolactin, Thyroid Stimulating Hormone, Free T3, Free Thyrozine, Total Testosterone, Free Testosterone, DHEAS and Androstenedione. The normal levels for each of these during specific parts of your cycle can be found by clicking here.

After the initial fertility workup, many doctors will go on to do some or all of the following tests as well.

HYSTEROSALPINOGRAM:used to examine the woman's uterus and fallopian tubes. A radio-opaque dye is injected through the cervix into the uterus and fallopian tubes. The area is then x-rayed. The dye appears white on the x-ray and the radiologist and your doctor can see if there are any abnormalities in the shape of the uterus or if there are any tumors, scar tissue or blockages in the fallopian tubes. This procedure is mostly known to cause only minor cramping and discomfort, but some women (especially those with blockages) do experience intense pain.
HYSTEROSCOPY:This procedure allows the doctor to see any abnormalities or growths in the uterus. This is done by inserting a thin telescope mounted with fiber optic light called a hysteroscope through the cervix and into the uterus. Photos of the uterus are then taken for future reference. I believe this procedure is performed under a mild anesthetic but no hospital stay is required.
LAPAROSCOPY:In this procedure a narrow fiber optic telescope is inserted through a small incision in the woman's abdomen to look at the uterus, fallopian tubes, and ovaries. This enables the doctor to see any endometriosis or pelvic adhesions that may be present as well as get the best look possible at the ovaries.
ENDOMETRIAL BIOPSY:This procedure involves scraping a small amount of tissue from the lining of the uterus shortly before menstruation is due. It is used to determine if the woman has a luteal phase defect, or a hormonal imbalance which prevents sustaining a pregnancy because of a lack of progesterone production. NOTE: This test should ONLY be performed after a blood test shows that the woman is not pregnant!

Well, there you have it. Those are the basic tests that your OB/GYN or RE should perform in determining the nature of your infertility. Once your specific fertility problems are determined, you can then go on to treatments to overcome, or at least bypass, these conditions and with any luck achieve a successful pregnancy.

DISCLAIMER: Please recognize that I am NOT a medical professional. The information in these pages should NOT be taken as medical advice. It is simply information that I have gathered through the process of educating myself about this devastating condition which I am currently afflicted with. I accept no responsibility for the outcome of any interpretations the readers of this page may have. Please consult your doctor if you have any questions or concerns. Also, if any information on this page is found to be incorrect, please inform me of such with something to substantiate your claim. Thank you.