Basic Workup for Female Infertility
Among those ages 15 to 44 years, around 10% of women in the United States have trouble getting or staying pregnant. Infertility means not being able to get pregnant after 12 months of unprotected intercourse. To become pregnant, a woman’s body must release an egg from the ovaries in the process of ovulation. The egg must pass through one of the fallopian tubes to implant into the uterus. Somewhere along the way, the man’s sperm must fertilize (join) the egg. Once this egg is fertilized, it must attach itself to the uterus (implantation). Any problem or interference with this process could result in infertility. To assess female infertility, the fertility specialist uses a variety of techniques.
The doctor will ask you questions to gain insight into your fertility problems. The history involves medical, surgical, obstetric, and gynecological information that is relevant to your case. The fertility specialist will also review all medical records and clinic notes from other doctors you have seen.
The fertility specialist will conduct a detailed physical examination. The pelvic ultrasound is done to help assess for any abnormalities of the ovaries, fallopian tubes, and/or uterus. This helps us gather information regarding the woman’s potential for adequate ovarian stimulation using medications.
Assessment of the Ovarian Reserve
The fertility specialist conducts an assessment of the woman’s remaining egg supply, which is referred to as the ovarian reserve. This is done using blood testing and ultrasound:
• Blood – Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (estrogen) levels
• Ultrasound – Used to assess ovarian volume and antral follicle counts
To get pregnant, the woman must be ovulating appropriately. Around one-fourth of all female infertility is related to an ovulation disorder, such as polycystic ovarian syndrome. Ovulation assessment can be done by evaluating body temperature.
Semen analysis is used to evaluate the man’s sperm. When a severe sperm defect is found, the female partner’s testing is then modified so therapy can be directed at the sperm issue. Around one-fourth of all male infertility is related to a sperm defect. Additionally, approximately 45% of all infertility cases have a sperm defect as either the contributing cause or the main cause.
Laboratory Blood Tests
Various blood tests are required for either the man, the woman, or both partners. These tests include:
• Day 3 FSH
• Thyroid hormone levels
• Lupus anticoagulant
• Anti-cardiolipin antibody (ACL)
Because about 25% of all infertility is related to a structural problem, the hysterosalpingogram (HSG) is used to test for tubal patency and normalcy of the uterine cavity. This test is used to assess the fallopian tubes, as well as the anatomy of the endometrial cavity. HSG is scheduled between days 6 and 13 of the menstrual cycle, after bleeding occurs and before the onset of ovulation.
This is a surgical procedure performed after basic testing has been done on both the man and the woman. Laparoscopy is used to assess for endometriosis, adhesions, and pelvic scarring.
Ovarian Function Tests
Ovarian function is assessed using the Clomiphene Citrate Challenge Test. This involves taking blood for an FSH level on day 3 of the cycle, and taking Clomiphene Citrate on days 5 through 9. After completing five days of the medication, another FSH blood test is done to measure if the ovaries respond to the medicines. To evaluate further, a transvaginal ultrasound may be used to count the small resting follicles.
Infectious Disease Testing and Immunity Screening
The fertility specialist will assess for:
• Hepatitis B surface antigen
• Hepatitis C antibody
• Human immunodeficiency virus (HIV)
• Syphilis (RPR)
• Rubella titer
• Blood type and Rh factor