Diagnosis of Infertility
Infertility Diagnostic Studies
Although the sequence of these studies may vary, it may include some or all of the following:
- History of both partners
- Physical Exam
- Pelvic Exam and/or pelvic ultrasound
- Evaluation of uterine cavity +/- tubal patency with either hysterosalpingogram (HSG) or saline infusion sonogram (water ultrasound)
- Semen Analysis
Female Partner Diagnostic Studies
Ovarian Reserve Testing
As part of the standard fertility evaluation, we obtain an assessment of egg supply. Typically, this involves performing a pelvic ultrasound, where we count the total number of follicles that have been recruited for potential ovulation (antral follicle count). Additionally, we will check blood levels for anti-Mullerian hormone (AMH), another measure of ovarian reserve. Both of these tests can be performed at any point during the menstrual cycle.
Infectious Disease Panel and Pre-Natal Labs
You may be screened for HIV, Hepatitis B and C, RPR, and sexually transmitted diseases (STDs). The female partner may need a blood type and Rubella/Varicella Titer (to make sure she is immune to German measles and Chickenpox).
This test is done on an outpatient basis. It involves injecting dye into your uterus that shows up on an X-ray. The dye outlines the inside of the uterus and tubes. If the fallopian tubes are open, the dye passes into the surrounding pelvic cavity and is re-absorbed by your body. It may be associated with cramping. This test is done after you have stopped menstruation but before ovulation, generally between days 6 and 12 of your cycle. If there is a concern for tubal blockage, or evidence of a blocked, swollen tube (hydrosalpinx) you be placed on a course of antibiotics.
LH Surge/Ovulation Predictor Kits
Usually on Cycle Day 10 (10 days from the first day of your menses), you will be asked to check your urine every morning with a special test stick provided in an ovulation predictor kit. When you have a positive result, you will ovulate within 24-36 hours. This test predicts whether you are releasing the egg at the correct time of your cycle, and helps us to schedule your post ovulation diagnostic testing.
Saline infusion sonogram (Sonohysterogram, hydrosonogram) (water ultrasound)
This is a test to examine the uterine cavity for abnormalities, such as polyps or fibroids. It is performed between cycle days 6-12, and involves injecting sterile saline into the uterine cavity while performing a pelvic ultrasound. Distension of the uterine cavity allows more accurate evaluation of the uterine cavity. It takes approximately 10 minutes in the office and is associated with minimal discomfort.
Other Possible Tests
On certain individuals, additional hormone testing may be performed based on clinical history.
Male Partner Diagnostic Tests
The male partner contributes half of the genetic material to the new offspring by way of the sperm. There are several tests available to assess the male partner to determine if he is contributing to the couples’ infertility struggle. The simplest testing is used first and followed by more invasive testing if abnormalities are found.
This is a simple test to check for the presence and quantity of sperm as well as evaluate the characteristics of the sperm found. It is typically obtained by masturbation after 2 – 5 days of abstinence. The sample needs to be kept at room to body temperature and transported to the laboratory within one (1) hour. Results are usually available within 1 day.
If the semen analysis demonstrates a low sperm count then hormone blood tests may be ordered to try to determine the cause of the low count. Common hormones that may be ordered are FSH, LH, Estrogen, Prolactin, TSH and a testosterone level.
Depending on the results of the hormone testing, additional genetic testing may be requested. Certain genetic mutations (such as Y-microdeletions) or chromosomal abnormalities (such as Klinefelter’s syndrome, 47XXY) can cause a low sperm count. The genetic tests are performed on blood samples.
Infectious Disease Panel
Both male and female partners, in which body/fluids may be transferred through the laboratory, are required to have infectious disease screening. You may be screened for HIV, Hepatitis B and C, syphilis, human T-cell lymphotropic virus (HTLV) and cytomegalovirus (CMV).