Wednesday, 25 March 2015

Fertility Tests for Women

Doctors arbitrarily diagnose infertility when a couple hasn't conceived a child after 12 months of unprotected and regular sex. Impaired fertility may be a better description, though. Many women who keep trying will get pregnant in the second year or later.

Whatever its name, infertility is a call to take advantage of available fertility testing and treatments that can improve your chances of pregnancy. Fertility testing is something couples should do together, since the male is the sole cause of fertility problems 30% of the time.

The Infertility Interview
Experts recommend visiting a doctor for an infertility evaluation after six to 12 months of unprotected and regular sex without pregnancy. Infertility testing is best done by an infertility specialist.

The first step is a detailed interview. A thorough infertility interview should involve both partners, and ask about:

Your medical histories, including any chronic illnesses or surgeries
Your use of prescription medication
Your use of caffeine, alcohol, cigarettes, and drugs
Your exposure to chemicals, toxins, or radiation in the home or at work
How often you have sex
Your history of birth control use
Any history of sexually transmitted diseases
Any problems having sex
Whether either of you has had sex outside the relationship

Infertility is due to problems related to the woman about two-thirds of the time. A doctor will likely ask a woman questions about her gynecologic history:

Have you been pregnant before and what was the outcome of those pregnancies?
How often have you had periods over the last year?
Have you had irregular and missed periods or had spotting between periods?
Have you had any changes in blood flow or the appearance of large blood clots?
What methods of birth control have you used?
Have you seen a doctor before for fertility problems and undergone treatment for them?

Infertility Tests for Women
There is no single best test or ideal workup for infertility. In practice, doctors perform multiple tests and exams to identify any problems that might be contributing to a woman's infertility.

Pap Smear
Most women are familiar with this basic gynecologic test. The Pap smear and pelvic exam are best at detecting cervical cancer, other problems with the cervix, or active sexually transmitted diseases. Any of these can interfere with fertility in women.

Ovulation Tests
In order to get pregnant, a woman has to release an egg each month (ovulation). Women who have inconsistent periods may need testing to confirm they're ovulating. Tests related to ovulation include:

A urine test at home can detect luteinizing hormone (LH), which appears in high levels in the urine just before ovulation.

The doctor may check levels of the hormone progesterone in a woman's blood. Increases in progesterone indicate ovulation.

A woman can check her body temperature each morning. Basal body temperature rises a bit just after ovulation. By checking her body temperature each morning, a woman can detect this rise, showing her ovulation pattern over months.

The doctor may also run tests on a woman's thyroid, or check for other hormonal problems, to rule out underlying causes of missed or irregular ovulation.

Tests of Reproductive Organs
The uterus, fallopian tubes, and ovaries must all be working well in order to get pregnant. Different procedures can check the health of these organs:

Hysterosalpinogram. Also called an HSG or "tubogram," a series of X-rays is taken of the woman's fallopian tubes and uterus after a liquid dye has been injected through the vagina. Another method involves using saline and air instead of dye and an ultrasound. The HSG can help diagnose fallopian tube blockages and defects of the uterus. If one of the tubes is blocked, the obstruction should be seen on an X-ray. An HSG is usually done just after a menstrual period.

Transvaginal ultrasound. An ultrasound wand is introduced into the vagina to bring it close to the pelvic organs. Using sound waves, a doctor can see images of the ovaries and uterus. Often the doctor can determine whether there are follicles in the ovaries.

Hysteroscopy. A thin, flexible tube with a camera on its lighted end is threaded through the cervix into the uterus. The doctor can see problems with the uterus, and take tissue samples if needed.

Laparoscopy. Small cuts are made in the abdomen and tools including a camera inserted into the belly. This surgery can evaluate the entire pelvis and potentially correct problems, such as endometriosis. However, laparoscopy is invasive and involves small risks.

Other Infertility Tests
A doctor may order numerous other tests for infertility in women. They include:

Follicle-stimulating hormone (FSH) blood level. FSH stimulates the ovaries to prepare an egg for release each month. Abnormally high baseline levels of FSH can mean lower fertility in women. The FSH blood level is checked early in the menstrual cycle (often on day three).

Clomiphene citrate challenge testing (CCCT) can be done with the FSH test. A pill of clomiphene citrate is given on the fifth through the ninth days of the menstrual cycle. FSH is checked on day three (before the medicine is given) and on day 10 (after). High FSH levels suggest a lower likelihood of pregnancy.
Inhibin B is a hormone checked with a blood test. Levels may be lower in women with infertility. However, experts are divided as to its ability to predict infertility.

Postcoital testing involves a doctor examining a woman's cervical mucus shortly after she has sex. This test has a long history, but studies cast doubt on its usefulness.

Endometrial biopsy is a sampling of tissue from the lining of the uterus. A healthy uterus is necessary for an egg to implant and create a pregnancy, and endometrial biopsies have traditionally been checked for this reason. However, evidence is mounting that endometrial biopsy is not helpful in predicting or treating infertility.

Of course, not all women undergo all these tests. Each woman's doctor will guide her through those that are most appropriate for her situation. After the testing is done, about 85% of couples will have some idea why they're having trouble getting pregnant.

Source: WebMD Medical Reference
Reviewed by Trina Pagano, MD on July 22, 2012