Fertility Testing

Whenever you see a doctor for any problem you are likely to hear, "We need to do some tests." Telling a doctor that you have not been able to conceive should evoke that response. Actually, tests are not the first step the doctor usually takes. The first step is usually a thorough medical history of the couple as well as an in-depth review of their reproductive history. If you go to see a doctor who, after hearing that you have difficulty getting pregnant, immediately suggests a laparoscopy to see if your tubes are open or hands you a prescription for Clomid, this is not the doctor for you. And, even worse, if he or she immediately recommends one of the assisted reproductive technology (ART) procedures like IVF at this point, head for the exit! Most doctors have their own order for scheduling tests. The common thread through all their regimens will be that the less expensive and non-invasive tests should be done first. This reserves the more invasive, expensive, and risky tests for later. And later may never come. You may get pregnant before later arrives. The safest, simplest, and least expensive part of the evaluation will be the history - which is where all doctors should start.

Fertility Testing is done to evaluate the reasons for infertility in both the male and the female partner.

For women:

A detailed history will be taken about your pregnancy history and the outcome of those pregnancies as well your menstrual history.

There will be a physical examination and blood tests to check the levels of female hormones, thyroid hormones, prolactin and male hormones, as well as for HIV and hepatitis. The physical exam may include a pelvic examination to look for chlyamydia, gonorrhea or other genital infections that may contribute to the fertility problem.

Transvaginal (pelvic) ultrasound examination may be recommended. This checks the condition of the uterus and ovaries. If performed around 14 days before your period, it can often it can detect whether the follicles in the ovaries are working normally.

Hysterosalpinogram. Your doctor may also suggest a hysterosalpinogram, to check that your fallopian tubes are not blocked. If one of the tubes is blocked, the obstruction would be seen on the X-ray since the liquid dye won’t get past it.

Hysteroscopy. In this procedure, a thin telescope-like instrument is inserted through the cervix into the uterus to allow the doctor to see and photograph the area to look for problems if he/she suspects any abnormality in the uterus.

Laparoscopy. This is usually done to look for endometriosis, scarring, and other conditions. A slim tube with a light and camera is inserted through a very small incision. The procedure is done under general anesthesia and is usually done as a day surgery.

Not all women undergo all tests. Your doctor will guide you through those that are most appropriate for you.

For men:

A medical history and general physical examination will be completed. This includes questions about any chronic health problems, illnesses that could be inherited, injuries or surgeries that could affect fertility. In addition a discussion about your sexual habits and sexual development will give your doctor some baseline impressions. There will be a genital examination in addition to a general physical examination.

Semen analysis is done to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections.

Several semen analysis tests are done over time to get an accurate result. This is because sperm counts fluctuate significantly from one specimen to the next.
There may be additional tests advised if required to identify the cause of your infertility such as:

Scrotal ultrasound. To identify a varicocele or other problems in the testicles or supporting structures.

Hormone testing. Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production.
Abnormalities in other hormonal or organ systems might also contribute to infertility. A blood test measures the level of testosterone and other hormones.

Genetic tests. A genetic cause could be the reason for infertility when sperm count is extremely low. Genetic testing might be ordered to diagnose various congenital or inherited syndromes.

Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).

Testicular biopsy. This test involves removing samples from the testicle with a needle. If the results of the testicular biopsy show that sperm production is normal your problem is likely caused by a blockage or another problem with sperm transport.

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