Diagnosis of Infertility in Women
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The chance of a normally fertile conceiving after 6 months of trying is 50%-65%. The chance after 12 months is >85%. The chance after 18 months is >95%.
Typically, a diagnosis of infertility is not made until after at least one year of attempted conception in a healthy couple. The diagnosis can be made earlier if there are known risk factors for infertility, irregular menstrual cycle, or older age.
When you see your healthcare provider, he or she will ask about your symptoms and will take a detailed family and medical history. You should expect questions about:
- Your menstrual history
- Your pregnancy history
- Use of contraceptives
- Your history of sexually transmitted diseases or reproductive tract infections
- Your current sexual patterns
- Any medications you may be taking or have taken in the recent past
- Your surgical history
- Any other health problems
- Your lifestyle and work environment
Your healthcare provider will also perform a complete physical exam, which may include a pelvic exam, ]]>Pap smear]]> , and examination of your breasts.
Ovulation Tests and Tests of Ovarian Function
Several different tests are used to see if you have been ovulating and to predict when you might ovulate again. Ovulation testing is also used to assess your ability to produce eggs and to determine if your uterus is receptive to pregnancy during the second half of your menstrual cycle (after ovulation and just before your period, known as the luteal phase).
Basal body temperature (BBT) —Taking your BBT (at rest, when you first wake up) and recording it on a chart is a way to document whether you have ovulated and when ovulation has occurred. Your BBT rises at ovulation and remains elevated during the second half of your cycle and throughout pregnancy.
Blood tests —Blood tests are used to measure hormone levels. Blood concentrations of estrogen and luteinizing hormone (LH) rise just before ovulation. High blood concentrations of the hormone progesterone indicate that ovulation has occurred. Your physician may also measure other hormones to make sure that your endocrine (hormone) function is normal.
Ultrasound —Ultrasound is used to track the growth of the follicle, which is the place in the ovary where the egg matures. The follicle grows during the first half of your menstrual cycle (from the beginning of your period until ovulation), which is known as the follicular phase.
Endometrial biopsy —This test is performed after day 21 of your menstrual cycle. A small amount of tissue from the endometrium (the lining of the uterus) is removed to see if the uterine lining is thick enough for a fertilized embryo to implant.
Tests of Ovarian Function
Day 3 FSH —This blood test is taken on day 3 of your menstrual cycle (the third day of bleeding). It measures the concentration of follicle-stimulating hormone (FSH), a hormone produced by the pituitary gland that controls the development of eggs. High levels of FSH may indicate that a woman’s ovaries are not working properly; low levels of FSH can prevent a woman from producing eggs. Your physician will interpret your results for you.
Day 3 estradiol tests —This blood test measures the amount of estrogen (also called estradiol or E2) in your blood. Levels that are unusually high may indicate poor egg quality.
Day 21 serum progesterone —This blood test measures circulating progesterone, which should be elevated about 1 week after ovulation. Levels that are low may indicate suboptimal ovulation
Transvaginal ultrasound —A transvaginal ultrasound, in which an ultrasound device is inserted into the vagina, may be performed several days after a rise in LH to determine if ovulation has occurred.
Diagnosing Uterine and Other Physical Abnormalities
Several tests can be performed to determine whether the anatomy of the uterus, fallopian tubes, and vagina is normal.
Pelvic exam —A pelvic exam can reveal many abnormalities, including conditions such as uterine fibroids. Fibroids are benign, muscular tumors in the uterine wall that can contribute to infertility by distorting the uterus, blocking the cervix or fallopian tubes, or interfering with uterine blood supply needed for the embryo to implant and grow.
]]>Hysterosalpingography (HSG)]]> —An HSG is an x-ray of the uterus and fallopian tubes that is usually performed in the first half of the menstrual cycle. Water- or oil-based dyes are used to identify structural abnormalities in the uterus or fallopian tubes.
Transvaginal ultrasound —An ultrasound device is inserted into the vagina to take a "picture" of the pelvic organs.
Hysteroscopy —During this procedure, a hysteroscope (tiny telescope mounted with a fiber optic light) is inserted through the cervix to look inside the uterus and identify abnormalities that may have appeared in an HSG.
]]>Laparoscopy]]> —This is a surgical procedure, performed under general anesthesia, in which the doctor inserts a small camera and fiber optic light through a small incision in your navel. This allows the doctor to get a clear view of your pelvic cavity, including your ovaries, the outside of your fallopian tubes, and uterus. If certain abnormalities are found, such as adhesions or ]]>endometriosis]]> , a laser mounted on the scope can be used to remove them.
Sonohystogram —This ultrasound procedure uses saline (salt water) to inflate the uterine cavity to allow for careful examination of the uterus.
American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/ .
American Society for Reproductive Medicine website. Available at: http://www.asrm.org/ .
Infertility. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/infertility.html
RESOLVE: The National Infertility Association website. Available at: http://www.resolve.org/site/PageServer .
Last reviewed November 2008 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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