Several fertility tests are ordered to rule out the common causes of infertility. Even if one cause is known (such as blocked fallopian tubes), the basic tests will still be done because oftentimes there is more than one cause of infertility.
Male infertility is present in almost half of infertile couples. The semen analysis documents that enough quality sperm are present to cause fertilization. Our lab uses the Kruger Strict Criteria for evaluating sperm, which is the "gold standard".
Levels of FSH, LH, and estrogen are measured on day three of your menstrual cycle. High FSH levels are an indication of decreased egg quality. Anti-mullerian hormone levels, which also assess ovarian reserve, are often measured. The Clomid Challenge Test may be administered to further assess ovarian reserve. Androgen levels are measured to rule out conditions such as PCOS. Thyroid hormones will be measured to rule out " hyper" or "hypo" thyroidism.
You must ovulate regularly to achieve pregnancy. Ovulation can be monitored/predicted by using a basal body temperature chart (BBT). We rarely use BBT measurements because the urinary LH test kits are much more accurate (Clearblue Easy).
The progesterone level is measured because it increases after successful ovulation.
Development of the Endometrium
The lining of the uterus (endometrium) must thicken and become more vascular during the ovulatory cycle to support the embryo’s implantation and provide nourishment. The hormones estrogen and progesterone are measured because they support endometrial development. The width of the endometrium may be measured using ultrasound and an endometrial biopsy may be performed.
Evaluation of the Fallopian Tubes
Your tubes must be open for the eggs to travel from the ovaries to the fertilization site at the end of the fallopian tube. The hysterosalpingogram (HSG) involves following the flow of dye from the uterus through the tubes using X-ray images. Laparoscopy is also used to assess the health of the tubes and other reproductive organs.
The cervical mucus may be evaluated to determine if it has the correct consistency for sperm to swim through the vagina into the uterus. The post coital test may also be performed to learn if antisperm antibodies are present.
Evaluation of the Uterus
Uterine Cavity The uterus is examined using hysteroscopy /saline sonogram/and/or laparoscopy to insure there are no large polyps or fibroids and that is shaped normally.
Genetic Testing If you are at risk for a genetic disease, genetic testing may be considered. Many genetic conditions can be identified in the embryo using IVF/PGD. Only embryos without the defect are transferred to the uterus.