Tests and Diagnosis
Some patients have already had some diagnostic testing for infertility before seeing a fertility specialist. However, fertility clinics can usually perform more comprehensive or advanced testing than your general practitioner or OB/GYN. Your fertility specialist will discuss the types of diagnostic testing you and your partner need to have at your initial consultation. As previously discussed, both men and women's conditions can contribute to infertility, so it is important that both partners get tested.
Female Fertility Tests
Basic diagnosis involves a normal physical and gynecological examination, including a pap smear to verify the condition of your cervix. Depending on your symptoms, your fertility specialist may also perform:
- A hysterosalpingogram. This is an x-ray for your uterus. The doctor or technician will inject a special dyed fluid into your uterus through your cervix. During the x-ray, your fertility specialist will look for proper fluid motion and distribution through your uterus and fallopian tubes. This test can help diagnose a tubal blockage or irregular uterus shape.
- A pelvic ultrasound. Many women know that doctors use ultrasounds to look at a developing fetus, but ultrasound imaging can also help your fertility specialist assess the shape and function of your uterus and fallopian tubes. For more information, your doctor may also perform a hysterosonography, during which he or she will perform an ultrasound while gradually injecting sterile saltwater into your uterus. Your specialist may also perform your ultrasound transvaginally, with a lubricated wand.
- Hormone testing. Your hormone function can impact your ability to conceive, so fertility specialists use blood tests to measure the levels of different hormones to determine if you are ovulating properly, have sufficient reserve ova, or check related hormones, such as those of the pituitary gland or thyroid.
- Urine tests. Two or three days before you ovulate, your body should release a surge of LH, luteinizing hormone. This causes the follicle to develop properly into an egg. Urine tests may be able to determine if your body is properly producing LH.
- A basal body temperature test. During ovulation, your temperature increases slightly. Therefore, if you or your doctor measure your basal body temperature either vaginally or orally every day during your estimated ovulation time, this can help determine if you are ovulating normally. Basal body temperature testing can also help you and your partner better time sex for conception.
- A hysteroscopy. Usually performed when other diagnostic tests have not yielded results, a hysteroscopy is an outpatient minor surgery performed under general anesthesia. If you need a hysteroscopy, your specialist will insert a small, lighted instrument through your cervix into your uterus. Your doctor uses this tool to look for abnormal tissue growth or uterine shape. Your specialist may also recommend a hysteroscopy to confirm your diagnosis before beginning fertility treatment.
- A laparoscopy. Like a hysteroscopy, a laparoscopy is a minor surgical procedure used to examine the uterus, ovaries, and fallopian tubes more closely. During this procedure, your fertility specialist will make tiny incisions at your navel and pubic bone. Then, he or she will insert a probe into one incision and a long, thin tube with special lights and lenses into another. Lit by the tube, the laparoscope, he or she will look for scar tissue in your fallopian tubes, ovaries, or uterus. If your doctor finds scar tissue or abnormalities, he or she may remove them during your laparoscopy.
- An endometrial biopsy. Usually performed as a follow-up to basal body temperature tests, your doctor will take a sample of tissue from your endometrium, the lining of your uterus. He or she can do this either through jet irrigation and a brush, an electronic aspirator, or through a thin pipette. This can help diagnose abnormal uterine bleeding, cancer, or other irregularities with your menstrual cycle.
- A post-coital test. During the five or six fertile days of your cycle (before and during ovulation), you will come into the fertility clinic within twelve hours of unprotected sex. Then, the doctor will swab your vagina for a sample of cervical mucous, which can then be tested to determine if it is hospitable to sperm.
- Genetic tests. If you have a family history of certain genetic conditions or your infertility is still unexplained after regular testing, your fertility specialist may recommend genetic testing. During this process, your doctor will examine your DNA to look for specific sequences that might make it difficult for you to become pregnant.
Male Fertility Tests
Diagnostic exams for male fertility exams can include:
- A general physical. Your fertility specialist or general practitioner can perform a typical physical exam to assess your overall health and look for more visually noticeable conditions such as varicoceles, enlarged veins in the testicles that can cause them to overheat and damage sperm.
- Hormone analysis. Similar to female hormone testing, your fertility specialist may perform blood tests to measure your levels of testosterone or other important hormones. Your doctor may also measure hormones produced by your pituitary gland or hypothalamus, since these can affect fertility.
- Semen specimen testing. For this test, you will provide semen for testing so that your fertility specialist can determine if they are moving properly, normally shaped, and in the correct concentration in the ejaculate. Generally, a healthy concentration of sperm is 20 million cells per milliliter of semen. More advanced tests may determine your sperm's ability to attach to or fertilize an egg.
- Ultrasounds. Ultrasound imaging can help your doctor look for obstructions or abnormalities within your reproductive organs. During a scrotal ultrasound, your fertility specialist will examine your testicles and scrotum for any blockages. A transrectal ultrasound is slightly more invasive-your specialist will insert a thin wand into your rectum, which will allow him or her to look for obstructions in your seminal vesicles or ejaculatory ducts, the tubes that transport semen. This procedure can also check your prostate for issues.
- Testicular biopsy. If other semen analysis tests are inconclusive, your specialist may use a small needle to remove tissue from your testicles. From this sample, your specialist will determine if you are producing healthy sperm. In severe cases, your specialist can also use a testicular biopsy to harvest sperm for treatments such as IVF.
- Urinalysis. For this test, you will provide a sample of urine, typically directly after ejaculation. Your fertility specialist will then examine it for white blood cells, which could be a result of infection. He or she will also look for semen in your urine, which could be a sign of retrograde ejaculation.
- Genetic testing. As with female fertility testing, your doctor may recommend examining your DNA to look for hereditary conditions or disease that could be causing infertility. This is usually a last resort effort for couples that have gone through usual testing but have not yet received a clear diagnosis for their infertility.
