There are several ways to determine what is preventing a woman from becoming pregnant. Below we outline some of the more common tests related to infertility.
Most physicians today recommend ovulation predictor kits, which measure the amount of LH in the urine. LH spikes approximately 36 hours prior to ovulation. These kits are very accurate and help the couple ensure intercourse occurs near ovulation.
Transvaginal guided ultrasound can be used to monitor follicular development. Sometimes an endometrial biopsy is done to confirm that the endometrium has developed properly to receive the embryo. Improper development may be caused by a luteal phase defect, which can often be treated medically.
A Hysterosalpingogram (HSG) allows the physician to document that fallopian tubes and uterus are free of obstruction. This procedure is conducted at the hospital radiology department as an outpatient procedure. The HSG also allows visualization of the inside of the uterus making polyps, fibroids, adhesions, or congenital abnormalities visible.
Hysteroscopy and Sonohysterogram
A hysteroscopy or sonohysterogram involve expanding the uterus to allow a hysteroscope to be inserted into the uterus to allow for close examination. Congenital abnormalities such as a uterine septum, fibroids, polyps, and adhesions may be seen, and can be repaired by a reproductive endocrinologist
Laparoscopy in a minimally-invasive procedure that allows the physician to view the tubes, ovaries, uterus and other internal organs and structures. In general, a reproductive endocrinologist should perform the laparoscopy for infertility. These specialists have years of advanced training in laparoscopic techniques. Many times a specialist can treat conditions, like endometriosis, during the laparoscopy, eliminating the need for a second procedure.
The semen analysis examines many factors according to the Kruger Strict Criteria or the World Health Organization Criteria. In general, the semen analysis includes:
- Volume of sperm in the ejaculate- the normal value is more than 20 million sperm/milliliter.
- Motility (ability to swim)-More than 50% should be actively motile (moving)
- More than 14% normal forms- the heads and tails are properly shaped.
- Less than 5 white blood cells per high power microscope field. More could indicate infection or antibodies.
- Other characteristics, such as viscosity, are also evaluated.
The ultrasound is a valuable tool used during the infertility evaluation and for monitoring the growth of ovarian follicles. The size and number of follicles is measured, and medications are adjusted accordingly (also depending upon other factors such as estrogen levels).