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Infertility Testing


Couples who are having trouble conceiving can meet with a fertility specialist who has had specific training in the reproductive system and the issues that can cause infertility problems. Once you find the fertility clinic that is right for you, doctors can perform various fertility tests to diagnose infertility problems and recommend the appropriate course of fertility treatment.

When is Fertility Testing Necessary?

The ability to conceive varies from couple to couple and, for some, careful fertility monitoring is essential to success. However, when a couple has been unsuccessful for a full year, fertility testing is indicated to identify physiological factors that may be involved.

The first step in obtaining infertility therapy is fertility testing. There are many reasons why couples have trouble conceiving, including low sperm count, low hormone levels, and abnormalities in reproductive organs. Only comprehensive fertility testing can isolate the problem and allow your doctor to suggest appropriate courses of treatment.

The inability to conceive may be due to physiological factors present in one or both partners. Comprehensive fertility tests are essential to identifying the cause of the problem.

Female Diagnostic Surgical Testing

If signs of fertility problems are not detected through semen analysis and hormone testing, your fertility specialist may recommend female diagnostic surgical testing. These tests can diagnose (and in some cases treat) blockages, adhesions, endometriosis, and other abnormalities. The most common female reproductive surgical tests are defined below.

  • Endometrial Biopsy: An endometrial biopsy should be taken after the 21st day of the woman's cycle. A sample of endometrial tissue can provide your fertility specialist with more specific details regarding your endometrial development. It also allows your physician to determine whether the endometrial lining is thick enough to support embryo implantation.
  • Falloposcopy: During the falloscopy procedure, a specially designed telescopic device is inserted into the vagina, through the cervix and uterus, and finally, into the fallopian tubes. This provides doctors with a clearer view of the fallopian tubes, resulting in a more accurate diagnosis of the problem and more effective treatment options. Common infertility problems affecting this area include proximal and distal tubal blockage.
  • Hysterosalpingogram: A hysterosalpingogram is an X-ray used to record detailed images of the uterus and fallopian tubes. Prior to having the X-rays taken, a dye is injected into these organs, allowing the fertility specialist to identify blockages and other problems.
  • Hysteroscopy: During the hysteroscopy procedure, a small fiber optic telescope is used to examine the uterus for abnormalities such as scarring and adhesions. The device allows physicians to record images of the uterus and correct certain abnormalities.
  • Laparoscopy: Laparoscopic surgery is typically performed under general anesthesia on an outpatient basis. During this minimally invasive procedure, your fertility doctor will insert the laparoscopic device through a naval incision. The laparoscope can then explore the uterus, fallopian tubes, and ovaries, providing your physician with clear images of the areas so any problems can be detected.

Male Surgical Diagnostic Tests

When other types of fertility tests, such as semen analysis, fail to reveal the cause of male infertility problems, surgical diagnostic tests may be performed. These tests can determine the causes of infertility due to low sperm count, low semen volume, and other male factor infertility problems.

Testicular Biopsy Procedures: A biopsy of the testicles can determine whether sperm production is normal or abnormal, as well as the possible location of blockages. There are two types of testicular biopsy procedures that can be performed - needle or open - and both take about 30 minutes to complete.

Needle Biopsy: Performed under local anesthesia and involves obtaining a sample of tissue from the testis using a small needle.

Open Biopsy: Typically performed under general anesthesia and involves making a small incision in the skin to remove a sample of tissue from the testis.

Vasography: Vasography is a test used to determine the site of possible blockages. A radiographic dye is injected into the vas deferens and ejaculatory ducts. An x-ray image is then taken to observe the flow of the dye through the ducts to determine the site of any blockages. In some cases, an incisional vasography procedure can be performed when the location of a blockage cannot be found through the X-ray examination.

Semen Analysis

If a couple suspects that they suffer infertility problems, they may want to undergo fertility testing to diagnose conditions that could be affecting their ability to conceive. One of the first tests that is generally performed is a semen analysis, as it is one of the least invasive types of fertility tests performed. A semen analysis includes an evaluation of the amount of semen produced in one sample, as well as the number and quality of the sperm within the sample.

Problems Detected through Semen Analysis

According to Web MD, semen problems affect more than one-third of couples who face fertility problems. A semen analysis can detect the following issues:

  • Sperm count
  • Sperm shape
  • Sperm motility
  • Semen volume
  • Semen liquification time
  • Semen pH levels
  • Semen white blood cell count
  • Semen fructose levels

The Semen Analysis Process

Prior to undergoing a semen analysis, men should avoid ejaculation for two to five days so sperm count is at its highest. However, men should not avoid ejaculation for more than one to two weeks before the semen evaluation, as this could lead the sperm to be less active.

Men should also avoid alcohol in the days before the test, and speak to their fertility specialist about any medications or herbs they are taking. The day of the test, men will provide their physician with a semen sample for analysis. Results of the semen evaluation are typically available within a day or two.

Postcoital Fertility Test

The postcoital fertility test is performed after intercourse to determine the ability of the man's sperm to survive in the woman's cervical mucus. This test can determine female infertility as well as male fertility problems, and is often performed when other tests, such as sperm analysis and hormone testing, have not found a cause for a couple's infertility.

Because there are only a few days during a woman's menstrual cycle when sperm can survive in the cervical mucus, timing of the postcoital test is very important. The postcoital fertility test is performed one to two days before ovulation occurs when the woman's cervical mucus is thin, allowing the sperm to easily move through it, eventually reaching the egg.

Preparation for the Postcoital Test

Your postcoital test appointment will be scheduled according to when you ovulate. Your doctor will give you instructions for determining ovulation, which typically includes checking your basal body temperature, the level of luteinizing hormone (LH) in your urine, and the condition of your cervical mucus.

You and your partner should have intercourse within two to eight hours before the visit. For accurate results, it is recommended that you not use lubricants during sex, and that you not take a bath or douche afterwards. You may, however, take a shower before your appointment.

How the Postcoital Test Is Performed

Within two to eight hours after intercourse, you will visit your health care provider or fertility specialist to have the test performed. The doctor collects a sample of the cervical mucus through a procedure similar to a Pap test. This sample is then examined by the doctor or health care professional.

Postcoital Test Results

The postcoital test assesses the condition of the cervical mucus sample and how the sperm interacts with the mucus. The doctor will examine the mucus for certain characteristics that may be signs of fertility problems, including:

  • Dead sperm that may signal the presence of sperm antibodies produced either by the woman, or in rare cases, by the man.
  • Mucus that cannot be stretched at least two inches, or doesn't dry in a fern-like pattern, which may mean that it is not allowing the sperm to travel through it sufficiently.
  • Other cervical factors that can cause infertility.
  • Problems with the quality of the sperm.

Once you have received the results of your postcoital test, it is important to speak with your fertility doctor about how to proceed with fertility testing and treatments. If no problems are apparent, additional testing may be recommended to determine the source of your fertility problems.

Blood tests allow fertility doctors to evaluate hormones and test for male and female infertility problems. Like the semen analysis, this is one of the less-invasive forms of fertility testing available. Because blood tests are relatively simple to perform, hormone testing is usually one of the first fertility evaluations specialists perform when testing for infertility problems.

Female Hormone Testing

Various hormones affect the reproductive process. When a woman undergoes hormone testing in an attempt to diagnose female infertility problems, the following hormone levels are typically evaluated:

  • Luteinizing Hormone (LH)
  • Follicle Stimulating Hormone (FSH)
  • Estradiol
  • Progesterone
  • Prolactin
  • Free T3
  • Free T4
  • Total Testosterone
  • Free Testosterone
  • Androstenedione
  • SHBG
  • 17 Hydroxyprogesterone
  • Fasting Insulin

Hormone testing takes place on the third day of the woman's menstrual cycle. At this time, the fertility specialist establishes baseline FSH and LH levels, while other hormone levels can be evaluated for imbalances.

The second hormone testing appointment occurs a day or two before ovulation, during the LH surge. At this time, FSH and LH levels are measured and evaluated again. Low and high levels of these hormones may be a sign of fertility problems. Potential Female Infertility Problems Caused by Hormonal Imbalances

High levels of FSH and LH can lower the quality of eggs and indicate ovarian problems; low levels of FSH and LH can be a sign of a pituitary or hypothalumus disorder that is causing infertility problems.

High estrogen levels could affect egg quality, while low progesterone levels can indicate an ovulation problem.

Male Hormone Testing

Abnormal levels of male hormones can cause fertility problems in men. The following hormone levels are generally evaluated in men:

  • Testosterone
  • Free Testosterone
  • Luteinizing Hormone (LH)
  • Follicle Stimulating Hormone (FSH)
  • Prolactin
  • Estradiol
  • Progesterone
  • Potential Male Infertility Problems Caused by Hormonal Imbalances
  • High levels of FSH and LH can be a sign of testicular problems, such as primary testicular failure

Ultrasound Fertility Tests

Ultrasound tests are often used as a non-surgical method of determining certain fertility problems in both women and men. Pelvic ultrasound tests use high-frequency sound waves to create an image of the organs and structures of the pelvis. These sound waves travel through the organs and tissues of the body at different speeds, and are reflected back to a device called a transducer which transmits the image through a computer to a video screen for viewing. Ultrasound tests typically take 30 minutes to perform, and you must remain still throughout the procedure.

Ultrasound Fertility Tests for Women

For women, the ultrasound test is used to look at the ovaries, uterus, cervix, fallopian tubes, and bladder to determine possible causes of infertility. Specifically, ultrasound tests are used to:

  • Determine the size and condition of the ovaries
  • View the uterus to check the condition of the lining and for structural defects
  • Monitor ovulation by checking the growth of follicles in the ovary
  • Check for growths in the organs, including uterine fibroids and ovarian cysts

Ultrasound Fertility Tests for Men

For men, ultrasound fertility tests are used to look at the seminal vesicles, prostate gland, and bladder. The tests are typically used to:

  • Show swelling in the seminal vesicles which can be an indication of an obstruction of the ejaculatory ducts
  • Reveal other ejaculation or erectile problems
  • Check if a problem with the prostate gland may be causing infertility
  • Examine the condition of the scrotum
  • Determine if sperm is circulating through the system and being stored normally

Types of Ultrasound Tests

There are several ways in which an ultrasound test can be performed. Each method uses a device called a transducer to collect the sound waves and transmit them to a computer.

  • Transabdominal Ultrasound: Uses a handheld transducer, which is moved over the lower abdomen. It is typically used for fertility tests in women when checking for large uterine fibroids or other problems that could cause infertility. Before transabdominal ultrasound, you will be asked to drink four to six glasses of water or juice.
  • Transrectal Ultrasound: Uses a transducer designed to fit into the rectum, and is often used in male patients to view the pelvic organs, including the seminal vesicles and prostate. Patients may need an enema about an hour before the procedure.
  • Transvaginal Ultrasound: Uses a transducer designed to fit into a woman's vagina, and is used to look for a range of problems that may cause infertility.
  • Hysterosonogram: Also called a sonohysterogram, the hysterosonogram is a transvaginal ultrasound test in which the uterus is filled with saline during the examination. It may be performed during fertility tests for very detailed images of the ovaries, uterus, and endometrial lining. It also helps show uterine abnormalities, such as polyps or fibroids, and can determine whether the fallopian tubes are open.

Find a Physician in Your Area

With the help of DocShop, you can find a fertility specialist in your area who can explain the testing process and discuss the cost of different infertility tests. Locate a skilled fertility specialist in your area today for more information on fertility tests and testing options.

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