Part II - Infertility: How It's Identified

In part two in our series on infertility, the physicians at All About Women explain the causes of infertility and how they're identified

If think that you're facing infertility, you may wonder exactly what to do next. The first step is to make an appointment with a physician specializing in infertility to discuss your concerns and get a complete evaluation.

What is an Infertility Evaluation?

An infertility evaluation is a multi-step process that takes both partners and several menstrual cycles for you to complete. On your initial visit, your doctor will complete a detailed medical history of you and your partner:

  • Past and current illness, including sexually transmitted infections
  • Surgeries
  • Birth defects within your family
  • Use of tobacco, alcohol, and drugs
  • Your occupation (to asses for environmental toxins that could affect fertility)

Some questions focus on you and your partner's sexual history, and are intimate in nature:

  • Methods of birth control
  • Frequency of sex
  • Any difficulties during sex
  • If lubrication is used
  • Prior sexual relationships

There are also questions primarily focused on you:

  • Your length and regularity of your menstrual period
  • If you have pelvic pain, abnormal bleeding or discharge
  • If you have any disorders that may affect reproduction like thyroid disease
  • If you've had any past pregnancies and their outcome

Testing for Infertility

At some point early on in your infertility evaluation, your male partner will be required to have his sperm count tested. This is a low-cost, non-invasive procedure that can save a woman from more invasive and costly testing. As mentioned in "Infertility: Introduction, Definition, and Causes," the CDC reports that the man’s sperm is the cause of infertility in one-third of cases.

When your doctor suspects that your reproductive system may be the cause of infertility, you will undergo a series of procedures, labs and imaging tests. The American College of Obstetricians and Gynecologists (ACOG) note several basic tests for infertility:

  • Ovulation testing: your doctor will have you track ovulation with urine test kits available at any pharmacy. This is a simple and accurate method of confirming the timing of ovulation.

  • Progesterone test: This blood sample test is taken to see if your progesterone level has increased, which indicates that you've ovulated.

  • Urine test: A urine test reveals the level of luteinizing hormone (LH) in your body. LH triggers ovulation.

  • Prolactin test: This test ensures you don't have abnormally high levels of prolactin, a hormone made by the pituitary gland that's associated with pregnant and nursing mothers. High levels of prolactin could interfere with your ability to become pregnant.

While the above tests are generally standard, your infertility doctor may also have other tests conducted, depending on your health history:

  • Ovarian Reserve Test: If you are over the age of 35 or have known fertility problems, your doctor will examine your blood for hormones in the blood involved in ovulation. This test helps assess the number of eggs still left in your ovaries and how healthy they are.

  • Thyroid Test: If your doctor thinks for any reason that you may have a thyroid problem, they will draw blood work to examine your thyroid hormone levels. Since the thyroid controls much of our hormonal system, a problem with its functioning can affect fertility.

In addition to the basic lab tests listed above, you will also undergo a series of imaging tests. The tests your gynecologist performs will depend on your health history and what your doctor deems most useful:

Ultrasound

Ultrasound is used to determine how thick the lining of the uterus. The uterine lining must be thick enough in the last half of a woman's cycle to support an embryo.

Hysterosalpingogram(HSG)

An HSG reveals the condition of the fallopian tubes and if they are open enough to allow sperm and embryos to move through. It is an x-ray taken after dye is injected into the uterus and tubes. HSGs also show the shape of the uterus.

Sonohysterography

A sonohysterogram achieves the same result as an HSG- revealing the fallopian tubes - but does so with an ultrasound and a salt-water solution injected into the uterus and tubes.

Hysteroscopy

A hysteroscope is a telescopic device inserted through the vagina and cervix. It can show the shape of the uterus and also take samples of your uterine lining.

Laparoscopy

A laparoscope is a small, lighted viewing instrument that is inserted through a small incision in your pelvic cavity. It is used to look at your reproductive organs, and is often used to look for endometrial growths. Other attachments can be used with a laparoscope to perform surgery in the pelvic area. Since this is technically a surgery, it is not used unless endometriosis is suspected.

Understanding Your Tests

Your physician will use the results of these many tests and procedures to determine if there is an underlying cause of infertility that can be treated in order to improve you chances of conceiving.

It is important to remember that even if your doctor can't find a cause for your infertility, the ACOG notes that infertility may still be successfully treated.

To learn more about infertility treatment, read our third article in our series, "Treating Infertility".

While this information is meant to help you understand the standard procedures that surround infertility testing, it's important to note that each case is different and a board-certified physician is still required for getting the tests and interpreting the results. The compassionate physicians at Florida's All About Women are here to help you through the taxing process of infertility evaluation. Contact our Gainesville or Lake City office to schedule an appointment today.