Semen analysis: the male partner is often tested early in the evaluation as it is a test that easy to perform and generally of low cost. In 20% of infertile couples, the infertility appears to be exclusively attributable to the male partner and in 40 % of couples the male is partly responsible.
Documentation of ovulation: A variety of methods exist to document that a woman is ovulating. A common approach is to test at home with basal body temperature chart (BBTs) or ovulation predictor kits (OPKs), which can be obtained over the counter at the pharmacy. Unfortunately these methods are not sufficiently precise or accurate. A better test, in our experience, is a simple blood test called progesterone, which can be drawn approximately one week prior to the next anticipated menses. An alternative is to do an ultrasound, but generally this is not necessary and more expensive than the blood test for progesterone. A lack of ovulation as predicted by a low progesterone level may be found in up to 20% of infertile women and can be relatively easy to treat.
Documentation of normal female anatomy: The uterus should ideally be free of tumors that are large and/or near the endometrium, which is the site of embryo attachment. Additionally the tubes should be free of obstruction and freely mobile in order to capture an egg efficiently. A combination of tests may be necessary to fully evaluate all of these factors. An ultrasound is a commonly performed at the first visit. The purpose of the ultrasound to exclude the presence of uterine tumors, ovarian cysts, and estimate the number of eggs contained within the ovaries (preantral follicle count).
Commonly the next test is a hysterosalpingogram (HSG), which is scheduled on a different day. If the tubes are closed, the sperm cannot reach the egg and fertilization will not occur.
Lastly, a laparoscopy can be performed and is typically the last test of normal anatomy to be scheduled. This test is actually an outpatient surgery to identify endometriosis or scar tissue that can interfere with conception in a variety of ways.
Other miscellaneous tests. Based on a couple’s history, the age of the female, or the test results from the above testing, additional tests may be ordered. These include:
Follicle stimulating hormone (FSH). Elevations of this hormone are generally not good as it indicates a limited number of eggs remaining within the ovaries
Antimullerian hormone (AMH). Diminished levels of this hormone are another indicator of limited egg number.
Semen profile. This is a more sophisticated sperm test than an ordinary semen analysis. It is often used as a follow up to an abnormal semen analysis and is performed when decisions are needed as to whether a procedure such as in vitro fertilization is necessary.
Individuals with irregular ovulation should be tested with a variety of blood tests. These tests look for a variety of hormones that could explain the irregular or absent periods, and could be a clue to a simple treatment, such as hyperthyroidism (high thyroid levels) or hypothyroidism (low thyroid levels). One important test looks for an abnormality of blood sugar (glucose) levels and can be important for the baby’s and mother’s health. Control of abnormal blood sugar levels is best accomplished prior to conception.
