When a couple has been unsuccessful at achieving pregnancy after one year, both partners need to go through a comprehensive physical and medical assessment. Tests for female infertility and a semen analysis should start immediately. Because male factors account for approximately 50% of all infertility cases, it is important to examine both partners for possible infertility issues.
You may find male and female fertility support products in our Fertility Shop helpful for easier and quicker conception.
What is the process for female fertility testing?
The first step in diagnosing an issue relating to fertility is a comprehensiveappointment with your fertility physician. During this appointment, yourmedical history and lifestyle will be discussed extensively. Topics suchas birth control use, menstrual and pregnancy history, current and pastsexual practices, medications used, surgical history, other health issuesand what your lifestyle is like as well as your work/living environmentwill all be discussed.
A thorough physical exam will also be done. Areas such as your thyroid,breasts, and hair growth will be looked at. A pelvic exam is also an importantpart of evaluating fertility, along with a pap smear.
After this first appointment, your physician may want to proceed with someinitial testing. This initial testing will evaluate things such as if ovulationis occurring, when it should be occurring, ovarian function, and uterinefunction during the ovulation process.
Ideally, you will have already begun tracking your ovulation through fertilityawareness or a fertilitymonitor. This will provide your reproductive specialists with valuableinformation about your ovulation. Usually one of the first questions regardingfemale fertility is whether you are ovulating or not.
Ovulation evaluation may be broken down into types:
- Ovulation testing– to confirm if ovulation is occurringby looking through your temperature charts, using ovulation predictorkits and blood tests and ultrasound.
- Ovarian function tests–These tests are looking tosee how the hormones are functioning and working during your ovulationcycle. Tests include the Day 3 FSH (measuring follicle stimulating hormone),Day 3 Estradiol (measuring estrogen), ultrasound (to confirm ovulationoccurred) and blood tests to determine the levels of inhibin B.
- Luteal Phase testing- Testing will evaluate progesteronelevels, more extensive hormone testing, and possibly a endometrial biopsy( see below for more info on this procedure.)
- Hormone tests: Most all of this testing will revolvearound thorough hormone tests. These hormone tests include the following:
- Luteinizing Hormone
- Follicle Stimulating Hormone
- Free T3
- Total Testosterone
- Free Testosterone
The following tests are also commonly used in the first evaluated cycle:
- Cervical mucus tests: This involves a post coitaltest (PCT) which determines if the sperm is able to penetrate and survivein the cervical mucus. It also involves a bacterial screening.
- >Ultrasound tests: This is used to assess the thicknessof the lining of the uterus (endometrium), to monitor follicle developmentand to check the condition of the uterus and ovaries. An ultrasound maybe conducted two to three days later to confirm that an egg has been released.
If both the semen analysis and the above testing return normal results,there is also additional testing that your fertility specialists may recommend.These tests include any of the following:
- Hysterosalpingogram (HSG): This is an x-ray of youruterus and fallopian tubes. A dye is injected through the cervix intothe uterus and fallopian tubes. The dye enables the radiologist to seeif there is blockage or some other problem.
- Hysteroscopy: This is a procedure that may be usedif the HSG indicates the possible presence of abnormalities. The hysteroscopeis inserted through the cervix into the uterus, which allows your fertilityspecialist to see any abnormalities, growths, or scarring in the uterus.The hysteroscope allows the physician to take pictures which can be usedfor future reference.
Laparoscopy: This is a procedure done under generalanesthesia, that involves the use of a narrow fiber optic telescopeunder. The laparoscope is inserted into a woman’s abdomen to providea view of the uterus, fallopian tubes, and ovaries. If any abnormalitiessuch as endometriosis, scar tissue or other adhesions are found, theycan be removed by a laser. It is important to confirm that you are notpregnant before this test is performed.
- Endometrial biopsy: This is a procedure that involvesscraping a small amount of tissue from the endometrium just prior to menstruation.This procedure is performed to determine if the lining is thick enoughfor a fertilized egg to implant in and grow. It is important to confirmthat you are not pregnant before this test is performed.
These tests are not mandatory and your fertility specialists will knowwhich tests to recommend in your situation.
Compiled using information from the following sources:
RESOLVE: The National Infertility Association, http://www.resolve.org
American Society for Reproductive Medicine (ASRM), http://www.asrm.org