After a complete history and physical examination, a complete infertility evaluation requires the use of additional tests to more accurately understand the causes of infertility for the individual or couple. These tests will also help to guide recommendations for best treatment options to optimize chances for successful pregnancy.
Hysterosalpingogram (HSG)-The HSG is one of the first evaluations of infertility. This X-ray dye test is one ofthe best tests to evaluate the uterus and fallopian tubes, to ensure the tubes are open and confirm no gross uterine abnormalities. This evaluation is generally performed on day 6-10 of a spontaneous or induced menstrual cycle. During this procedure, contrast is injected via a special intracervical catheter, and concurrent X-ray is done to visualize the pelvic structures. The catheter is placed by a physician, or other medical provider, and is generally performed in a radiology center or hospital. The results of the test are transmitted to the referring physician. Generally, a nonsteroidal anti-inflammatory medication such as Ibuprofen is administered one hour prior to the procedure. , which helps to minimize discomfort.
Saline Infusion Sonogram (SIS)
Saline infusion sonogram is an additional test of the female pelvic organs. This exam is a more sensitive evaluation for uterine abnormalities such as the small endometrial (uterine) polyp, fibroid or adhesion. During this office- based procedure, saline solution is injected with a special transcervical catheter into the uterus. Distension of the uterine cavity with saline is necessary to see these smaller abnormalities. A transvaginal ultrasound is performed after placement of the catheter, and the injection of saline during the ultrasound allows for a complete picture of the uterine cavity. As in the case with the HSG, administration of a nonsteroidal anti-inflammatory medication one hour prior to the SIS helps to minimize discomfort.
A complete semen analysis is also an important part of the infertility evaluation if there is a male partner involved. Semen is collected via masturbation or with a specialized sperm-collection condom during sexual intercourse. The laboratory evaluation will include several aspects of sperm quality, including volume, count, motility (movement) and morphology (sperm shape). An additional analysis is sometimes necessary if there are significant abnormalities in the initial analysis. A period of abstinence from intercourse or ejaculation for 2-3 days prior to the analysis is recommended to ensure the quality of the specimen. The specimen should also arrive at the laboratory no more than one hour after production to ensure the viability of the sperm and an accurate analysis.
Reproductive Screening Blood work
Infertility testing also includes blood tests that screen for certain reproductive hormones and markers of egg quality. In addition, the blood tests include an infection screen and an evaluation of general health, genetic and immune factors that may play a role in the reproductive process. For the woman, these blood tests are generally performed on day 2 or 3 of the menstrual cycle, a time when the hormonal levels are most conductive to get maximal information about hormonal status and egg quality. Certain blood tests are sometimes performed later in the cycle, such as on day 21 to more accurately test hormones of ovulation. A blood pregnancy test is sometimes also necessary for women with irregular cycles as a pre-requisite to hormonal initiation of a menstrual cycle and to be better able to schedule additional tests. Male screening is also necessary if there is a male partner involved in the investigation.
In certain clinical situations, a sampling of uterine lining tissue is a helpful clinical evaluation. Indications for this procedure include recurrent pregnancy loss, certain cases of irregular ovulation and abnormal uterine bleeding. During this procedure, a small amount of tissue is taken from the uterus using an office- based procedure. This biopsy is performed using a soft, plastic biopsy catheter inserted into the uterus during pelvic exam. Betadine or other antiseptic solution is used to minimize risk of infection with this procedure. A nonsteroidal anti-inflammatory such as Ibuprofen is administered one hour prior to the biopsy to minimize discomfort.