Infertility Frequently Asked Questions
What tests are necessary to diagnose and treat fertility?
Infertility diagnosis and treatment may require a number of medical tests. Some tests are quite simple, while others are more involved. Adequate testing is a critical part of your infertility workup and treatment. Your doctor will base his/her treatment plan on the outcome of you and your partner's tests. Your doctor will start with simple, less invasive tests and then move on to those that are more involved.
If you are a man, you can expect your doctor to do a full history and physical examination and request a semen analysis. For a man to be fertile, he must produce a sufficient number of normally functioning sperm that are able to travel though his reproductive tract and be ejaculated into his partner's vagina. The process requires the appropriate production of male hormones as well as the ability to engage successfully in sexual intercourse.
After your initial workup, your doctor will determine what additional tests, if any, are necessary. The sequence of testing may depend on your medical history and is often coordinated with the evaluation of your female partner. Other tests may include evaluation of male hormones and evaluations of other male issues, including genetics, ejaculatory duct obstruction, testicular function, and sexual function.
If you are a woman, you can expect your doctor to do a full history and examination, and evaluate your ovulatory status, cervix, fallopian tubes, and uterus.
- Evaluation of ovulation:
- The first step in diagnosing female-factor infertility is determining whether or not a woman is ovulating. The presence or absence of ovulation can be determined by daily changes in your basal body temperature, or with blood or urine tests.
- Evaluation of the cervix:
- The cervix is the lower part of the uterus that leads to the vagina. After sexual intercourse, ejaculated sperm must pass into the uterus from the vagina. Problems in the cervix may block the passage of sperm into the upper part of a woman's reproductive tract, thus preventing the sperm from reaching the fallopian tubes and awaiting egg. Your doctor may need to assess the thickness of your cervical mucus as well as the presence of sperm antibodies in the mucus.
- Evaluation of the fallopian tubes:
- To fertilize an egg, sperm must travel through the uterus and into the fallopian tubes. The fallopian tubes are a complex set of organs, one on each side of the pelvis, leading from the right or left ovary to the upper corner of the uterus. The diameter is nearly one-half inch at the open end near the ovary, and narrows to the size of a pencil tip near the uterus. The fallopian tube is capable of picking up a newly released egg, providing nutrients and movement for the egg, transporting sperm up to the egg, sustaining an environment for fertilization and, finally, transporting the fertilized egg into the uterus. The fallopian tubes play a crucial role during reproduction and, at the very least, must be open throughout their entire length. Scarring, infection, and inflammation can all interfere with fallopian tube function by causing blockages and other problems.
- Evaluation of the uterus:
- The uterus must be able to transport sperm to the fallopian tubes and, after fertilization, accept the fertilized egg, and allow the egg to implant in its wall. A congenital abnormality of the uterus, scar tissue following uterine surgery such as a D & C, fibroids, polyps, or endometriosis can all interfere with normal uterine function.
Your doctor may recommend one or more of the following tests to evaluate the structure of your fallopian tubes and uterus: