TESTS FOR FEMALE INFERTILITY

Couples who are unable to conceive after 1 year of contraceptive-free intercourse are considered infertile. However, if a woman is over 35 years of age, and is unable to conceive after 6 months of contraceptive-free intercourse, she may consider fertility treatment. With advanced age of the female, her fertility declines, and hence the shorter time-frame is advisable for women over 35.

Initial Evaluation

Women who are tested for fertility are initially asked about their general medical history, sexual and surgical histories as well as lifestyle choices. A physical examination is required to identify any abnormalities in thyroid, breasts and the pelvic region. A Pap smear test will be performed. The physician will want to confirm the occurrence of ovulation as well as general ovarian and uterine functions.

Specialized Tests

Typical diagnostic tests for female infertility may include the following:

• Hormone levels will be measured using blood tests and urine samples. Typically, these hormones include luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, progesterone, prolactin, free triiodothyronine (T3), total testosterone, free testosterone, dehydroepiandrosterone (DHEAS) and androstenedione. Ovarian follicular development and oocyte release are controlled by different hormone levels, and hence hormonal measurement at specific times during the menstrual cycle can shed valuable light on a woman’s fertility. For example, the measurement of FSH on day 3 of the cycle can help determine the woman’s ovarian reserves.

• Pap smear is used to identify infections or abnormalities in the cervix.

• Basal body temperature measurements can be recorded periodically to identify the time of ovulation. It is known that body temperature rises slightly during ovulation. A woman can keep track of her most fertile days by recording her temperature either orally or vaginally over a period of time.

• Endometrial biopsy may be performed by removing a small piece of tissue from the woman’s uterine lining. This test identifies the preparedness of the uterus for conception.

• Transvaginal ultrasound enabling the examination of the uterus and ovaries may be done to determine abnormalities, such as fibroids or cysts. In addition, ultrasound may be used to measure uterus lining (endometrium), monitor follicular development and to confirm egg release.

• Post-coital test is usually performed on the cervical mucus sample taken within 12 hours of intercourse. This test determines whether the sperm can penetrate and survive the cervical mucus.

• Hysterosalpingogram (HSG) is performed to visualize the uterus and Fallopian tubes using x-ray techniques. With the help of a dye injected through the cervix into the uterus, any abnormal blockage in the female reproductive tract can be identified.

• Hysteroscopy is another procedure to identify scarring or blockage in the uterus. It is generally performed if the HSG test reveals an abnormality. A long narrow flexible catheter is inserted into the uterus through the cervix, and an attached camera is used to record pictures for physician’s reference.

• Laparoscopy is an invasive procedure required for the identification and removal of scarring, adhesions, or endometriosis. It involves passing a narrow tube through the woman’s abdomen into her reproductive structures (uterus, Fallopian tubes and ovaries). Laser surgery is then utilized to remove any unwanted tissues from these organs. This procedure requires general anesthesia.