When a couple is not successful at achieving pregnancy after a full year of unprotected intercourse, both partners should undergo a thorough physical and medical assessment. Because male factor infertility occurs 33% of the time, the semen analysis is usually done first. However, two-thirds of all infertility cases are related to a female factor.
Comprehensive Appointment with the Fertility Specialist
The first step in the workup for female infertility is a comprehensive appointment with the fertility specialist. At this appointment, the client must detail her lifestyle and history. Topics discussed include menstrual history, pregnancy history, birth control measures, current and past sexual practices, surgical history, medications, and other health issues. In addition, the fertility specialist inquires about lifestyle habits, concerns, and living environment.
The second step of the workup involves a thorough physical exam. The doctor assesses your thyroid gland, breasts, and hair distribution pattern. In addition, a pelvic examination and Pap test are done to check ovarian enlargement, structural deformities, and abnormal cervical cells.
The fertility specialist will schedule the initial testing after the first appointment. This involves evaluation of ovulation, ovarian function, and uterine function. Before this appointment, you will start tracking your ovulation using a fertility monitor or fertility awareness process. This gives the reproductive specialist crucial information regarding the ovulation. The main question regarding female fertility is whether or not you are ovulating.
There are four types of ovulation evaluation. These include:
Ovulation testing – Used to confirm if or not ovulation occurs by looking through temperature charts, and by using ovulation prediction kits, ultrasounds, and blood tests.
Ovarian function tests – Used to see how hormones are functioning and working during the ovulation cycle. Tests include day 3 FSH (measures follicle-stimulating hormone), day 3 estradiol (measures estrogen), inhibin B blood test, and ultrasound to confirm ovulation.
Luteal phase testing – Evaluates hormone levels, such as progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). In addition, an endometrial biopsy is often performed.
Hormone tests – Involves detailed extensive hormone evaluation, including DHEAS, testosterone, LH, FSH, progesterone, prolactin, androstenedione, and thyroid hormone.
Depending on the findings of the initial testing and male’s semen analysis, certain tests are used for further evaluation. These include:
Cervical mucus tests – Post coital test (PCT), which evaluates if the sperm is able to penetrate through and survive in the cervical mucus (at the bottom of the womb). This involves bacterial screening as well.
Ultrasound tests – Used to assess the endometrium (lining of the uterus) thickness, to monitor follicle development (in the ovary), and to check the uterus and ovaries for deformities. This test is usually conducted 2-3 days after the egg has been released during ovulation.
Hysterosalpingogram (HSG) – This is a special x-ray of the fallopian tubes and uterus. Dye is injected into the uterus and tubes through the cervix, and the doctor takes pictures and assesses for blockages.
Hysteroscopy – Procedure used when HSG shows abnormalities. A small scope is inserted into the uterus through the cervix, and the fertility specialist can detect growths, abnormalities, and scarring.
Laparoscopy – Procedure involving general anesthesia and done using a narrow scope. The doctor makes small incisions near the belly button, inserts the scope, and makes necessary repairs. Scar tissue, endometriosis implants, and adhesions are removed using a laser or cutting technique, and tube repairs can also be made.
Endometrial biopsy – Procedure that involves scarping a tiny amount of tissue from the endometrium right before the onset of menstruation. This alerts the specialist if the lining is thick enough to hold a fertilized egg, which implants 2-5 days after fertilization in the fallopian tube.