How Is Infertility Diagnosed?Tuesday, April 10, 2012 - 17:00
A complete medical history and a physical exam are the first steps in diagnosing a fertility problem. Both partners need to be evaluated. The couple may also need blood tests, semen specimens from the man, and ultrasound exams or exploratory surgery for the woman.
Need To Know:
Your Doctor Will Want to Know
During the initial medical exam and history, the doctor will need information about the couple's sexual and medical history. They should prepare for these questions:
For the woman:
For the man:
If a woman has an
- Blood tests and urine tests to check hormone levels.
- A Pap smear to study the health of the cervix.
- Urine tests to evaluate LH surges.
- A basal body temperature test, which checks whether the woman is releasing eggs from her
ovaries. A woman's temperature rises slightly during the days she ovulates. The woman will chart her basal body temperature every day for a few months on a graph. She will take her temperature orally or may take her temperature vaginally with a special ultra-sensitive thermometer available at most drugstores.
- An endometrial biopsy, in which the doctor removes a piece of tissue in the uterine lining. Examining this tissue will tell the physician whether eggs have been released and whether the corpeus luteum is producing enough
progesterone. This test is often done if the results from the woman's basal body temperature chart are unclear.
- An ultrasound to look for fibroids and cysts in the uterus and ovaries. This test uses sound waves to picture the uterus and ovaries, causes little discomfort, and is very effective.
- A postcoital test, in which the doctor takes a sample of mucous from the woman's vagina. She must have the test during her fertile days and within 12 hours after she and her partner have sex. The test will tell the doctor if the man's sperm can survive in the woman's cervical mucous.
More complex tests include:
- A laparoscopy: If the doctor suspects ovarian or fallopian tube scarring or endometriosis, a woman may undergo a laparoscopy. The doctor makes two small incisions at the pubic bone and navel, and carbon dioxide gas is injected into the stomach to enlarge it.
Then the doctor inserts a laparoscope, a long tube with lenses and a fiberoptic light, into one incision and a long probe through the other opening in the skin. With the probe, the doctor can view the ovaries,
fallopian tubesand uterus to check for scar tissue. In some cases, he may cut away scar tissue discovered during this operation.
The woman usually has to undergo general anesthesia for the procedure, but the risks of bleeding, infection and reaction to the anesthesia are slight.
- A hysterosalpingogram: This test checks the condition of the woman's fallopian tubes.
The doctor clamps the cervix and injects a needle filled with dye into the woman's uterus. An X-ray is taken to determine whether the dye passes through the open ends of the fallopian tubes. If the dye emerges from the end of the tubes, they are not blocked.
The test may also reveal other fertility problems, such as fibroid tumors, structural abnormalities and endometrial polyps. In some cases, the dye actually clears away blockages in the fallopian tubes, and restores the woman's fertility.
The dye is harmless and is absorbed by the woman's body after going through her tubes. The test may be uncomfortable, but is rarely painful. Unfortunately, it is noted for both false positive and false negative diagnoses.
The tests for male infertility are fairly simple and easy. After a medical history and an examination, the man's sperm are tested. He'll be asked to ejaculate into a cup in a private place in the doctor's office or at home, and this specimen will be evaluated. The man should not ejaculate for several days before he takes the test, because each ejaculation may reduce the sperm count.
Health workers will check the man's semen for several factors:
- sperm count (20 to 100 million sperm is the normal number)
- maturity and shape of the sperm (which reveal its quality)
- the amount of sperm produced (one teaspoon is sufficient)
- acidity (the semen should be slightly acidic)
The man may be asked to undergo this test twice, because some illnesses such as infections or viruses can affect the sperm. If a man has abnormal sperm, he'll be referred to a fertility specialist, where he'll experience more tests, such as:
- Hormonal blood tests.
- Imaging tests that check for swollen veins or reproductive system blockages.
- A testicular biopsy. This is a procedure done in the office. The doctor takes bits of tissue from the testes, and this tissue is examined to see whether the cells that produce the sperm are working properly.
- Anti-sperm antibody tests, which check whether the woman's mucous rejects the man's sperm. These tests also show whether the man produces antibodies to reject his own sperm.
- A hamster egg test, which studies the sperm's ability to penetrate a hamster egg. The outer covering of the egg is removed to allow the sperm to more easily penetrate. This test cannot result in a living embryo. It's expensive, however, and sometimes unreliable.
- A human zona penetration test, which tests whether the man's sperm can fertilize dead human eggs. Again, this test cannot result in a living embryo, and is thought to be more reliable than the hamster egg test.
- A bovine cervical mucous test, which checks whether the sperm can penetrate cervical mucous taken from a cow.