Fertility Testing / Assessment
The inability to conceive a child can be extremely frustrating for a couple, especially when they have been trying for months or even years. After numerous attempts at conception, a couple will begin to seek medical help in the way of fertility testing and assessment. Certain tests, for both men and women, can determine if they are suffering from infertility. As with any diagnosis, it progresses through various stages, with more complex tests performed as a last resort.
The first step for both men and women in this diagnostic process is to meet with a fertility specialist. A complete medical history will be recorded to learn about things such as prior sexual history, sexual partners, sexually transmitted diseases, illegal drug use, medicine use, birth control methods, and frequency of use of alcohol, tobacco, and/or caffeine.
The second step is to undergo a physical examination. For women, this will consist of a pelvic exam and a Pap Test. A pelvic exam will help your doctor detect vaginal issues like yeast infections, STD’s, bacterial infections, abnormal bleeding, fibroids, cysts, tumors, or any physical abnormalities of the cervix, uterus, or ovaries. A Pap test is typically done during the pelvic exam. This is a simple test in which cells from the cervix are collected and examined under a microscope to detect changes such as dysplasia, cancer, or Human Papillomavirus (HPV).
For men, the physical exam will include a testicular exam. A testicular exam is a procedure in which a doctor will physically feel and look at the penis, scrotum, and testicles to locate any abnormalities such as lumps, lesions, shrinking, or swelling. All of which may have an adverse impact on fertility. At this stage, both partners may be required to have blood drawn for STD testing.
Once the medical history has been given and a physical examination has been performed, the third step is to confirm that a woman is ovulating. Many times blood or urine tests can be performed to ensure a woman is ovulating. Luteinizing hormone (LH), progesterone, prolactin, and thyroid levels are checked to determine if ovulation is occurring. Once it has been confirmed that a woman is ovulating, the peak period of fertility will be pinpointed and the couple will then be encouraged to have sexual intercourse during this period of peak fertility. If conception still does not occur after a few months of this activity, other tests will be necessary.
A fourth step in determining fertility is for the man to undergo a semen analysis and woman to have a postcoital test. A man will be asked to ejaculate into a sterile container and the sperm will then be tested to determine the quantity and quality of the sperm. A woman’s postcoital test is conducted after sexual intercourse to see if the sperm are alive and if they are able to normally move through the cervical mucus.
If all of these methods of diagnosis still don’t result in a definitive diagnosis of infertility, further testing may be required. Here are some of the common tests used to determine a man or woman’s fertility:
Female Fertility Testing
Infertility in women is usually a direct result of improper ovulation or poorly functioning reproductive organs, so it would be logical that fertility testing would be aimed at identifying these issues.
1. Ultrasound Testing – This is used to monitor the development of the follicles that produce eggs, the thickness of the uterine lining, and to check the physical condition of the uterus and ovaries.
2. Hormone Testing – Done either via blood or urine, various hormone levels related to reproductive functioning are tested to ensure that they are working properly. The common hormones tested are progesterone, prolactin, testosterone, estradiol, follicle stimulating hormone, and Luteinizing Hormone.
3. Hysterosalpingogram or HSG – A blue dye will be injected into the uterus and fallopian tubes, then an x-ray will be performed on these areas. This will show if there is a blockage in either of these organs.
4. Hysteroscopy – This test is traditionally performed only after the HSG has shown some type of blockage. This procedure involves a hysteroscope being inserted into the uterus via the cervix, enabling your doctor to take pictures and see any possible growths, scarring, or other abnormalities.
5. Endometrial biopsy – A small amount of tissue from the endometrium is scraped and tested to rule out any possible hormone imbalances.
6. Laparoscopy – A narrow telescope is inserted into a woman’s abdomen so that her ovaries, fallopian tubes, and uterus can be examined for endometriosis, scar tissue, or other abnormalities.
Male Fertility Testing
A majority of fertility issues with men is directly related to the quality and quantity of sperm being produced. Therefore, testing is centered on testing, examining, and studying the sperm and its attributes.
1. Testicular biopsy – A small sample of tissue, taken from the tubules of the testes, are tested to see how well the sperm is being produced.
2. Vasography – This is simply an x-ray to determine if sperm is being leaked from the vas deferens or if there is a blockage.
3. Ultrasonography – Similar to a female ultrasound, this can enable your doctor to located any blockages or damage to the prostate, ejaculatory ducts, or seminal vesicles.
4. Hypo-osmotic Swelling – Sperm is placed into a special sugar and salt solution to see how they react. The tails of healthy sperm will swell whereas unhealthy or dead sperm will not.
5. Acrosome Reaction – Sperm must undergo certain chemical changes in order to properly dissolve the tough outer shell of a woman’s egg. This test can determine if the sperm is in fact undergoing these necessary changes.
6. Sperm Agglutination – This is a simple test in which sperm are examined under a microscope to see if they are clumping together. If sperm are clumped together, they are not able to swim or penetrate the egg.
These lists of tests are not by any means comprehensive and your doctor may choose to use some of these tests or all of these tests. Or other tests not listed above may be recommended by your doctor.