Fertility Diagnosis & Testing
No two patients are alike — but many women and men walk into our clinic with the same question: Why?
At Advanced Fertility Center of Chicago, we leverage decades of shared experience and cutting-edge, state-of-the-art technology to get to the bottom of your fertility issues.
Starting Male and Female Infertility: Causes and Diagnostic Testing
Our patients often come to us burdened with questions they’ve been unable to answer: Why can’t I get pregnant on my own? Why haven’t other treatments worked? Why can’t I get a clear diagnosis?
So for every patient, before jumping into a treatment plan, we find the answers we need. Then, we use that information to give you the best possible chance of building the family you deserve.
Causes of Infertility
Our team has decades of experience in diagnosing and successfully treating the conditions that cause or contribute to infertility. Below is a brief overview of the more common diagnoses we see at AFCC.
Anovulation is the absence of ovulation. A common cause of anovulation is polycystic ovarian syndrome (PCOS) — more on that below.
Typically, we can tell from the information you share regarding previous menstrual cycles whether there is likely to be an ovulation disorder. Blood testing and ultrasound studies of the ovaries at various times of the menstrual cycle can affirm this and provide more information.
In general, cumulative pregnancy success rates are high with treatment from a fertility specialist when the fertility issue is an ovulation problem.
PCOS, short for polycystic ovarian syndrome, is a common cause of anovulation and female infertility. It’s also sometimes referred to as PCO (polycystic ovaries) or PCOD (polycystic ovarian disease).
Women who are having fertility issues due to polycystic ovaries typically are not releasing an egg (or ovulating) regularly, and their ovaries may contain small — unharmful — cystic structures.
PCOS is a clinical diagnosis. First, blood tests are done to rule out other causes of anovulation. After these causes are ruled out, the diagnosis is made by patients having 2 out of 3 clinical criteria:
- polycystic ovaries on ultrasound
- evidence of elevated testosterone
- irregular menstrual cycles.
The chance of getting pregnant with PCOS using fertility treatments is very good. Especially for women under age 35 with polycystic ovaries, the real question is more about which treatment will be effective — and not so much whether any treatment can ever work.
The endometrium is the tissue that lines the inside of the uterine cavity. Endometriosis is a disease in which some of this tissue has spread elsewhere.
Sometimes we strongly suspect that endometriosis is present if you have a history of very painful menstrual cycles, painful intercourse, etc. There may also be indicators from a physical exam or ultrasound.
Recently, a commercial test has become available to look for a biomarker associated with endometriosis. However, the only way to be sure whether a woman has endometriosis is to perform a minimally invasive surgical procedure called laparoscopy — scroll down for a few more details on that.
There are effective treatment options for endometriosis associated with infertility. The best option for you will depend on several factors, like the severity of the disease, its location in your pelvis, your age, and length of infertility.
Tubal factor infertility accounts for about 20-25% of all cases of infertility. It includes cases of:
- completely blocked fallopian tubes
- 1 blocked tube
- no blockage but tubal scarring or other damage
Tubal factor infertility is often caused by pelvic infection, such as pelvic inflammatory disease (PID), endometriosis, or scar tissue that forms after pelvic surgery.
The diagnosis of tubal factor infertility is initially investigated in most cases with a hysterosalpingogram, and sometimes surgically via laparoscopy. There are two types of tubal blockage, one that occurs at the junction of where the tube and uterus meet, and one where the tube is blocked at its distal end (hydrosalpinx). Treatment options for proximal blocks include tubal cannulation (surgical or radiologic procedures), medications to suppress endometriosis for endometriosis-related blocks or in vitro fertilization.
For a distal block, or hydrosalpinx, a treatment option is tubal surgery to attempt repair of the tube by opening up the blocked end. However, with current advances in IVF, this option has become less popular because of increased risk of tubal (ectopic) pregnancies and risk of re-closure of the diseased tube. Hydrosalpinx can also decrease fertility rates in women attempting to do IVF. However, removal of the diseased tube restores pregnancy chances with IVF.
“Several issues in the uterus and uterine lining can cause or contribute to infertility or recurrent miscarriage. These include:
- uterine polyps
- uterine fibroids
- intrauterine adhesions (Asherman’s Syndrome)
- congenital uterine malformations, such as a bicornuate uterus, a T-shaped uterus, or a uterine septum
- luteal phase defect
- thin endometrial lining
- Uterine isthmocele (defect at prior cesarean section scar)
A hysteroscopy is a surgical procedure that allows us to see any defects inside the cavity. The fertility treatment we recommend will depend on your individual diagnosis.”
Sometimes, following standard infertility testing and procedures, we’re still unable to identify a reason for infertility. This is known as “unexplained infertility” or “idiopathic infertility.”
While this can be frustrating, it does not mean that pregnancy is impossible. Treatment options that lead to successful outcomes for women with unexplained infertility include oral medication (Clomid, Letrozole); intrauterine stimulation (IUI); and in vitro fertilization (IVF).
About 25% of all infertility is caused by a sperm defect, and 40-50% of infertility cases have a sperm defect as the main cause or a contributing cause. What matters is not really how many sperm there are, or how fast the sperm swim — but whether they can fertilize the female partner’s eggs.
A semen analysis is the best test to assess male fertility and provide insight as to what could be causing infertility.
Fertility Testing Procedures at Advanced Fertility Center of Chicago
As we work to determine what may be preventing you from achieving pregnancy on your own, we may perform one or more of these infertility tests or procedures.
History
Before performing any tests, we start with a conversation. Our doctors ask questions to get clues as to the cause of your infertility. These questions will be regarding your medical, surgical, gynecological, and obstetric history, as well as some lifestyle questions. A review of records from other fertility doctors that you have seen is also important.
Physical exam and ultrasound
Typically, we’ll perform a physical exam that includes a pelvic ultrasound. Ultrasounds can help us discover abnormalities with the uterus, fallopian tubes and/or ovaries, and it’s also a good way to assess adequate ovulation.
Ovarian Reserve Tests
This is a very important assessment of a woman’s remaining egg supply, and it’s done through blood testing and ultrasounds.
Semen analysis
The semen analysis is performed early in the evaluation process. If a severe sperm defect is discovered, testing on the female patient is typically modified, and therapy is immediately directed to the sperm problem.
Blood tests
Blood tests that might be needed include day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), AMH, prolactin, testosterone (T), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating hormone (TSH). If there is a history of recurrent miscarriages (2 or more) a lupus anticoagulant (LAC) and anti-cardiolipin antibody (ACL) are often done, as well as other tests.
Hysterosalpingogram (HSG or Dye Test)
The HSG assesses the uterus and fallopian tubes. It’s usually scheduled between days 6 and 13 of the cycle — after bleeding and before ovulation – and is often performed in a radiology facility.
Hysteroscopy
Hysteroscopy is a minimally invasive surgical procedure, performed under anesthesia, that involves insertion of a narrow telescope-like instrument through the vagina and cervix into the uterus. The uterus is then distended with fluid (such as salt water) and can be visualized through the scope. This procedure allows us to see any defects inside the cavity.
Laparoscopy
Laparoscopy is a minimally invasive surgical procedure, performed under anesthesia, that involves insertion of a narrow telescope-like instrument through a small incision in the belly button. This allows visualization of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries. We always perform basic testing on both partners before considering laparoscopy.
