THE BASICS OF INFERTILITY TESTING FROM A TOP FERTILITY CLINIC

An Infertility evaluation is performed when a couple has been trying to conceive for 1 year and have been unsuccessful despite having regular intercourse (or after 6 months if the female partner is over 35). An infertility evaluation will include an detailed medical history, a limited physical exam, a Gynecologic pelvic ultrasound, X-rays or ultrasounds, a semen analysis and blood work. Evaluation of each of the “parts” needed in conception (eggs, ovulation, fallopian tubes, uterus, sperm) is generally performed.   Over the past 20 years infertility testing has become more simplified and the basic tests can often be completed within one month.

A basic infertility evaluation for Women

Probably the most important part of an infertility evaluation is the medical history. If the fertility doctor takes a detailed history it will direct the physician to a targeted infertility evaluation.  Important questions an Infertility physician should ask in the medical history include details about the menstrual history, history of sexually transmitted diseases, surgical history and family history of infertility including a family history of premature ovarian failure, recurrent miscarriages, genetic problems or endometriosis.

Evaluation of the ovaries

There are several tests available to test the quality and quantity of the eggs in the ovaries, and assess if the ovaries are functioning normally.

One of the basic tests performed by a  Colorado fertility doctor include an ultrasound to look at the ovaries.  An ultrasound of the ovaries is performed to look at the position of the ovaries, shape of the ovaries  and  the antral follicle count.  An Antral follicle count (or resting follicle count) will  count the follicles that are visible on the ovary at any given time. The higher the antral follicle count the better the chances are of conceiving.  Assessing the position of the ovaries or if there are cysts on the ovaries is important as it may make the fertility doctor suspicious that there is endometriosis or pelvic adhesions.

The most common way to assess the eggs in the ovary is with blood work performed on day 2, 3 or 4 of a natural menstrual cycle. Typically the FSH, estradiol and AMH hormone levels are evaluated.  The higher the AMH the better the chance one has of conceiving.  Low FSH levels (less than 10 mg/mL) and low estradiol levels are also a good prognostic indicator for fertility.   Sometimes physicians will order a progesterone level after ovulation, an Inhibin B level, or an LH level  if the fertility doctor is concerned there is an ovulation problem.

Diagnostic Tests for checking the Fallopian tubes:

There are several ways to check the fallopian tubes.  Which test is best is determined by the patient’s medical history.

• Hysterosalpingography – Also called HSG, this is a X-ray examination that checks the condition of the uterus and fallopian tubes. A HSG involves the use of contrast x-ray dye being injected through the cervix up into the fallopian tubes, under Xray guidance.

• An Ultrasound guided Saline infusion with air contrast is another way to check the fallopian tubes.  If the uterus and ovaries are easy to see by ultrasound then often an ultrasound is performed rather than a HSG x-ray procedure. This procedure will inject very small air bubbles in Saline and watch them travel thru the fallopian tubes by ultrasound.

• Laparoscopy – This is a procedure that is done under anesthesia, often in the operating room. For this procedure the physician inserts a small endoscope thru the navel to look at the pelvic organs. Visualization of the pelvic organs is the best way  to detect possible defects of the uterus and fallopian tubes, but it is very invasive.

Diagnostic Tests for checking the uterus:

The uterus is most commonly evaluated by ultrasound.  Abnormalities such as fibroids, polyps or abnormalities in the shape of the uterus can be easily seen.  Additionally,  the above Saline infusion and HSG tests will evaluate the uterus.

A basic infertility evaluation for Men

Infertility isn’t just a woman’s problem. According to the survey of CDC, data indicates that 30% of infertility is due to “male” issues alone and 30% of infertility is due to female issues alone, while 40 % is due to a combination of male and female problems. . When a male presents for an infertility evaluation, the infertility doctor will ask questions regarding the male partner’s medical history and sexual habits.

The most important test for men is a semen analysis. Using this test, infertility physicians can determine the number of sperm in a sample, what percent of the sperm have a normal shape (morphology), and the sperm motility. Men may have to undergo hormonal tests and ultrasound examinations if the medical history or semen analysis indicates a problem.

Final Thoughts

It is important that testing of both the male and female partners occurs when infertility is the problem. As indicated above 40% of infertility is due to both male and female factors.