What female fertility tests are available?A woman's fertility declines substantially by age 35 and even more so after age 40. Common factors in female infertility include blocked fallopian tubes, polycystic ovary syndrome (PCOS interferes with egg release), fibroids, endometriosis, autoimmune disorders (producing antibodies against fetal tissue), diabetes, hypothyroidism, eating disorders, excessive smoking and alcohol use, and gluten intolerance (celiac disease).
The woman’s fertility may also be affected by factors such as fluctuating or diminished hormone levels; inconsistent ovulation; or a poor reproductive environment that does not support proper fertilization of the egg, interferes with the sperm’s transport, or impairs retention of a fertilized egg. The initial evaluation of a woman’s fertility includes a personal and family history with a thorough physical examination. A number of tests can be used to help diagnose the problem and aid in treatment.
Women who are older than 35 (as well as couples who have been unsuccessful for several years) should have a CCCT (clomiphene citrate challenge test) performed so that their physicians can evaluate their ability to become pregnant on the basis of the number and quality of their remaining eggs.
At-home ovulation predictions. There are three types of at-home methods useful for predicting ovulation. Basal body temperature (BBT) can be measured at home using a special thermometer to help predict the most fertile days in the woman’s monthly menstrual cycle, around the time of ovulation. Body temperature rises just after ovulation and remains elevated for at least 3 days. If the cycle is charted for 3 to 4 months, a pattern can be recognized and intercourse can be timed to occur in the 5 days before the expected temperature rise. This method is not as reliable or accurate as other monitoring techniques, but it is simple and inexpensive. Self-examination of vaginal discharge is another method in which ovulation can be predicted at home, but it too is subject to error. When a woman is most fertile, the mucus is stretchy, clear, thin, and slippery. When the mucus can be stretched between the thumb and index finger into a thin strand 2 to 3 inches long, ovulation is about to occur and the woman is entering her most fertile period. Ovulation predictor kits are the most accurate of the three methods. The test detects an increased level of luteinizing hormone (LH) present in an early morning urine sample 1 to 2 days before ovulation.
Blood tests. Blood tests that measure the levels of various hormones, such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), estradiol, and progesterone, aid greatly in determining the cause of infertility. Because changes in pituitary or thyroid function can also affect the menstrual cycle and ovulation, blood tests that measure thyroid function (TSH and/or T4) and steroids, such as testosterone and DHEA-S (dehydroepiandrosterone sulfate is used in creating androgens and estrogens), are also informative.
Hysterosalpinogram (HSG). Radio opaque dye is injected through the cervix into the uterus and fallopian tubes. A special X-ray machine then scans the pelvic region before the fluid is allowed to flow out. The X-ray images can help the doctor diagnose fibroid tumors, an unusually shaped uterus, scar tissue or blockages in the fallopian tubes. If you have a blocked tube, the procedure can be extremely painful. Take ibuprofen about half an hour before.
Hysteroscopy. If the result of the HSG suggests the presence of a uterine problem, your doctor may do a hysteroscopy to look inside the uterus. The procedure uses a hysteroscope - a thin telescope passed through the cervix into the uterus.
Post-coital test. This painless office procedure should be done the day you ovulate and several hours after sex. A small amount of cervical mucus is removed and examined under a microscope. The PCT determines how compatible a man's sperm is with his partner's cervical mucus.
Endometrial biopsy. A sample of the endometrium (tissue lining the inside of the uterus) is removed and studied under a microscope. Problems with the endometrium are called luteal phase defect. The test checks to see if the endometrium can support implantation and growth of a fertilized egg. The test must be done about three days before your period starts.
Laparoscopy. After you get local or general anesthesia, your doctor makes a small incision into your abdomen and inserts a narrow fiber-optic telescope into the pelvic area. This allows the doctor to inspect the outside of the uterus, the fallopian tubes and ovaries for endometriosis, pelvic adhesions or other problems.
Testosterone testing. The doctor may want to measure the man's testosterone levels to see if they are high enough. The doctor measures the level by taking blood from your arm. A woman may also get the test if she is having irregular periods or none at all. Testosterone levels can rise in women because of tumors that develop in the ovaries or PCOS.