The goal of the initial infertility evaluation is to determine the likely cause of infertility, and to determine the best approach to infertility treatment. Your doctor will take a careful history and order various tests.
A number of infertility problems are due to health issues in females, however, in 20-25 percent of cases, infertility can be attributed exclusively to male factor problems and an additional 10 percent of couples have male infertility in addition to other factors. A complete evaluation and diagnosis should include testing of both male and female partners.
Most patients are very anxious to get started on their evaluations and treatment. Ask your primary care physician or general gynecologist to perform as many preliminary tests as soon as possible before your visit to the infertility specialist and bring your test results to your first appointment with one of our infertility specialists.
Male Partner Test
At the beginning of the evaluation, the male partner should have a semen analysis. He should avoid ejaculation for 48 hours (but no more than six days) before providing the sample on the day of the test.
Female Partner Tests
There are several baseline tests that are used to evaluate the cause of female infertility.
Testing for ovulation Regular menstrual cycles occurring every 26 to 32 days are likely ovulatory with ovulation occurring between days 12-18 of the cycle. Over-the-counter urine ovulation kits also are available and the instructions on the kit should be followed.
Day Three Follicle Stimulating Hormone (FSH) level, Estradiol (E2), Anti-Mullerian Hormone (AMH) This is done by testing the blood for FSH, E2, and AMH on day three of the menstrual cycle.
Progesterone level Serum progesterone level can be measured in the second half of the cycle (day 20-22 in a 28-day cycle).
Clomiphene Citrate Challenge Test (CCCT)
An oral medication, clomiphene citrate (Clomid®), is taken on days five to nine of the menstrual cycle. A blood test is performed on day three and day 10 to measure FSH and E2 levels.
Additional testing that may be ordered by a gynecologist or a fertility specialist:
Hysterosalpingogram (HSG, or tubogram) This is a test to assess if the Fallopian tubes (the tubes connecting the ovaries to the uterus) are open. The test is performed under x-ray and involves injecting dye into the cervix to see if the tubes are open and whether the dye can flow freely through them. The size and the shape of the uterine cavity are also examined in this test.
Laparoscopy This is an outpatient surgery in which a magnifying scope is used to look inside the abdominal and pelvic cavity. This test is performed if& endometriosis or adhesions are suspected
Hysteroscopy In this procedure, a small scope is inserted into the uterus through the vagina and cervix to look at the inside of the uterus. This test is done if uterine abnormalities are seen during the HSG (tubogram) or if scar tissue or polyps are suspected.
Pelvic ultrasound An ultrasound may be ordered if enlarged uterine size or ovarian masses are noted on an exam.