Fertility tests for women
The following tests may be recommended as part of
your initial infertility evaluation:
How is Ovulation Detection and Assessment done?
Urinary Luteinizing Hormone (LH)
Over-the-counter ovulation predictor kits detect the presence of LH in urine and can
detect a rise in this hormone that occurs one to two days before ovulation. In contrast to
blood progesterone levels, urinary LH tests can predict ovulation before it occurs.
Urinary LH testing helps define the times of greatest fertility: the day of the LH surge
and the following two days. However, these tests can be expensive and should only be
used by women with menstrual cycles that are consistently 25-35 days in length.
What is Ovarian Reserve Testing?
When attempting to test for a woman’s ovarian reserve, the clinician is trying to predict
whether she can produce an egg or eggs of good quality and how well her ovaries are
responding to the hormonal signals from her brain. The most common test to evaluate
ovarian reserve is a blood test for follicle stimulating hormone (FSH) drawn on cycle day
- In addition to the FSH level, your physician may recommend other blood tests, such
as estradiol, antimullerian hormone (AMH), and/or inhibin-B, as well as a transvaginal
ultrasound to do an antral follicle count (the number of follicles or egg sacs seen during
the early part of a menstrual cycle).
Ovarian reserve testing is more important for women who have a higher risk of reduced
ovarian reserve such as —
Other Blood Tests:
Thyroid-stimulating hormone (TSH) and prolactin levels are useful to identify thyroid
disorders and hyperprolactinemia, which may cause problems with fertility, menstrual
irregularities, and repeated miscarriages. In women who are thought to have an
increase in hirsutism (including hair on the face and/or down the middle of the chest or
abdomen), blood tests for dehydroepiandrosterone sulfate (DHEAS), 17-α
hydroxyprogesterone, and total testosterone should be considered. A blood
progesterone level drawn in the second half of the menstrual cycle can help document
whether ovulation has occurred.
The following tests are for evaluating the patency of your
fallopian tubes and uterus:
What is Hysterosalpingogram (HSG)?
Hysterosalpingogram is an X-ray procedure to see if the fallopian tubes are open and if
the shape of the uterine cavity is normal. A catheter is inserted into the opening of the
cervix through the vagina. A liquid containing iodine (contrast) is injected through the
catheter. The contrast fills the uterus and enters the tubes, outlining the length of the
tubes, and spills out their ends if they are open.
What is Sonohysterography?
Sonohysterography is a procedure that uses transvaginal ultrasound after filling the
uterus with saline (a salt solution). This improves detection of intrauterine problems
such as endometrial polyps and fibroids compared with using transvaginal
ultrasonography alone. If an abnormality is seen, a hysteroscopy is typically done. This
test is often done in place of HSG.
What is Transvaginal Ultrasonography?
A Transvaginal Ultrasonography is an ultrasound probe placed in the vagina allows the
clinician to check the uterus and ovaries for abnormalities such as fibroids and ovarian
cysts.
What is Hysteroscopy?
Hysteroscopy is a surgical procedure in which a lighted telescope-like instrument
(hysteroscope) is passed through the cervix to view the inside of the uterus.
Hysteroscopy can help diagnose and treat abnormalities inside the uterine cavity such
as polyps, fibroids, and adhesions (scar tissue).
Why is a Laparoscopy performed?
Laparoscopy is a surgical procedure in which a lighted telescope-like instrument
(laparoscope) is inserted through the wall of the abdomen into the pelvic cavity.
Laparoscopy is useful to evaluate the pelvic cavity for endometriosis, pelvic adhesions,
and other abnormalities. Laparoscopy is not a first line option in the evaluation of a
female patient. Because of its higher costs and potential surgical risk, it may be
recommended depending on the results of other testing and a woman’s history, such as
pelvic pain and previous surgeries.
For best results, the infertility evaluation should be individualized based on each
woman’s specific circumstances.