Understanding Fertility Problems: The Woman’s Evaluation

To help your doctor look for the cause of fertility problems, you will have an evaluation. This evaluation includes a medical history, physical exam, and some basic tests. If needed, your doctor may also recommend procedures that provide a closer look at the reproductive organs.

During the evaluation, your doctor will ask about health and lifestyle issues that can affect fertility.

Medical History

Your doctor will ask about your health, lifestyle, and other factors that can affect fertility. This includes how often you have sex, your menstrual periods, and any medications or herbs you take. Be sure to mention any prior pregnancies or surgeries. You should also mention if you’ve had any pelvic infections or STDs.

Physical Exam

A physical exam helps your doctor learn about your general health, as well as the health of your reproductive organs. It includes a pelvic exam to check for swelling, infection, or other signs of problems. Your hormone function is checked by looking at your breast development, body fat, and hair distribution.

Basic Tests

Your evaluation will likely include some basic tests, such as blood tests. In certain cases, it may also include tests related to your cervix.

• Blood tests can be used to check a variety of factors. These include:

  • FSH, LH, estrogen, and progesterone levels.

  • Blood sugar and insulin levels.

  • Tests for current or prior pelvic infection.

  • Thyroid function.

  • Prolactin levels. This is a hormone that affects the production of breast milk. However, high levels of prolactin can also prevent ovulation.

• Cervical cultures are samples taken from the cervix using a sterile swab. The sample is then sent to a lab and checked for signs of infections that can affect fertility.

• Postcoital tests are done using a sample of cervical mucus taken a few hours after sexual intercourse. The sample helps show the quality of the mucus, and whether sperm can swim through it. The test is usually done 1 or 2 days before ovulation.

Imaging Tests

As part of the evaluation, your doctor may recommend imaging tests. These make it easier to view the reproductive organs. They can also help pinpoint the location of problems. Imaging tests may be done in your doctor’s office, a hospital, or a surgery center. In most cases, they cause little or no discomfort.

•   HSG (hysterosalpingogram) is an x-ray test. It is used to view the shape of the uterus and make sure the fallopian tubes are open. During the test, a contrast dye is placed in the uterus and fallopian tubes. The dye makes it easier to see problems on the x-rays.

• Ultrasound testing uses painless sound waves to produce images of internal organs. This can help show problems with the ovaries or uterine lining.

  An HSG test shows the uterus and fallopian tubes. They are seen as white on the x-rays.

• Sonohysterogram testing is an ultrasound test done with a saline solution placed in the uterus. The saline makes it easier to view the inside of the uterus.

Other Tests

If needed, your doctor may recommend other, less common tests. Some can be done in your doctor’s office. Others are done in a hospital or surgery center. For certain procedures, you’ll be given anesthesia to prevent discomfort.

• Hysteroscopy uses a small, lighted telescope-like device (hysteroscope) to view the inside of the cervix and uterus. It is usually done just after menstruation.

• Endometrial biopsy is used to take a small sample of the uterine lining. This can help show problems that may prevent an embryo from implanting. A small suction tube (catheter) is inserted into the uterus to take the sample.

• Laparoscopy is a type of surgery that can help reveal problems on the surface of the reproductive organs. A thin, lighted telescope-like device (laparoscope) is inserted into the body. Your doctor then views the reproductive organs through the scope.