Infertility Testing Basics

Infertility occurs when a couple is unable to conceive after 12 months of having intercourse without the use of birth control. The male partner, the female partner, or both partners may have a problem with their fertility. Men and women are equally likely to have fertility problems.

In men, the most common reasons for infertility are sperm disorders such as low sperm count, low sperm motility, malformed sperm, and blocked sperm ducts. The main causes of infertility in women are anovulation, or lack of ovulation, and the inability of the fallopian tubes to carry eggs from the ovary to the uterus.

It is generally recommended that you have an infertility evaluation after you have tried unsuccessfully to become pregnant for 12 months or more. In cases, where the female partner is over 35, it is recommended that you have an infertility evaluation after 6 months of unprotected sex. The infertility evaluation will determine the reasons you have been unable to conceive so that a treatment plan can be developed.

The Basic Infertility Workup

Since men and women are equally likely to have fertility problems, the infertility evaluation includes both partners. The basic infertility workup includes:

• Physical exam for both partners
• Medical history of both partners
• Semen analysis
• Check for ovulation
• Tests to check for a normal uterus and open fallopian tubes
• Discussion of how often and when you have sexual intercourse.

Testing for the Male Partner

A semen analysis is a key part of the basic infertility workup. This analysis may need to be done more than once. The semen sample is obtained by masturbation. Sometimes the semen sample can be obtained at home, other times it is obtained in a lab. Your doctor will give you instructions and make sure you feel as comfortable as possible about the semen analysis.

The semen sample is sent to a lab, where it is analyzed for:

• The number of semen present
• The shape of the semen
• The movement of the semen
• Any signs of infection.

If any potential problems with the urinary tract are found, the male partner most likely will be referred to a urologist for further testing.

Testing for the Female Partner

For the female partner, the infertility evaluation begins with a physical exam and a comprehensive health history. The health history will focus on four key points:

• Menstrual function, such as irregular bleeding or pain
• Pregnancy history
• Sexually transmitted disease (STD) history
• Birth control.

Another important part of the evaluation is determining whether or not and when you are ovulating. Here are some of the tests that may be performed:

• Urine test: This test is performed at home and indicates if ovulation is about to occur.
• Basal body temperature: You take your temperature every morning before you get out of bed and record it on a chart. Keeping this body temperature chart for two to three menstrual cycles will show whether or not you are ovulating.
• Blood test: The blood test measures progesterone, which can indicate whether or not you are ovulating.
• Endometrial biopsy: Because the lining of the uterus changes during ovulation, analyzing sample tissue from the uterus can determine if ovulation occurs.

Other tests may be used to examine your reproductive organs. These tests check the appearance of your uterus and determine if your fallopian tubes are open. Your individual circumstances and symptoms determine which of these tests are performed.

• Hysterosalpingography (HSG): This test is an x-ray that shows the inside of your uterus and fallopian tubes. A small amount if dye is placed in the uterus through a thin tube inserted through the cervix. An x-ray is then taken.
• Transvaginal Ultrasound: A device is inserted in the vagina that uses ultrasound waves to produce images of your ovaries and uterus.
• Hysteroscopy: A thin telescope-like device is placed through the cervix. The inside of your uterus may be filled with a harmless gas or liquid so that the doctor can correct any problems and obtain a tissue sample if needed.
• Laparoscopy: A small telescope-like device is inserted through a small cut at the lower edge of the navel. The doctor looks for pelvic problems in the fallopian tubes, ovaries, and uterus.