Female Infertility Diagnostic Testing
Identifying Female Infertility Through Diagnostic Tests
Some women have a difficult time becoming pregnant or maintaining the pregnancy. Infertility is diagnosed when a woman tries to conceive for a year without success. Also, women are considered to be infertile when they have repeated miscarriages. More than 10 percent of couples experience infertility, and 1 out of 3 times it is due to a problem with the woman's fertility. There are numerous diagnostic tests that are done to assess fertility. Ovulation tests include basic hormonal testing for LH, FSH, testosterone, estradiol, DHEAS, progesterone, LH urine evaluation, luteal phase testing, thyroid assessment, and basal body temperature monitoring. A fertility specialist can use ultrasound, MRI, hysterosalpingography, laparoscopy, and hysteroscopy to evaluate the uterus, fallopian tubes, and ovaries. Certain procedures allow the doctor to treat and repair infertility causes, such as scarring, adhesions, and growths. Other fertility tests include the cervical mucus test, the clominophene citrate challenge test, and endometrial biopsy.
Pelvic Exam and Pap Smear
Most women are familiar with a basic general gynecological exam. During the pelvic exam, the doctor feels the uterus and ovaries for masses and structural abnormalities. The Pap smear is a screening test for cervical cancer and/or active sexually transmitted infections. These conditions can interfere with a woman's ability to conceive.
In order to become pregnant, a woman must release an egg each month in a process called ovulation. Women who have inconsistent menstrual periods are usually tested to confirm that they are actually ovulating. Tests related to ovulation include:
- LH urine test. This is a test where the urine is evaluated for the presence of luteinizing hormone, which appears in high levels just before ovulation.
- Ovarian function tests. These tests examine how the hormones are functioning during the ovulation cycle. The Day 3 FSH test measures serum levels of follicle stimulating hormone. The Day 3 estradiol test measures the serum estrogen level, and the Inhibin B test determines the levels of inhibin B in the blood.
- Progesterone blood test. Progesterone is the hormone that increases during ovulation. A low progesterone level could lead to infertility.
- Luteal phase testing. This test evaluates extensive hormone levels to see if the woman has a normal luteal phase of the menstrual cycle.
- Thyroid blood test. The doctor may run a blood test to assess thyroid function. Hypothyroidism is a common cause of missed or irregular ovulation.
- Basal body temperature. A woman's basal body temperature rises a small amount right before ovulation. By checking this temperature each morning, a woman can self-determine the rise and identify ovulation patterns.
- Other hormone tests. There are numerous hormones and substances that alter ovulation. The fertility specialist may also assess the blood levels of prolactin, LH, FSH, estradiol, total and free testosterone, DHEAS, and androstenedione.
Cervical Mucus Test
This test involves a postcoital test (PCT) of the cervical mucus. This is done to determine if the sperm are able to penetrate and survive in the cervical mucus, which is located at the opening of the cervix. This test also involves bacterial screening.
Clomiphene Citrate Challenge Test
The clomiphene citrate challenge test (CCCT) is done along with a blood evaluation of FSH. A pill of clomiphene citrate is given to the woman on the fifth through the ninth days of the 28 day menstrual cycle. FSH is checked on day three before the pill is given and again on day ten after the woman takes the medicine. High FSH levels suggest a low chance of pregnancy.
Transvaginal ultrasound and pelvic ultrasound both are important tools in the evaluation and monitoring of female infertility. These tests are done to detect endometrial polyps, uterine fibroids, ovarian cysts, and other structural abnormalities in the pelvis. The ultrasound also assesses the thickness of the lining of the uterus (called the endometrium), checks the condition of the uterus, fallopian tubes, and ovaries, and monitors the follicle development in the ovary. Ultrasonography utilizes sound waves to generate pictures of the pelvic organs and structures. A special test that uses ultrasound with saline solution injection into the uterus is called a sonohystogram or saline infusion sonography (SIS).
The hysterosalpingogram is an imaging study of the uterus, fallopian tubes, and ovaries. Dye is injected through the cervix into the uterus, where it then travels to the other structures. This test allows the doctor to visualize the shape of the uterus, the ovaries, and to see if the fallopian tubes are open. Also, the test shows if or not the fluid passes out of the uterus or spills from the fallopian tubes. In order to avoid disruption of an egg or developing embryo, this test is typically performed right before ovulation.
The hysteroscopy is a surgical procedure that is done when the hysterosalpingogram indicates the presence of a growth, scarring, or other abnormality. The hysteroscope is inserted through the cervical os and advanced into the uterus. This test allows the doctor to take pictures for future reference and treat any structural abnormalities or problems.
Laparoscopy is a procedure that is done under general anesthesia. This surgical diagnostic measure involves the use of a narrow fiber optic telescope, called a laparoscope. This scope is inserted into the uterus via the abdominal region. It allows the doctor to examine the uterus, fallopian tubes, and ovaries. During the procedure, the doctor can remove and treat with a laser any abnormalities found, such as endometriosis, scar tissue, adhesions, or structural growths.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) is an imaging procedure that uses magnetic waves to create images of the internal pelvic organs and structures.
An endometrial biopsy is done to assess the lining of the uterus (the endometrium) to see if it is thick enough for a fertilized egg to implant and sustain. This procedure involves scraping a tiny amount of tissue from the endometrium, and it is done right before the onset of menses.
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