Infertility testing is a serious concern for many couples because the diagnosis has the potential to dramatically alter the life plan and dreams that you always imagined. However, using today’s technology and advanced medical practices, the prospect of infertility is not as bleak as it once was.
Prior to seeing a reproductive specialist or obstetrician couples younger than age 30 are encouraged to try to conceive a child for at least 12 months and those over age 30 are encouraged to try for six months. A person might be considered infertile after one full year of trying but a study conducted by the National Institute of Environmental Health Sciences found that the majority of women who did not become pregnant in the first year did so in the second year without any medical assistance. (1)
The act of becoming pregnant and conceiving a child is very natural and normal one but it is also complex. The body orchestrates the secretion of a variety of different hormones in order to mature and release an egg at just the right time that it will meet up with viable sperm. So even if you’ve been trying to get pregnant for 12 months it does not mean that you are on able to get pregnant.
Infertility tests are often not covered by insurance companies so before undergoing them check with your physician about the cost. A reproductive specialist will want to ask questions about medical history, use of prescription and recreational medications, use of caffeine, alcohol and cigarettes, your exposure to toxins or radiation and your sexual habits. Believe it or not, even your choice of underwear (if you’re the man) will make a difference in your ability as a couple to have a baby. Tightfitting briefs will keep the scrotum temperature too warm to allow for normal sperm production.
The history will also include if the woman had ever been pregnant before and the outcome, the frequency and regularity of periods over the last year, any changes in the flow, what methods of birth control have been used and whether you have seen a physician for fertility problems in the past.
At this point the physician will decide on some basic information gathering techniques. He may ask the woman to go home and keep a basal temperature charts and fertility chart for two months to get a baseline information about ovulation, mucus changes in temperature changes. This can give him significant information about what testing should be done first. Depending upon this information the physician can order several different blood tests.
A day three FSH test is done on the third day of the menstrual cycle and will measure the follicle stimulating hormone in the system. When a woman has high levels of FSH it indicates a lower quality of an egg which also is significant when seeking conception. Also on the third day of the menstrual cycle is a day three estradiol test. This is also a blood test that will evaluate the amount of estrogen in the body because too much estrogen will also affect egg quality.
During these tests the physician may also do a Clomid challenge test during which he he gives the woman three to five days of Clomid, a fertility drug, to challenge the development of the ovaries. Another blood test is the plasma progesterone level test which evaluates the level of progesterone. This is done just before the first day of the menstrual cycle. If the progesterone level is low it indicates a likely problem with ovulation.
The luteinizing hormone and follicle stimulating hormone tests can actually be done for both men and women. When the hormone levels are high it suggests that fertility problems are an issue with the ovaries or the testicles. Low levels may indicate a problem with the pituitary or hypothalamus glands.
If the physician finds no observable problems or issues with these tests they may move on to things that are slightly more invasive. The reproductive specialist may want an abdominal or transvaginal ultrasound. This is a tool using a high frequency sound waves which are bounced off the body in order to produce an image. The abdominal ultrasound is done on the exterior of the body with a hand-held instrument on the top of the abdomen while the transvaginal ultrasound uses a probe that is inserted into the vagina. Because the transvaginal ultrasound is closer to the pelvic structures the reproductive specialist will get significantly clearer images.
At other times the physician may recommend a sonohistogram which is a slight variation on an ultrasound. It uses water or sterile saline to inflate the uterus which gives the doctor a clearer view of the organ.
Slightly more invasive is a laparoscopy which is a surgical procedure done under an anesthetic but on an outpatient basis. During this procedure the uterus is illuminated using a camera and light inserted through a small incision so that the doctor can get a good view of the ovaries, uterus and Fallopian tubes.
During a laparoscopy the doctors also able to insert very small tools to help correct any problems, locate any scar tissue and take an endometrial biopsy. An endometrial biopsy is often taken during the 21st day of the cycle and gives the doctor a detailed analysis of the endometrial development in the uterus. The biopsy can show whether the lining is thick enough for implantation and is helpful for women who have experienced multiple miscarriages.
Related to the laparoscopy is a hysteroscopy which uses a fiber-optic telescope in order to look around the pelvic region and uterus. It is inserted through the vagina and cervix into the uterus and is also possible to use small tools to fix any problems. A hysterosalpingogram is a special type of machine that takes an x-ray of the uterus and Fallopian tubes but only after a water or oil-based dye is injected into the uterus and Fallopian tubes. This is often used to locate blockages and other problems that may be fixed using a laparoscopy or open surgery.
Using information from this testing procedures reproductive specialist and obstetricians are able to give excellent estimates as to how conception will potentially be achieved and what infertility treatment methodologies will be best attempted first.
(1) Scientific American: Study Shows Fertility Declines in late 20s
The National Institute of Environmental Health services: Reproductive Health