Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various methods to evaluate infertility.
Hi, I'm Dr. Roger Lobo with the American Society for Reproductive Medicine.
Today we're talking about the diagnosis of infertility and the basic infertility evaluation when a couple does not conceive after one year of unprotected intercourse or after six months if the woman is over age thirty-five or if there are known problems with infertility.
We recommend that both partners be evaluated, but at-home questions that a woman might be able to ask herself include:
- Are my menstrual cycles regular?
- Are they coming basically every month with a little bit of variation?
- If I track my cycles, do I ovulate every month?
A board-certified obstetrician-gynecologist can provide a basic infertility evaluation and treatments. However, many causes of infertility are best treated by a board-certified reproductive endocrinologist. If there are sperm abnormalities, then the man should be referred to a urologist who specializes in male infertility.
The basic infertility evaluation for a woman looks at her ability to produce eggs and the condition and function of her uterus and tubes. A complete medical history and physical examination are important starting points. One of the first areas to check is a woman's menstrual cycles: is she menstruating regularly, and how often? This provides clues about whether she is ovulating. An over-the-counter ovulation kit can also be used to tell if her hormones are stimulating the release of eggs. Ultrasound may also be used to measure the growth of follicles.
For women who don't have regular periods, it's important to check hormone levels. When there is too little estrogen or too much of certain other hormones, ovulation can be affected. A test for ovarian reserve can check the number and quality of eggs remaining in the ovaries, which is important for the potential for a pregnancy.
Another important diagnostic test is a hysterosalpingogram (HSG). This X-ray procedure is performed to find out if the fallopian tubes are open and to see if the shape of the uterus is standard. A small tube is inserted through the cervix, and dye enters the uterus and flows out through the fallopian tubes.
Another test similar to the HSG is called a saline sonohysterogram, which uses ultrasound and a water-based solution to image the inside of the uterus.
The most basic test for male fertility is a semen analysis. Men are asked to abstain from ejaculating for two days and then collect a semen sample, usually by masturbation. Under a microscope, the number, movement, and shape of sperm are examined. If the sperm count is low, a repeat sample is requested.
When the results of all these tests are in, the couple and their physician can set up a plan for treatment or order additional tests if necessary.
To learn more, check out our other videos on fertility, including treatments for infertility.