Tests to Diagnose Infertility in Women

If you have been unable to conceive post having sexual intercourse without contraception for at least a year, you may be experiencing Infertility. This inability to conceive could be related to various reasons such as; age, gender, medical history, comorbidity, either associated with one partner or both.

It is important to note that 3 out to 10 times, infertility may be related to an underlying issue with the male partner, while 4 out to 10 times it may be associated with the female partner. Sometimes it is a mix of conditions associated with both partners. And sometimes it is just unexplained.

At CReATe West Fertility, the team of fertility specialists will diagnose the underlying cause(s) of your infertility, which may be related to reproductive age, egg or sperm production and motility, medical history of STDs, fibroids, polyps, or blockages with the fallopian tubes, hormonal imbalances or complications due to endometriosis and early menopause.

When should I see a fertility specialist?

If you are planning to start a family, and are facing difficulties conceiving, you should consult a fertility specialist. Your treatment plan and the specialists recommendations may depend on your reproductive age:

• Up to 35 yrs of age: Most doctors recommend trying to get pregnant for at least a year before testing or exploring treatment options.
• If you’re between 35 and 40, discuss your concerns with your doctor after six months of trying.
• If you’re older than 40, your doctor may want to begin testing or treatment right away.

Major causes of infertility in women

Female infertility may be caused by one or more of the factors below:

• Hormonal imbalances
• Ovulation disorders such as Polycystic ovary syndrome (PCOS), Hypothalamic dysfunction, Premature ovarian failure, or high prolactin leading to reduced estrogen production.
• Damage to fallopian tubes (tubal infertility). This could be due to pelvic inflammatory disease, a previous surgery involving the abdomen or the pelvis, ectopic pregnancy, or pelvic tuberculosis.
• Endometriosis - when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may block fallopian tubes and keep an egg and sperm from uniting. It can also disrupt the implantation of the fertilized egg.
• Uterine or cervical causes such as benign polyps or tumors, uterine abnormalities present from birth or cervical stenosis
• Unexplained fertility - A combination of several minor factors in both partners could cause unexplained fertility problems.

Other factors such as age, insulin - resistance or lifestyle habits such as smoking or alcohol usage and co-morbidities such as obesity and sexually transmitted infections can also contribute to or enhance infertility.

Tests to diagnose Infertility in Women

Post your medical consultation with your fertility specialist, you will be advised to go through a few diagnostic procedures to deduce the cause(s) of infertility. These tests can be divided into 3 categories:

1. Tests for Hormone Evaluation

Hormones play a pivotal role in the reproduction cycle as they regulate egg development, ovulation, fertilization, and implantation. Hormone levels can be dependent on reproductive age, comorbidities as well as previous medication or treatment plans. Any imbalance can cause infertility; hence your fertility specialist will recommend some blood tests to evaluate ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes.

Your doctor will order an assessment for Luteinizing Hormone (LH) Follicle Stimulating Hormone (FSH), Estradiol, Progesterone, Prolactin, Thyroid Stimulating Hormone (TSH), Total Testosterone and/or DHEA-S to list a few.

2. Tests for Ovulation

This is done through transvaginal sonography - an ultrasound probe placed in the vagina allows the clinician to check the uterus and ovaries for abnormalities such as fibroids and ovarian cysts. Patients can be advised timed intercourse depending on the day of their ovulation. Medication if required, may be prescribed to induce ovulation.

3. Tests for Reproductive Organs (Tubal Status and Uterine Cavity)

These tests are done to assess if your fallopian tubes, uterus, ovaries are healthy for the planned pregnancy. They can be a combination of non-invasive diagnostic tests to invasive surgical procedures to ascertain the reasons causing infertility.

• Ultrasound
  This test checks the condition of your uterus and ovaries to ascertain if the follicles in the ovary are working normally. This test may be ordered 15 days before a woman’s expected menstrual cycle.
• Sonohysterography (Uterine Cavity Check)
  This diagnostic test detects intrauterine problems such as endometrial polyps and fibroids in addition to checking the condition of your uterus, ovaries, and ovary follicles If an abnormality is seen, a hysteroscopy is typically done.
• Hysterosalpingography
  Hysterosalpingography evaluates the condition of your uterus and fallopian tubes and detects blockages or other problems. X-ray contrast is injected into your uterus, and an X-ray is taken to determine if the cavity is normal and to see if the fluid spills out of your fallopian tubes.
• Hysterosonogram (Tube Check)
  A Hysterosonogram is one of the ways to evaluate the inner lining of the uterus, the endometrium. This is a procedure for women who have abnormal or excessive bleeding
• Hysteroscopy
  Hysteroscopy can help diagnose and treat abnormalities inside the uterine cavity such as polyps, fibroids, and adhesions (scar tissue). This is a surgical procedure in which a lighted telescope-like instrument (hysteroscope) is passed through the cervix to view the inside of the uterus.
• Laparoscopy
  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. This is a surgical procedure in which a lighted telescope-like instrument (laparoscope) is inserted through the wall of the abdomen into the pelvic cavity.