Diagnostic testing for infertility causes
The doctor and nurse counselor will undertake an initial assessment and investigation to find out the cause of infertility. We will ask you for your medical history, current general health and your lifestyle. We will advise you what tests you should have done, step by step. You might have to come back several times to complete all the investigations.
Diagnostic tests for infertility
An evaluation of a woman for infertility is appropriate for women who have not become pregnant after having 12 months of regular, unprotected intercourse. These women might need to be evaluated earlier after six months if:
- They are 35 years old or more
- They have a history of irregular menstrual cycles or the interval between cycles is more than 35 days or they have no period at all
- They have known or suspected problems with the uterus, tubes, or other problems in the abdominal cavity, for example pelvic endometriosis, pelvic adhesion
- There is known or suspected male infertility
The following tests are recommended as part of your infertility evaluation:
- Semen analysis
At least 40% of the causes of infertility are from the male factor. Therefore, semen analysis is an essential part of the infertility evaluation. A semen analysis should provide information about the number, movement and shape of the sperm. A semen analysis is necessary even if the male partner has fathered a child before.
- Blood tests for hormone profile
- FSH (Follicular stimulating hormone), LH (Luteinizing hormone), estradiol on day 2 or day 3 of the period
- Ovarian reserve test by checking AMH (Anti-mullerian hormone) levels, antral follicle count to evaluate the ovarian function
- Day 21 blood test to measure progesterone levels. This test ensures you have natural ovulation and optimal progesterone levels for pregnancy support
- Pelvic ultrasound
A transvaginal ultrasonography is the ultrasound technique used to find out some causes of infertility.
- Assess anatomical disorders
- detect ovarian cysts and uterine fibroids, which are two of the most common causes of female infertility
- identify tubal obstruction and hydrosalpinx
- assess ovarian reserve by conducting an antral follicle count
A hysterosalpingogram is a relatively noninvasive procedure and is used to detect a blockage of the fallopian tubes and anatomical disorder of the uterus. A small catheter is inserted through the cervical canal and a dye is slowly injected. During the dye injection, real-time images are taken by X-ray machine to see the flow of dye pass out from the uterine cornu to the fimbrial end and out into the pelvic cavity.
This procedure can sometimes be painful. Before the test, we need to prepare the patient for the procedure by performing the procedure after the menstrual blood is stopped. Taking a painkiller one hour before the test can help the patient to feel more comfortable during procedure.
The additional benefit of this test is that by injecting the viscous dye into the uterine cavity can pass some cause of blockage out of uterine tube and the dye can clean the uterine cavity at the same time. There are studies showing that some patients can conceive naturally after the test.