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Basic Infertility Evaluation - Fertility Tests
Advanced Fertility Center of Chicago
In Vitro Fertilization Specialist Clinic
Gurnee & Crystal Lake, Illinois
What should be included in the initial infertility evaluation?
Costs for fertility testing and treatments
History
The doctor will ask questions about your past to try to get clues as to the cause of your infertility. These questions will be regarding your medical, surgical, gynecological, and obstetric history, as well as some "lifestyle" questions. A review of fertility-related records from other doctors that you have seen is also important.
Physical exam
A directed physical exam that may include a pelvic ultrasound should be performed. Ultrasound can help us discover abnormalities with the uterus, fallopian tubes and/or ovaries. We can sometimes see evidence of pelvic scarring, such as when an ovary appears to be stuck to the uterus. We can also get some information regarding the woman's potential for adequate ovarian stimulation for infertility treatment cycles by counting antral follicles.
Assessment of ovarian reserve
This is a very important assessment of a woman's remaining egg supply. It is generally done with day 3 FSH and estradiol testing and a vaginal ultrasound assessment of ovarian volume and antral follicle counts
Assessment of adequate ovulation
This can be done in a variety of ways. About 25% of all infertility is caused by an ovulation disorder. One type of ovulation problem, polycystic ovarian syndrome, is usually quite amenable to treatment with medications.
Semen analysis
The semen analysis is a very important test and should be done early in the evaluation process. If a severe sperm defect is discovered, the testing on the female partner might be modified, and therapy can be immediately directed to the sperm problem.
Blood tests
Depending on the individual couple's situation, various blood tests on either the female or the male may be needed. Blood tests that might be needed include day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone (T), estradiol (E2), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating hormone (TSH).
If there is a history of recurrent miscarriages (2 or more) a lupus anticoagulant (LAC) and anti-cardiolipin antibody (ACL) are often done, as well as other tests.
Immunological testing has not been proven to have any value in infertility patients without a history of 2 or more miscarriages.
Testing for tubal patency and normalcy of the uterine cavity with a hysterosalpingogram
The hysterosalpingogram, or HSG is done in order to assess the anatomy of the endometrial cavity of the uterus and the fallopian tubes. The HSG is usually scheduled to be done between days 6 and 13 of the cycle - this also depends on the specifics of the woman's normal cycle.
Laparoscopy
This is a surgical procedure and should not be performed until the basic testing has been done on both partners. In some cases, laparoscopy will be indicated to look for pelvic scarring or endometriosis. As in vitro fertilization success rates have improved dramatically over the past 20 years, far less laparoscopy is being done for infertility than in the past. Many couples are skipping the invasive laparoscopic surgery and trying treatments with intrauterine inseminations and then moving on to IVF if inseminations are not successful.
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