Based on your individual history, your doctor will order specific tests to evaluate your infertility. The results of these tests will assist us in tailoring your treatment.
The basic infertility evaluation will include testing to assess ovulatory function, the fallopian tubes, the uterus and the male partner, if applicable. The tests include Semen Analysis, Hormone Levels, Home Urine LH Testing, Basal Body Temperature Charting, Transvaginal Ultrasound, HSG and Post-Coital Test. A surgical evaluation may also be indicated to evaluate for pelvic adhesions (scarring) or endometriosis. This procedure is called a Laparoscopy.
Click through the list of tests to find out more about each one.
It is estimated that about 40% of all infertility is attributable to a problem with the male partner. The semen analysis, therefore, is an essential step in the infertility evaluation.
What is Semen Analysis?
Semen Analysis is also called a seminogram and it is one of the most important tests for determine male fertility or infertility. This test evaluates the semen and the sperm within and identifies any issues that may be hindering conception. Some of the issues this analysis is able to determine includes:
How A Semen Analysis Sample is Collected
The sample should, ideally, be collected by masturbation. You should only use a lubricant safe for fertility use, like PreSeed. If you are unable to collect a sample by masturbation, please let your doctor or nurse know. We can provide a special Silicone condom that you may use with intercourse. Abstain from intercourse for 48 hours prior to collecting your semen sample, but do not abstain for longer than a week. There are no known side effects or risks associated with this type of analysis.
We also recommended that patients abstain from alcohol before the test as well as avoid caffeine or drug use including cocaine and marijuana. We also encourage our patients to suspend taking any herbal medications and avoid any hormone medications that have not been prescribed by a doctor.
How to Care for the Sample
It is important that the semen sample arrive to the laboratory within 45 minutes after collection. Keep it warm, but do not overheat the sample. Our laboratory accepts samples for semen analysis by appointment. We do have a private room for sample collection in our office. If it is more convenient, we will be happy to assist you in scheduling this test at a laboratory near your hometown.
As this type of analysis is by appointment only, your physician will go over any questions, concerns, and what to do with the sample in greater detail. However, if you have questions or if you’d like to schedule an appointment contact Alabama Fertility today and one of our specialists will schedule your appointment.
Hormone Levels
Hormone evaluation is particularly useful in evaluating ovarian function. These tests are performed by obtaining a blood sample at specific times during your menstrual cycle. The following are some of the tests that may be ordered for you based on your history:
Androgens, often referred to as “male hormones,” are normally produced in women by the ovaries and adrenal glands. However, some women produce high levels of androgens that result in ovulatory dysfunction.
Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and Estradiol (E2) levels are generally low in the very early part of the menstrual cycle of women with normal ovarian reserve. However, in women with diminished ovarian reserve (perimenopause or menopause), these levels may be elevated. Anti-mullerian hormone (AMH) is another marker of ovarian reserve. This is a blood test that can be done at any time in the menstrual cycle.
Progesterone is produced by the remnants of the follicle after ovulation, called the corpus luteum. Ovulation can be confirmed if the progesterone level reaches a specific threshold a week after ovulation.
A large amount of Luteinizing Hormone (LH), also referred to as the “LH surge,” occurs prior to ovulation. This surge may be detected in blood testing in our office or urine testing at home. Although a number of home ovulation prediction kits are commercially available, we recommend Clear Blue Easy. This particular kit is simple, accurate and takes less than five minutes to perform the test. Testing should begin prior to the expected time of ovulation, generally beginning on day 10 of the menstrual cycle. It is important to test your urine between 11am and 2pm to detect the onset of the LH surge. Ovulation will occur the following day. Therefore, unless other tests or procedures are scheduled, you should have intercourse that day and the following day. You may stop testing after you test positive for your LH surge.</sp
Basal body temperature (BBT) charting may be recommended to evaluate your ovulation. Although BBT charting is not predictive of ovulation, it can be useful in confirming that ovulation has occurred in a particular cycle. This test is inexpensive, relatively convenient and noninvasive.
BBT charting is performed by taking the temperature immediately upon awakening each morning using a basal body thermometer. This thermometer is graduated in 0.1°, as opposed to 0.2° and can be found at any pharmacy or grocery store. After taking your temperature each morning, you should plot it on a graph that we will give to you. Your temperature will increase by about one degree after you have ovulated due to progesterone production. Therefore, do NOT wait until your temperature rises to have intercourse.
Transvaginal ultrasound, or sonography, is extremely useful in the diagnosis and treatment of infertility. This technique is useful in the evaluation of the pelvic structures, monitoring follicle growth and assessing ovulation.
A transvaginal ultrasound is often recommended early in your infertility evaluation. Such abnormalities as uterine fibroids, endometrial polyps, ovarian cysts and endometriomas can be visualized with sonography.
The hysterosalpingogram, or HSG, is an X-ray procedure to evaluate your uterus and fallopian tubes. This procedure involves the introduction of dye into the uterus through a small catheter placed through the cervix. X-rays are then taken as the dye passes through the uterus and out the ends of the fallopian tubes. This procedure generally takes only about 10-15 minutes to complete. Please let your doctor know if you are allergic to iodine or contrast. Please follow the instructions listed below:
The post-coital test (PCT) is used to evaluate cervical mucus production and mucus-sperm interaction at the time of ovulation. At this time, the cervical mucus should be clear, thin and watery. You may notice this as a vaginal discharge. During intercourse, sperm must swim through the cervical mucus to the uterus and fallopian tubes. Thus, sperm must be able to survive in the cervical mucus for pregnancy to occur after intercourse. The PCT is a quick, simple test that is performed on the day of ovulation based on the LH surge. You will be asked to check your urine with a home ovulation kit (Clear Plan Easy) beginning on the 10th day of your menstrual cycle. You should call our office on the day of your surge to schedule your test for the following day. You should have intercourse 2 to 6 hours prior to your appointment time. The actual test involves the placement of a speculum into the vagina (similar to a Pap smear), sampling the cervical mucus and evaluating the sample under the microscope. You will be given the results of this test before you leave our office.
Laparoscopy is an outpatient surgical procedure that is used to evaluate a woman’s pelvis. Conditions such as endometriosis, pelvic adhesions, uterine fibroids and tubal disease may be diagnosed during this procedure. Oftentimes, the physician is able to treat these problems during the laparoscopy.
Patients undergoing laparoscopy will have general anesthesia. Once you are asleep, a thin, lighted telescope-like viewing instrument is inserted through the navel and abdominal wall, and your abdomen is filled with carbon dioxide gas. This allows the physician to examine the female reproductive organs and abdominal cavity.