Diagnosis of Infertility in Women
by Cynthia M. Johnson, MA
Both partners will be evaluated for fertility problems during the first visit. The female partner will be asked about their symptoms and their personal and family health history. Questions will also be asked about their menstrual cycle and pregnancy history. A physical exam will be done. It will include a pelvic exam, Pap smear, and an exam of the breasts and thyroid gland.
Other tests that may be done are:
Ovulation Tests and Tests of Ovarian Function
Many tests are used to find out if a person has been ovulating and to predict when it might happen next. Ovulation testing is also used to find out a person's ability to produce eggs. It can also find out if the uterus is able to have an embryo attach to it.
Basal Body Temperature (BBT)
Taking a BBT (at rest, when a person first wakes up) and recording it on a chart is a way to find out if a person has ovulated and when ovulation happened. BBT rises at ovulation. It stays high during the second half of a cycle and during pregnancy.
Blood tests measure hormone levels. Estrogen and luteinizing hormone (LH) rise just before ovulation. High levels of the hormone progesterone are a sign that ovulation has happened recently. Other hormones may also be measured to check for overall function.
Transvaginal ultrasound is used to track the growth of the follicle. This is the place in the ovary where the egg matures. The follicle grows during the first half of the menstrual cycle (from the beginning of a period until ovulation).
Tests of Ovarian Function
Day 3 FSH
This blood test is taken on day three of the menstrual cycle (the third day of bleeding). It measures follicle-stimulating hormone (FSH). This is made by the pituitary gland that controls the growth of eggs. High levels may be a sign that the ovaries are not working the right way. Very low levels can stop a person from producing eggs.
Day 3 Estradiol Tests
This blood test measures estrogen in the blood. Levels that are very high may be a sign of poor egg quality.
Day 21 Serum Progesterone
This blood test measures circulating progesterone. It should be higher about one week after ovulation. Levels that are low may be a sign of poor ovulation.
Diagnosing Uterine and Other Physical Problems
Many tests can be done to find out whether the anatomy of the uterus, fallopian tubes, and vagina is normal.
A pelvic exam can find problems like uterine fibroids. These are harmless, muscular tumors in the wall of the uterus. They can change the shape of the uterus, block the cervix or fallopian tubes, or block the uterine blood supply that the embryo needs to implant and grow.
HSG is an x-ray of the uterus and fallopian tubes. It may be done in the first half of the menstrual cycle. Water- or oil-based dyes are used to look for problems.
An ultrasound probe is put in the vagina to take a picture of the pelvic organs.
A hysteroscope (a small scope with a light) is put through the cervix to view the uterus and look at problems that may have been seen during an HSG.
Laparoscopy is surgery. A small camera with a light will be inserted through a small cut in the navel. It allows the doctor to look at the pelvic cavity, which includes the ovaries, the outside of the fallopian tubes, and the uterus. If problems are found, a laser mounted on the scope can be used to remove them.
Evaluating infertility. The American Congress of Obstetricians and Gynecologists website. Available at: https://www.acog.org/womens-health/faqs/evaluating-infertility. Accessed November 17, 2021.
Infertility in women. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/infertility-in-women. Accessed November 11, 2021.
Overview of infertility. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/infertility/overview-of-infertility. Accessed November 17, 2021.
Treating infertility. The American Congress of Obstetricians and Gynecologists website. Available at: https://www.acog.org/womens-health/faqs/treating-infertility. Accessed November 11, 2021.
Last reviewed November 2021 by EBSCO Medical Review Board Mary-Beth Seymour, RN
Last Updated: 11/17/2021
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