Treating infertility takes teamwork. We encourage both male and female partners to participate in an infertility evaluation, a step-by-step process that typically takes one to two months. A thorough evaluation of you and your partner may determine the cause of your infertility and help our specialists recommend the most appropriate treatment. Sometimes the causes are readily detectable. Other cases require more in-depth testing.

This testing may begin with your medical history, a review of records of previous treatment and testing, and in-depth questions. These questions may include the following topics: previous infertility experience, previous surgical procedures, any infertility tests already performed, occupational risks, history of sexual development, use of birth control, previous pregnancies, sexual practices, and any current complaints, such as weight gain. Alcohol and/or tobacco use and history is also thoroughly explored.

For the female partner, this would include the regularity of your menstrual periods, cramping, pelvic pain, bleeding, discharge or genital infection. For the male partner, this will include genital injury and/or infection, surgery, past history of infertility (if any), and medication or drug usage.

The female partner’s physical exam may include a pap smear, pelvic exam, cervical cultures, urine analysis, blood tests, and pelvic imaging. The male partner will undergo a semen analysis and a general physical exam if indicated.

Diagnostic tests will help to determine the cause of infertility in the reproductive process. The major components of the reproductive process include production and delivery of sperm, the ovulatory cycle, fertilization and implantation. After a history and physical exam have been performed, the physician will order the appropriate blood tests. These may include:

Reproductive Hormone Tests

Any or all of the following blood tests may reveal clues to infertility: FSH, LH, prolactin, progesterone, estradiol, thyroid function tests, testosterone, and androstenedione. After basic hormonal tests are performed, the physician will review the results and order other diagnostic tests, if appropriate.

Basal Body Temperature (BBT)

The BBT is a measure of the female’s body temperature. In most women, body temperature prior to ovulation is low (97.2 to 97.4 degrees) and it rises to more than 98 degrees just after ovulation. This temperature rise is due to the production of the hormone progesterone following ovulation.

Beginning with the first day of menstruation, the woman should take her temperature immediately upon awakening each morning. Special thermometers that show a range of just a few degrees are more accurate. The woman should record the daily temperature, along with other events such as intercourse, bleeding, sleepless nights, or an illness. A slight temperature rise (more than half a degree) at approximately mid-cycle indicates that ovulation could have occurred. Due to advances in technology, this test is rarely requested by physicians.

Luteinizing Hormone (LH) Monitoring

LH testing may be used in addition to BBT charting. Measurement of daily blood LH levels is the most reliable predictor of an LH surge. This surge is an important event, since ovulation normally occurs about 12-36 hours after detection. While daily blood testing to determine serum LH levels is both inconvenient and costly, simple, inexpensive urinary LH ovulation kits for home use have become readily available and are generally reliable.

Post-Coital Test:

The post-coital (after intercourse) test determines whether sperm are able to progress through the woman’s cervical mucus. The test is timed close to the time of ovulation. After the couple has intercourse, a physician exams the woman eight to 12 hours later in the clinic. A sample of cervical mucus is examined for the quality and quantity of mucus and for the presence of active sperm.

Endometrial Biopsy:

This test requires the removal of a small sample of tissue from the lining of the uterus. The test determines if the uterine lining is properly developed to allow implantation of a fertilized egg or may be used to rule out inflammation of the lining leading to infertility or miscarriage.

Semen Analysis:

For semen analysis, the male produces a semen sample through masturbation or through intercourse using a special condom which does not have spermicidal chemicals. A lab specialist examines the semen sample for volume of the ejaculate, concentration of sperm, motility and morphology (size and shape) of the sperm cells, and survival ability.

Cultures for Chlamydia and Mycoplasma:

A swab of the cervix yields a culture for detecting these infectious agents, which are associated with infertility in both men and women. Research has shown chlamydia to be a cause of tubal infection in women. Mycoplasmas are associated with decreased sperm motility, antisperm antibodies, and abnormal egg penetration.

Immunologic Testing

Immunologic factors may play a role in infertility, suggesting a need for testing. This type of testing is not routinely performed as part of infertility evaluation.

Hysterosalpingogram

This test determines if the uterine cavity is normal in size and shape and if the fallopian tubes are open or blocked. A physician introduces dye into the uterus through the cervix, and X-rays are taken to determine if the tubes are open. The female undergoes this test after a menstrual period but before anticipated ovulation, usually between days 5-12 of a menstrual cycle.

Over the course of an infertility evaluation, diagnostic clues appear. By the conclusion of the investigation, a physician has a better idea of the possible causes of infertility in the majority of couples.

In some couples, infertility is due to one specific factor such as low sperm count, fallopian tube damage, ovulatory dysfunction or endometriosis. In other couples, a variety of factors may be present. Other diagnoses that may cause infertility include improper sexual technique, smoking, alcohol or drug use. In a small percentage of couples, there is no apparent cause for infertility.

Once the evaluation process is complete, the physician meets with the patients to discuss the diagnosis and the appropriate treatment options. In addition, at RSC, our nurses, counselors and financial staff are available to provide patients support and guidance in making decisions.