Testing for Infertility

Testing for Infertility
(From the PDR Family Guide to Women's Health)

If you have been trying to become pregnant unsuccessfully for a year, consider consulting a fertility specialist. Within 3 months of your first visit, you'll probably go through the following agenda.
Physical Workup

First, the doctor will perform a physical exam and take a thorough health history. You'll be asked many questions about your reproductive history, including how regular your periods are and whether you have ever had a sexually transmitted disease (STD). Some STDs, if untreated, can lead to pelvic inflammatory disease (PID), impairing fertility even years later. Many other seemingly unrelated conditions, such as recurrent urinary tract infections and hypothyroidism, can cause infertility as well.

You will be asked to measure your basal body temperature (BBT) every day. The BBT is your lowest body temperature during waking hours. A measurable drop in temperature may precede ovulation by 12 to 24 hours. After ovulation, the sex hormone progesterone usually causes the body temperature to rise. Your doctor may measure your progesterone levels at various times since an increase during the second half of the monthly cycle suggests that ovulation has taken place.

One simple test that's usually part of the initial workup is an analysis of your partner's semen, which will be checked for the number and quality of sperm. Semen problems are frequently due to substances that can be eliminated, such as alcohol or illicit drugs (especially marijuana), caffeine, cigarettes, and certain prescription medications.

You'll probably also be given a postcoital test, performed after intercourse to assess the characteristics of your cervical mucus at the time of presumed ovulation, as well as the liveliness of the sperm that have just been deposited. Ideally, the test is performed 2 to 8 hours after intercourse on the day before ovulation. In this painless procedure, the physician collects a few drops of mucus from the cervix and examines it to see whether it can be stretched easily and to determine how slippery it is. Both qualities are needed by sperm attempting to enter the uterus.
Other Procedures and Tests

If results of the tests described above are normal, more complex procedures can be tried:

Hysterosalpingography (HSG) involves the insertion of a small tube into the cervix. A physician or radiologic specialist then injects dye. An x­ray of the uterus and fallopian tubes is taken and examined for any blockages or abnormalities. Although somewhat uncomfortable, an HSG usually doesn't require local anesthesia or require an overnight hospital stay.

Laparoscopy is another way of looking inside the reproductive system. The physician inserts an operating microscope called a laparoscope through a small incision made just under the navel. Looking through the scope, he or she examines the ovaries, fallopian tubes, uterus, and other internal structures. Laparoscopy is a surgical procedure that usually requires general anesthesia and sometimes a night in the hospital.
If a problem still hasn't surfaced, there are several laboratory tests that can help determine whether an infection, allergic reaction, or hormonal problem may be responsible for a couple's infertility. For example, sometimes a woman's immune system treats semen like germs, attacking and killing the sperm with antibodies. Or an infection with no symptoms in either partner may interfere with their reproductive systems, blocking the fallopian tubes or the passages through which sperm flow.

When the results of all tests are negative or normal, it's probably good news. The great majority of couples in whom no cause can be determined conceive a baby within 2 years of undergoing fertility testing.