Basic infertility evaluation

What should be included in the initial infertility evaluation?

History

The doctor will ask questions about your past to try to get clues as to the cause of your infertility These questions will be regarding your medical, surgical, gynecological, and obstetric history, as well as some "lifestyle" questions.

A review of fertility-related records from other doctors that you have seen is also important.

Physical exam

A directed physical exam that may include a pelvic ultrasound should be performed. 

Ultrasound can help us discover abnormalities with the uterus, fallopian tubes and/or ovaries. We can sometimes see evidence of pelvic scarring, such as when an ovary appears to be stuck to the uterus. We can also get some information regarding the woman's potential for adequate ovarian stimulation for infertility treatment cycles by counting autral follicles..

Assessment of adequacy of ovulation

This can be done in a variety of ways.

About 25% of all infertility is caused by an ovulation disorder. One type of ovulation problem, polycystic ovarian syndrome, is usually quite amenable to treatment with medications.

Semen analysis

This is a very important test and should be done early in the evaluation process. If a severe sperm defect is discovered, the testing on the female partner might be modified, and therapy can be immediately directed to the problem.

About 25% of all infertility is caused by a sperm defect and 40-50% of infertility cases have a sperm defect as the main cause, or a contributing cause.

Blood tests

Depending on the individual couple's situation, various blood tests on either the female or the male may be needed.

Blood tests that might be needed include day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone (T), estradiol (E2), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating hormone (TSH), lupus anticoagulant (LAC), anti-cardiolipin (ACL), complete blood count with platelets (CBC), etc...

Immunological testing has not been proven to have any value in infertility patients without a history of 2 or more miscarriages.

Hysterosalpinogram (HSG)

 

This test is done in order to assess the anatomy of the endometrial cavity of the uterus and the fallopian tubes. The HSG is usually scheduled to be done between days 6 and 13 of the cycle - this also depends on the specifics of the woman's normal cycle.

This test is usually performed in the radiology department of a hospital.

About 25% of all infertility is due to a tubal factor.

Laparoscopy

This is a surgical procedure and should not be performed until the basic testing has been done on both partners. In some cases, laparoscopy will be indicated to look for pelvic scarring or endometriosis.