Fertility Problems
Examinations and Tests
Testing for a cause of infertility usually starts with simple tests for both partners. In addition to an interview and physical examinations, your initial tests will check semen quality and both partners' hormone levels in the blood. Hormone imbalances can be a sign of ovulation or sperm production problems that can be treated.
If your initial test results show no cause of infertility, your doctor may recommend checking fallopian tube function. Depending on your age and other risk factors, you may then be offered further testing or you may begin treatment with superovulation, intrauterine insemination, or both.
Commonly used tests for finding the cause of infertility Who is tested Type of test The woman
- Charting basal body temperature (BBT) at home to identify ovulation phases, often for a few menstrual cycles before considering medical testing. Use a simple Celsius temperature chart
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Both the man and the woman
- Medical history and physical examination
- Chlamydia test, because untreated chlamydia can cause female infertility and can infect a newborn at birth.
The man
- Semen analysis, to check the amount and quality of semen and sperm and for signs of infection. Abnormal test results are usually confirmed with another semen analysis, then followed with testosterone and FSH tests.
The man or the woman
Hormone tests, to check for a woman's ability to ovulate or a man's ability to produce sperm. These may include:
- Luteinizing hormone (LH). Abnormal LH levels can be a sign of female ovulation problems or male testosterone production problems.
- Progesterone. Low progesterone levels can be a sign of ovulation problems.
- Follicle-stimulating hormone (FSH), sometimes followed by a more specific clomiphene challenge test of the egg supply. High FSH levels may be a sign of low egg supply, or ovarian reserve; low FSH levels can prevent ovulation or, in men, sperm production.
- Thyroid-stimulating hormone (TSH). Abnormal thyroid function can affect the menstrual cycle and ovulation.
- Prolactin. High prolactin can be a sign of a pituitary problem, which can affect ovulation.
- Testosterone. Low testosterone in men can cause sperm production problems. High levels in women can cause irregular menstrual periods.
No test provides absolute proof that the ovaries are releasing eggs. But basal body temperature charting, LH, and progesterone testing can provide strong evidence of ovulation.
If the above tests are normal (sperm is within normal ranges and ovulation is regular), one of the following tests is often done next.
Other infertility tests Who is tested Type of test The woman
- Pelvic ultrasound to study egg follicle development
- Hysterosalpingogram or sonohysterogram (through the vagina) to check the uterus and fallopian tubes for signs of damage or structural problems
- Hysteroscopy (through the vagina) to examine the uterus, sometimes done in addition to a hysterosalpingogram
- Laparoscopy (through an abdominal incision) to look for and possibly repair conditions such as uterine fibroids, scarring from pelvic inflammatory disease, or endometriosis that can prevent pregnancy
If initial testing reveals no cause of infertility or if infertility treatment has been unsuccessful, one or more of the following tests are sometimes used.
Less common infertility tests Who is tested Type of test Both the man and the woman
- Sperm antibody test to see whether the man's or woman's body is producing antibodies that impair the sperm, possibly preventing pregnancy
If initial testing reveals no cause of infertility or if infertility treatment has been unsuccessful, one or more of the following tests are occasionally used.
Rarely used infertility tests Who is tested Type of test The man
- Testicular biopsy (through an incision, rarely used) for men lacking sperm, to see if the fertility problem is linked to a sperm production problem in the testicles
Both the man and the woman
- Genetic test, to see whether a genetic problem is contributing to infertility and/or to assess for possible genetic disorders that a parent could pass on to a child. Many, but not all, genetic conditions can currently be identified.
- Testing semen and cervical mucus, to check for infection that should be treated before trying to start a pregnancy
What to Think About
Should I have infertility testing?
If you have had three or more miscarriages or repeated in vitro fertilization (IVF) failures with no known cause, talk to your doctor about whether genetic testing might help identify a cause. In about 4% of couples who have had two or more pregnancy losses, one partner has a chromosomal defect that is responsible.4
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| Author: | Bets Davis, MFA Sandy Jocoy, RN Ralph Poore | Last Updated: May 6, 2008 |
| Medical Review: | Sarah Marshall, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Andrew Swan, MD, CCFP, FCFP - Family Medicine | |
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