Female Infertility Testing

The first question regarding female infertility is whether or not the female is ovulating.  The first test that is typically performed by the fertility specialist is a test that measures follicle stimulating hormone (FSH) and luetinizing hormone (LH).  This will give the doctor a baseline look at the female ovulating pattern.  This test is done on the third day of the cycle and ideally is performed on the first visit to the specialist.  The second visit to the specialist will occur the day of the LH surge, which occurs immediately prior to ovulation.  During the first cycle, there are several tests that will be performed.
1.    Cervical mucus tests determine the ability of the sperm to swim through the cervical mucus and survive in it.  This test is called a post coital test meaning that it is performed within a few hours of sexual intercourse.
2.    Ultrasound examinations are used to inspect the female reproductive system and to look for potential problems.  These exams are also used to determine the number of eggs the ovaries are producing and about three days later to make certain the egg released from the ovary.
3.    Hormone tests are done to determine whether or not the hormones are all working correctly to contribute positively to the reproductive process.  Some of the hormones that are tested include estradiol, progesterone, prolactin, testosterone, DHEAS, and androstenedione.
If these tests are normal then it is necessary to do further testing of the female reproductive system.  There are four additional tests that can be performed to check for abnormalities within the female system.
1.    Hysterosalpingogram (HSG) is an x-ray of the uterus and fallopian tubes.  A blue dye is injected through the cervix into the uterus and the doctor can watch on x-ray as the dye spill out through the tubes.  This test will show blockages or abnormalities within the uterus and the fallopian tubes.
2.    Hysteroscopy is usually performed is the HSG indicates that there are indeed problems within the uterus or fallopian tubes.  A small instrument with a camera on the end called a hysteroscope is inserted through the cervix and allows the doctor to see inside the uterus and to take pictures.
3.    Laparoscopy is similar to the hysteroscopy only the camera called a laparoscope is inserted through the abdomen into the abdominal cavity.  This allows the specialist to visualize the reproductive organs and to check for endometriosis, scar tissue, or adhesions that can be causing fertility problems.
4.    Endometrial biopsy is a test that involves removing a small amount of tissue from the uterine lining or endometrium at the point in the cycle just prior to menstruation.  This test can reveal hormonal abnormalities that have not previously been identified.
When a couple has been trying for a year unsuccessfully to conceive a baby, it is important for female testing to begin immediately.  Men should also have preliminary testing at the same time but because it can take longer to perform female tests because of the importance of cyclical timing of some of the tests the female testing should begin quickly.