Fertility Evaluation

Basic Infertility Evaluation – Fertility Tests

What tests may be included in your initial fertility evaluation?

• Physical exam

  We'll perform a physical exam that may include a pelvic ultrasound. Ultrasounds can help us discover abnormalities with the uterus, fallopian tubes, and/or ovaries. Sometimes, we can see evidence of pelvic scarring, such as when an ovary appears to be stuck to the uterus. This exam gives us information regarding your potential for adequate ovarian stimulation with medications by counting antral follicles.

• Assessment of ovarian reserve

  This is an important assessment of a woman’s remaining egg supply. It is done with blood testing and an ultrasound. For your bloodwork, we evaluate FSH, LH, estradiol, and AMH hormone levels. For the ultrasound, we assess your ovarian volume and antral follicle count.

• Assessment of adequate ovulation

  This can be done in a variety of ways and about 25% of all infertility is caused by an ovulation disorder.

• Semen analysis

  The semen analysis is a very important test and should be done early in the evaluation process. If a severe sperm defect is discovered, testing on the female partner should be modified, and therapy can be immediately directed to the sperm problem. 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.

• Blood tests

  Depending on the individual couple’s situation, various blood tests on either the female or the male partner may be needed. 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), and thyroid stimulating hormone (TSH).

  If there is a history of recurrent miscarriages (2 or more), a lupus anticoagulant (LAC) and anti-cardiolipin antibody (ACL) test are often done.

  Immunological testing has not been proven to have any value in infertility patients without a history of 2 or more miscarriages.
  
  

• Hysterosalpingogram (HSG)

  The hysterosalpingogram, or HSG, is done in order to assess the anatomy of the endometrial cavity of the uterus (normalcy of uterine cavity) and the fallopian tubes (tubal patency). The HSG is usually scheduled between days 6 and 13 of the cycle – after bleeding and before ovulation. This test is usually performed in a radiology facility and about 25% of all infertility is due to a tubal factor.

• Laparoscopy

  This is a surgical procedure and should not be performed until basic testing has been done on both partners. In some cases, laparoscopy for infertility will be indicated to look for pelvic scarring or endometriosis. As IVF success rates have improved dramatically over the past 20 years, laparoscopy for infertility is being performed much less than before. Many patients skip laparoscopic surgery and do treatments with intrauterine inseminations and then IVF if inseminations are not successful.