Fertility Testing And Evaluation

Who should consider fertility testing?

• Any woman under the age of 35 following 12 months of regular, unprotected intercourse
• Any woman over the age of 35 following 6 months of regular, unprotected intercourse
• Couples who have experienced two or more pregnancy losses

Earlier evaluation is appropriate for the following:

• History of irregular menstrual cycles, or no cycles at all
• Known or suspected problems in the uterus, fallopian tubes, or abdominal cavity (like endometriosis)
• Known or suspected male infertility problems
• Women over age 40

What does fertility testing include?

A basic evaluation may include:

• Semen analysis
• Hormonal evaluation of the female partner
• Ultrasound evaluation of the uterus and ovaries
• Hysterosalpingogram or HyCoSy (below) to evaluate the patency of the fallopian tubes

Factors that influence the speed and extent of evaluation:

• Patient preference
• Age of the woman
• Duration of infertility
• Medical history and physical examination

Additional Information and Terminology:

Hormone testing: This can help predict whether a woman can produce an egg or eggs of good quality, as well as how well her ovaries are responding to hormones released by the brain.

• The most common blood test is follicle-stimulating hormone (FSH), drawn on day 2-3 of a woman’s cycle, in conjunction with Estradiol (E2) and luteinizing hormone (LH). Additional hormonal testing may include anti-mullerian hormone (AMH), drawn at anytime in the cycle.
• Thyroid function is evaluated using a blood test for thyroid stimulating hormone (TSH), since poor thyroid function has been shown to contribute to fertility problems.

Transvaginal ultrasound: This allows the physician to evaluate for any abnormalities in the uterus or ovaries (such as fibroids or cysts). This also allows the physician to count the “resting” or antral follicles present in the ovaries, which helps determine a woman’s ovarian reserve.

Sonohysterography, or saline-infusion sonography (SIS): This is a special ultrasound-guided procedure in which the physician fills the uterus with saline solution. This expands the cavity of the uterus and makes it easier to see problems like polyps or fibroids that can affect fertility. The physician can also instill air bubbles in the solution to see if the fallopian tubes are open (called HyCoSy).

Hysterosalpingogram (HSG): This is an X-Ray procedure to see if the fallopian tubes are open and the shape of the uterus is normal. A catheter is inserted into the opening of the cervix through the vagina. A liquid containing iodine (contrast) is injected through the catheter. The contrast fills the uterus and enters the tubes, outlining the length of the tubes, and spills out their ends if they are open.

Hysteroscopy: A surgical procedure in which a small fiberoptic scope is passed through the cervix to see the inside of the uterus. This procedure can help diagnose and treat abnormalities in the uterus, such as polyps, fibroids, and scar tissue (adhesions).

Laparoscopy: A surgical procedure in which a lighted scope is inserted through the abdominal wall into the pelvic cavity. This is a useful tool for evaluation of the pelvic cavity for endometriosis, scar tissue (adhesions), and other abnormalities. This is not a first-line option for evaluation of infertility, but it can be recommended based on results of other testing or medical history significant for pelvic pain or previous abdominal surgeries.

Semen analysis: This essential piece of the infertility workup provides information about the number, movement, and shape of the sperm, all of which can affect the sperm’s ability to travel and fertilize an egg. All men should have a semen analysis regardless of whether they have fathered children in the past.

Other testing can be considered based on the results of the semen analysis and may include hormonal or genetic testing.