Diagnosing Female Infertility

Finding the cause of infertility in women begins with a physical examination and complete medical history, including questions about the couple’s sexual habits. In some cases, only a few simple procedures are needed, such as an analysis of body temperature, blood tests to measure hormone levels, x-rays of the fallopian tubes and uterus, or a post-coital test of cervical mucus. In other cases, more invasive procedures may be required such as a biopsy of endometrial tissue or laparoscopy.

Summary of a Workup to test for infertility:

A couple who contacts the Fertility Center first receives a thorough assessment by a reproductive endocrinologist associated with the program. A reproductive endocrinologist is a physician specialist with expertise in the areas of hormone treatment, surgical reconstruction of the reproductive tract and the causes and treatment of infertility.

Because it is equally possible that the infertility problem may be due to the man and/or the woman, and because the female evaluation may be more involved and expensive, it is advisable to evaluate the man during the first visit. This usually simply involves a semen analysis.

While the man is being evaluated, the woman is tested to determine if she is ovulating. There are a variety of methods of determining ovulation. These include the use of temperature charts, ultrasound, urine or blood tests, and occasionally endometrial biopsies.

Endometrial biopsy is an office procedure in which a narrow instrument is inserted into the uterus for the purpose of removing a small bit of tissue. This tissue is then evaluated by a pathologist. This evaluation can determine if ovulation has occurred and also if there is a hormone deficiency that is preventing the fertilized egg from implanting into the uterus lining.

If it is determined that a hormone deficiency exists, then medical therapy is instituted. "Fertility drugs" which are medications to induce ovulation, or other hormones to correct specific abnormalities, may be used. The treatment plan is usually continued for several months.

A hysterosalpingogram is usually performed. This is an X-ray procedure performed on an out patient basis in the hospital radiology department. A physician inserts a dye into the uterus and observes its progress fluoroscopically. The purpose is to determine whether the tubes are open and whether an anatomic defect of the lining of the uterus.

A diagnostic laparoscopy may be recommended. This is an outpatient operative procedure performed in the operating room. Under general anesthesia, the physician inserts a telescopic device through the abdominal wall. The laparoscope is equipped with a light and operating instruments which allow the physician to see the pelvic structures and, in some instances, to correct abnormalities, such as endometriosis. The usual procedure is to help the doctor determine whether corrective surgery is indicated and whether surgery will offer a reasonable probability of pregnancy.