The decision to begin testing depends on a number of factors. They include your age and your partner's age, as well as how long you have been trying to get pregnant. Testing involves an evaluation as follows:
- Physical exam
- Medical history
- Semen analysis
- Ovulation check
- Tests to check for a normal uterus and open fallopian tubes
- Discussion about how often and when you have sex
The basic workup of an infertility evaluation can be finished within a few menstrual cycles in most cases. Your gynecologist will be able to discuss the the costs involved and help you find out whether it is covered by your insurance.
Basic Workup for the Man
A semen analysis is a key part of the basic workup for a man and it may need to be done more than once. You doctor will be able to let you know whether the sample can be be obtained at home or whether it needs to be obtained in a lab and will be able to give you all the instructions needed. The semen sample is then studied in a lab. The doctor will study the sperm for number, shape, movement and for any signs of infection. The man may be referred to a urologist (a doctor trained in treating problems of the urinary tract) who may perform an additional exam.
Basic Workup for the Woman
The workup for a woman begins with a physical exam and health history. The health history will focus on menstrual function, such as irregular bleeding and pain, pregnancy history, STD history and birth control. In addition to a Pap smear and blood test there are also a variety of test your gynecologist may perform in order to see if ovulation is occurring.
- Urine test. This test can be done by the woman at home with a kit. It is a way to predict ovulation. This test measures luteinizing hormone (LH), which is what makes ovulation occur. If the test result is positive, it means ovulation is about to occur. Sometimes these kits are used with basal body temperature charts.
- Basal body temperature. This test can be done by the woman at home. It is a way to tell that ovulation has occurred. After a woman ovulates, her body temperature increases a bit. To measure it, a woman takes her temperature by mouth every morning before she gets out of bed (basal temperature). She records it on a chart for two or three menstrual cycles. Other tests may be done, depending on a woman's risk factors.
There are several procedures that can be performed as well to check if the uterus is normal and the fallopian tubes are open. The tests you have depend on your factors and symptoms.
- Hysterosalpingography (HSG). This test is an X-ray that shows the inside of the uterus and fallopian tubes. In most cases, it is done right after a menstrual period. A small amount of dye is placed in the uterus through a thin tube inserted through the cervix. An X-ray is then taken. The dye outlines the inside of the uterus and fallopian tubes. If it spills from the tubes, it shows that the tubes are open.
- Transvaginal ultrasound. This test checks the ovaries and uterus by using sound waves to produce pictures of pelvic organs. First a device (a transducer) shaped like a wand is lubricated and inserted into the vagina. A machine displays an image of the organs.
- Hysteroscopy. This procedure lets the doctor look inside the uterus. A thin telescope-like device, called a hysteroscope, is placed through the cervix. The uterus may be filled with a gas or liquid to reveal more information. During this procedure, the doctor can correct minor problems or get a sample of tissue to study. The doctor also may decide other procedures are needed.
- Laparoscopy. This procedure lets the doctor view the tubes, ovaries, and the outside of the uterus. A small telescope-like device, called a laparoscope, is inserted through a small cut (about 1º2 inch or less) at the lower edge of the navel. Fluid is placed in the uterus to see if it spills from the ends of the tubes. This shows if the tubes are open or blocked. The doctor also can look for pelvic problems, such as endometriosis or scar tissue.
Infertility can be treated in many ways, including lifestyle changes, medication, surgery, and assisted reproductive technologies. The choice depends on the cause. After your evaluation, talk with your doctor about the best treatment options for you and your partner. You also may choose adoption or to live without children. It is important to discuss all of these options and the success rates with your spouse and gynecologist.