Fertility Tests Uncover the Causes of Infertility in Both Men and Women
Prior to deciding upon a treatment plan, it is important to do some basic fertility testing to uncover any issues that should be addressed before treatment. For the woman, it is important to evaluate the uterus, ovaries, and fallopian tubes. As well, there may be some recommended genetic testing to see if either patient or partner may carry a hidden genetic mistake that may increase the chance for a child with a genetic abnormality.
Bloodwork is an integral part of fertility testing and treatment. The most basic fertility evaluation for the woman often includes testing for ovarian function (FSH and estradiol) as well as a few other hormones (TSH and prolactin). Other scenarios (e.g. PCOS or recurrent pregnancy loss) may warrant other types of bloodwork to be analyzed. Also, any couple pursuing intrauterine insemination (IUI) or in vitro fertilization (IVF) is required to have infectious disease screening prior to treatment. Your physician will individualize the type of bloodwork to be ordered based upon your very specific situation.
Before proceeding with pregnancy, your physician may offer you the opportunity to screen for one or more genetic disorders. Even if you and your partner are perfectly healthy and have no history of genetic disorders in your or his family, either of you may still carry a ‘silent’ genetic mistake – which could increase the chance of a baby with a genetic disorder. The American College of Obstetrics & Gynecology (ACOG) has recently recommended that “preconception and prenatal cystic fibrosis (CF) carrier screening should be made available to all women of reproductive age as a routine part of obstetric care.” You doctor can discuss with you any other genetic tests that may be considered depending upon your family history and/or your ethnic background.
An important aspect of fertility evaluation is looking at the womb – the uterus. An internal ultrasound is done as part of the basic testing to look closely at the shape and size of the uterus as well as to evaluate the uterine lining and any other abnormality (e.g. fibroid, polyp, or septum). As other specialties may not look at the uterus the same way that we do, even if you have had a previous ultrasound elsewhere, your physician will want to repeat the ultrasound. The ultrasound also gives us important information about the ovaries – how they look and where they are located. Usually, fallopian tubes are not seen on ultrasound, so a separate test (called an HSG) is usually required to look at them more closely.
Since the ultrasound generally gives no information about the patency of fallopian tubes, it is important to look at them through a test called an HSG. This test is done by a radiologist and involves placing a thin catheter into the uterus and injecting dye into the cavity of the uterus (where a pregnancy would grow). This dye shows up on x-ray, and pictures are taken during this test to determine if both fallopian tubes are open. This test can also give more information about the inside of the uterus. This test is generally short (about 15-20 minutes usually), but it can cause cramping. Consider talking to your nurse about taking extra pain medication (e.g. ibuprofen) 30-60 minutes before the procedure. Even though it is not a comfortable test, it can be very informative for evaluation of anatomy – there also appears to be a mild fertility boost for some couples in the first few months following this test.
Some patients may benefit from having their physician perform a laparoscopy and/or a hysteroscopy. Laparoscopy involves placing a thin camera through the belly button. A laparoscopy can be used to evaluate and treat endometriosis, scar tissue, and certain fibroids. Alternatively, a hysteroscopy involves placing a thin camera inside the uterus. It is helpful for diagnosing and treating such things like a uterine septum, polyps, or certain fibroids. Both of these procedures are outpatient and can be done concurrently if necessary.
A thorough evaluation of infertility or recurrent miscarriage often includes specific testing designed to evaluate abnormalities uncovered during the initial medical history and physical examination. These tests help your physician determine the cause or causes of your condition.
As sperm problems affect around 30% of couples with infertility, it is important to do a semen analysis to identify any issues. After 2-5 days of abstinence, the male partner can provide a semen sample into a sterile cup. This can be done at home if the couple lives within an hour of the clinic. Alternatively, a collection room can be available. Usually collection is done via masturbation; however, a ‘collection condom’ can be used to collect sperm during intercourse. The semen analysis will give information about sperm numbers, the percentage of sperm moving, and the percentage of sperm that look ‘normal’. Certain treatments are not successful with low numbers of moving sperm, so this is important information for your fertility specialist to have.
The above tests are commonly done for couples having problems with fertility. Your doctor will let you know if there are further tests to consider for your specific situation. After basic testing, the next step will typically be a consult visit with your doctor to determine the best approach to get you closer to your goal of growing your family!