December 28, 2006

Evaluation/Test of Female Infertility


Infertility Evaluation process involves several steps. The steps in the evaluation portion of the process will include a complete history, physical examination and specific tests that should be clearly outlined by your physician at your first visit.The physician should provide her patient with the following information:The 4 Goals In The INFERTILITY EVALUATION for women are:

To determine potential causes so that effective therapy can be given.
To dispel misinformation and provide accurate information.
To create an environment of emotional support.
To determine the proper time of discontinuing investigation and treatment.

1) To determine potential causes so that effective therapy can be given.
Inability to conceive can be very frustrating & depressing , more so when the "trying time" has been going on for too long . We completely understand that motherhood is a blessing for every women. In the light of the same WF health & fitness experts will try in the best of their capacity to answer your innumerable doubts and questions through this article so as to facilitate you in taking a decision to overcome this crisis .

To understand the possible causes it is important that you consult a doctor who will go into a complete medical, surgical, sexual, social and family history, as a part of initial evaluation.
Possible questions your doctor might ask includes;

Your medical history includes questions concerning illnesses or diseases you & your partner have had or have including what medications, both prescription and over-the-counter preparations you currently use.
Consumption of tobacco products, alcohol, marijuana or other street drugs. Also the amount of caffeinated beverages you drink may be asked as all of these may adversely affect reproduction.
Questions about your previous contraceptive practices such as use of an Intrauterine Device (IUD) .Your occupation and your potential exposure to environmental hazards such as pesticides, heavy metals like mercury and lead, organic solvents, hot tubs and saunas.
Frequency of sexual intercourse.
How long you have been attempting pregnancy .
Your partners inability to achieve or sustain an erection (impotence) can also be a factor, as can pain on ejaculation if you experience or pain with intercourse, which is called (dyspareuia).
A history of previous pelvic infections or sexually transmitted diseases .
Your physician will also ask you questions concerning your menstrual history such as how old were you when you got your first period, when was your last period, how often does it come and how many days does it usually last. You may also be asked whether you experience premenstrual symptoms called molimina, which usually indicate ovulatory (egg release from the ovary) cycles. Moliminal symptoms often include breast tenderness, fluid retention (swelling) and irritability and pelvic discomfort experienced approximately 2 weeks before your period (mid-cycle pain or Mittleshmeritz) may also indicate ovulation. If you experience this, you will be asked if you take medications for this mid-cycle pain.
Questions concerning your bowel and bladder habits and whether you experience pain or bleeding with these .
How you and your partner are dealing with the intense emotional issues involved with infertility as it can be a life crises for many couples.

2) To dispel misinformation and provide accurate information.
It must be the goal of a health provider to help patient in doing away with the misconceptions regarding fertility/infertility and provide them easy to understand accurate information. To begin with they need to be listened to, before starting upon any advice . It is very important to understand patient's state of mind, put their doubts at rest and provide them with essential information.

3) To create an environment of emotional support.
Emotional support is an essential part of every therapy , more in the case of women suffering from this life crisis. Feeling alone, anxious, or even out of control are common reactions. The woman should be convinced that her behavioral reactions are normal and unpreventable .It might seem hard to seek out emotional support because of the fear of being left emotionally out of control at a time when they are already experiencing an enormous loss of control around their body’s ability to perform a basic function.

Try to come out with your problem and discuss it with your friend or a counselor. For some meeting with a group of individuals struggling with infertility is more comfortable. A counselor can help with questions about multiple pregnancy, pregnancy loss, and when and whether to start or stop treatment. Having a regular place to “leave” your emotional burdens can also help free you up to enjoy life more fully and spend less time obsessing about infertility

Whatever you decide, know that you are not alone in this struggle if you don't want to be, and feel free to talk with us about your frustrations and fears.

4) To determine the proper time of discontinuing investigation and treatment.
Treatment prescribed by the gynaecologist might need to be repeated in 6-7 cycles. If results are not achieved, your doctor might advice to other treatments options available.


There are many potentially useful tests that can be obtained as part of the infertility evaluation for women. However, therapeutic options largely depend on the results of three fundamental tests:
Uterine Structural Tests (i.e. for patency of fallopian tubes and anatomy of uterus)
Hysterosalpingography (HSG)
Office Hysteroscopy

Ovarian Reserve Testing
This includes a Cycle Day 3 FSH or preferably, a Clomiphene citrate Challenge Test.
There are several additional tests that have been used to evaluate infertility.

Tests for Ovulation

Problems of ovulation (egg release from the ovary) account for approximately 25% of infertility and may be suggested on the basis of the history and physical examination.If your menstrual periods occur at monthly intervals and you also have breast tenderness, fluid retention, irritability and menstrual cramps, then your cycles are usually ovulatory, but not necessarily.

Therefore some test of ovulation is necessary:
Urine LH Testing
Blood LH Testing
Basal Body Temperature Graph (BBTG)
Ultrasound Monitoring
MidLuteal Progesterone Testing
Endometrial Biopsy

More Tests in the Female
There are many tests that have been designed to evaluate potential causes of infertility in women. Very few of these tests, however have been well standardized or even definitively associated with infertility. Definitive therapy relating to abnormal test results is also lacking. The following tests although sometimes suggested are generally no longer recommended as part of the basic infertility evaluation:
Post Coital Test (Sims-Huhner Test, PK)
Cervical Mucus Penetration
Cervical Cultures
Immune Testing
Hormone Testing
Diagnostic tests are guided by the history and physical examination and include simultaneous analysis of both you and your partner. Testing implies that the knowledge of the result can be used to guide therapy leading to a successful pregnancy.

There are many tests that have been suggested. However, perhaps the most cost-effective and arguably the most clinically useful are a semen analysis, an intrauterine structural study and a test of ovarian age (ovarian reserve) and tubal patency tests.

Infertility testing in women is designed primarily to determine anatomical factors, most commonly abnormalities within the uterine cavity, and problems with ovarian function and tubal patency.

Adapted from WomenFitness