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Testing for Infertility

You should consider seeing a doctor about infertility if any of the following apply to you:

a) You have not become pregnant after trying for 12 months without using birth control.
b) You are older than 35 years and have not become pregnant after trying for 6 months without using birth control.
c) Your menstrual cycle is not regular.

Tests for infertility include laboratory tests, imaging tests, and certain procedures. Imaging tests and procedures involve looking at the reproductive organs and how they work to find problems. Laboratory tests often involve testing blood samples or other samples, such as semen, for problems.

Basic Testing for the Man

1. Semen analysis. A semen analysis is a key part of the basic testing for a man. It is done to assess the amount of sperm, the shape of the sperm, and the way that the sperm move. A semen analysis also can show if there is an infection in the reproductive system. The semen sample is obtained by masturbation or by using a special condom during intercourse. It can be collected at home or in a lab. The analysis may need to be done more than once. You and your partner may need to abstain from sex for 3-5 days before giving the sample.
2. Blood tests. These tests measure levels of male reproductive hormones, such as testosterone. Too much or too little of these hormones can cause problems with making sperm or with having sex.
3. Other tests. If results of a semen analysis or physical exam show a possible problem, other tests may be done. For example, an ultrasound exam may be done to find problems in the ducts and tubes that the semen moves through. Ultrasound also may be used to find problems in the scrotum that may be causing infertility.

Basic Testing for the Woman

You may not have all of the following tests and procedures. Some are done based on results of previous tests or procedures.

1. Tests. Some tests check the function of your ovaries. Other tests measure hormone levels.

a) Tracking basal body temperature—Tracking your basal body temperature can be done at home. It is a way to tell whether ovulation has occurred. After a woman ovulates, her body temperature increases slightly. To perform this test, you will need to take your temperature by mouth every morning before you get out of bed. You record it on a chart for two or three menstrual cycles.
b) Ovulation test (Urine test)—This test can be done at home with a kit. It is a way to determine when and if you ovulate. The test detects luteinizing hormone (LH) in the urine. LH triggers the release of an egg. If the test result is positive, it means ovulation is about to occur. Sometimes these kits are used with or instead of basal body temperature charts.
c) Progesterone test—A sample of blood is taken on a given day in the menstrual cycle. The level of a hormone called progesterone is measured. An increased level shows that you have ovulated.
d) Thyroid function tests—If a problem is suspected with your thyroid gland, levels of hormones that control the thyroid gland are measured to see if it is working normally.
e) Prolactin level test—This blood test measures the level of the hormone prolactin. High prolactin levels can disrupt ovulation.
f) Tests of ovarian reserve—If you are older than 35 years or if you have known fertility problems, you may have blood tests that check the function of the ovaries. These tests measure the levels of certain hormones in the blood that are involved in ovulation. Results of these tests can give an idea of the number of eggs the ovaries have and whether they are still healthy.

2. Imaging tests and procedures.

Different imaging tests and procedures are used to look at the reproductive organs. They check whether the fallopian tubes are healthy and whether there are problems in the uterus. The procedures used depend on your symptoms as well as the results of other tests and procedures. You may be given pain relief for some of these procedures:

a) Ultrasound exam—Ultrasound can predict when ovulation will occur by tracking changes in the follicles. Ultrasound can be used when results of other ovulation tests do not give enough information.
b) Hysterosalpingography—This X-ray procedure shows the inside of the uterus and whether the fallopian tubes are blocked.
c) Sonohysterography—This test is used to look for scarring or other problems inside the uterus.
d) Hysteroscopy—During this procedure, minor problems in the uterus can be treated or a sample of the uterine lining can be taken to study.
e) Laparoscopy—This surgical procedure lets the doctor view the fallopian tubes, ovaries, and the outside of the uterus. It often is done only after other tests show a problem. Some problems can be treated during this procedure. For example, areas of endometriosis can be removed.

The infertility evaluation can be finished within a few menstrual cycles in most cases. Ask us about the costs involved. Find out whether they are covered by your insurance.