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Infertility Center

Infertility Diagnosis

Some couples first talk to their family doctor when concerned about infertility issues. Others meet with an obstetrician/gynecologist (OB/GYN). Or some go directly to see a fertility specialist , also called a reproductive endocrinologist (RE), who can offer a full range of services-from the basic evaluation and diagnosis of the problem to treating it. In generally, fertility specialists are OB/GYNs who have completed additional training in advanced assisted reproductive therapies (ART).

Fertility awareness
Before performing any infertility tests, it might also help to learn about fertility awareness methods and identify the best time(s) to become pregnant. Some couples find that they have been missing the most fertile days when trying to become pregnant. A woman should keep a record of her menstrual cycle and when she ovulates. This record will help the doctor if the couple decide to have infertility tests.

Medical history
You can set up a meeting with a doctor or specialist and bring your partner as you begin to explore infertility issues. The doctor will review medical history and records looking for factors that might explain potential causes for infertility. The doctor will ask questions about your sex life, your birth control methods, any sexually transmitted disease (STDs), medicine use, and the use of caffeine, tobacco, alcohol, or illegal drugs. A woman's menstrual cycle and exercise patterns will be analysed as well.

Medical exams
Based on the information provided, a doctor should have a sense of whether or not a person is at particular risk for having a fertility problem. They can then begin to discuss potential testing options. If STDs are suspected, more tests may be done.

Blood or urine tests

  • Antibody blood tests - may be done to find antisperm antibodies in blood, semen, or vaginal fluids.
  • Follicle-stimulating hormone (FSH) - this test may be used to check a woman's egg supply (ovarian reserve) or for men with a very low number of sperm to determine the source of the problem.
  • Luteinizing hormone (LH) and progesterone tests - these tests may be done during a woman's menstrual cycle to see whether she is ovulating, or not. Home LH urine test kits can be used to verify when ovulation occurs. Sometimes a woman's basal body temperature (BBT) is also checked at the same time. LH may be checked in a man to see whether he has a pituitary gland problem.
  • Prolactin - this test for a hormone made by the pituitary gland and may be ordered if a woman experiences menstrual cycle or ovulation problems.
  • STDs tests - these tests may include urine samples or samples from the cervix or urethra.
  • Testosterone tests - used to detect problems with the testicles or pituitary gland, preventing a man from being able to father a child. A low amount of testosterone can lead to low sperm counts.
  • Thyroid function tests - check for thyroid hormone problems that may be preventing ovulation.

Genetic tests - Karyotyping is a blood test that looks for problems in the genetic material (chromosomes) in the cells. Some genetic problems cause miscarriages or make it hard to become pregnant.

Imaging tests

  • Hysterosalpingogram - an X-ray test that looks at the inside of the uterus and the fallopian tubes. The pictures can show a blockage of the fallopian tubes that would prevent an egg from reaching the uterus or prevent sperm from moving into a fallopian tube to join (fertilize) an egg. This test may also see problems on the inside of the uterus that might prevent a fertilized egg from attaching (implanting) to it.
  • Pelvic ultrasound - looks at the size and structure of the uterus and both ovaries. It can also check the condition and size of the ovaries during treatment for infertility.
  • Sonohysterogram - an ultrasound test that uses saline and ultrasound to look at the female reproductive organs.
  • Ultrasound - uses sound waves to make a picture of structures inside the body. It may be done to see whether a problem in the testicles is causing a problem with the sperm.

Medical procedures

  • Endometrial biopsy - a biopsy of endometrial tissue is done to take out a small piece of the uterine lining (endometrium) to see whether the lining has normal changes during the menstrual cycle.
  • Hysteroscopy - a procedure that looks at the lining of the uterus using a thin, lighted scope that is put through the vagina and cervix into the uterus. Hysteroscopy is used to find problems in the uterine lining. Sometimes your doctor can use small tools during the procedure to take out growths or take samples of tissue (biopsy) or open a blocked fallopian tube.
  • Laparoscopy - a procedure to look at a woman's pelvic organs (uterus, fallopian tubes, and ovaries) using a thin, lighted scope that is put through a small cut (incision) in the belly. This procedure is used to find cysts, scar tissue (adhesions), fibroids, and infections that can affect fertility. Laparoscopy can also be used to treat conditions, such as endometriosis. Laparoscopy is usually done with general anesthesia.
  • Testicular biopsy - in rare cases, when men have no sperm in their semen, a testicular biopsy may be done to check the sperm in the man's testicles.

Physical examination
A woman's physical examination usually includes a pelvic examination and Pap test. A man's physical examination usually includes a testicular examination. Not all fertility doctors will do a physical examination of the man. If there are problems with the semen, the doctor may refer the male partner to a urologist.

Postcoital test - checks a woman's cervical mucus after sex to see whether sperm are alive and able to move normally through the mucus. This test must be done the day before or the day of ovulation. Many doctors question the value of the postcoital test to check for infertility. It is not done very often.

Semen analysis - checks the number of sperm (sperm count), the number of sperm that look normal, the number of sperm that can move normally, the number of white blood cells in the semen, and how much semen is made.

Sometimes tests cannot find the cause of infertility and not all infertility problems can be treated. Other times, infertility tests may identify potential causes for fertility problem can sometimes include treatment during the tests. Infertility in men is often less successfully treated than infertility in women. But a woman may still be able to become pregnant using assisted reproductive technology, which can treat male or female problems. To learn more about how doctors treat infertility , and infertility options to conceive ntinue reading the next section on "Infertility Treatment" that follows.

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