Tests for Women

Initial evaluation of a woman’s fertility includes a personal and family history along with a thorough physical examination. Several tests can be used to help diagnose any issues and aid in treatment. An evaluation often begins with determining whether and when a woman is ovulating.

At-home Ovulation Prediction
There are three types of at-home methods useful for predicting ovulation.

• • Ovulation predictor kits are the most accurate of the three methods. The test detects an increased level of luteinizing hormone (LH) present in an early morning urine sample 1 to 2 days before ovulation.
  • Basal body temperature (BBT) can be measured at home using a special thermometer that specifically measures temperature between 96^o and 100^o F to help predict the most fertile days in a woman’s monthly menstrual cycle when ovulation occurs. Basal body temperature (taken before getting out of bed) decreases just before ovulation and rises at ovulation, remaining elevated for up to 3 days. If the cycle is charted for 3 to 4 months, a pattern can be recognized and intercourse can be timed accordingly. Though sperm have been shown to remain functional in women’s reproductive tracts up to 5 days, the most fertile period is 48 hours prior to ovulation. The BBT method is not 100% reliable, but it is simple and inexpensive.
  • Self-examination of vaginal discharge is another method to predict ovulation but is also subject to error. Prior to ovulation, the mucus is stretchy, clear, thin, and slippery, a necessary environment for the survival and transport of sperm. When mucus can be stretched between the thumb and index finger into a thin strand 2 to 3 inches long, ovulation is about to occur and a woman is entering her most fertile period. If a thin layer is placed on a glass slide, a fern-like appearance is present during ovulation (this is called the fern test). Post ovulation, no fern-like appearance will be present because the mucus becomes too thick and less conducive to sperm survival.

Laboratory Tests
Blood tests that measure the levels of various hormones can aid in determining causes of infertility. Examples include:

• • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • Prolactin (PRL)
  • Estradiol
  • Progesterone
  • Estrogen
  • Anti-Müllerian hormone (AMH)

Because changes in pituitary or thyroid function can also affect the menstrual cycle and ovulation, blood tests that measure thyroid function (TSH and/or free T4) and steroids, such as testosterone and DHEA-S, are also informative as high levels of androgens can contribute to infertility.

Imaging Procedures
Imaging techniques may be used to determine physical problems preventing proper fertilization or maintenance of a normal pregnancy. Fiber-optic endoscopy, x-rays, and ultrasound sonograms are used to detect abnormal growths (such as fibroids, polyps, abscesses, tumors), scarring (adhesions) of the uterine walls, and infections.

Tests for Men

For men, an evaluation of infertility includes a medical history and physical examination to detect any anatomic abnormalities. In some cases, examination using trans-rectal ultrasound (TRUS) can be used to identify specific abnormalities, such as obstructions blocking the sperm from being released during ejaculation. Absence of sperm (azoospermia) can also be due to missing vas deferens or seminal vesicles.

Laboratory Tests

Semen analysis—this is the primary test for infertility in men. Collection and prompt evaluation of a sample of semen can help determine whether there are any defects in the number, shape, and movement (motility) of sperm.

Blood tests can be used to evaluate hormone levels such as:

• • Free and total testosterone
  • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • Prolactin (PRL)
  • Sex hormone binding globulin (SHBG)

Biopsy
In some instances, a biopsy of testicular tissue can identify infertility problems such as sperm production, abnormal growths, tumors, or underdeveloped reproductive organs.