A preliminary infertility evaluation is done to determine the probable causes of infertility. It also helps in the determination of the best possible approach for treatment. Your health specialist will take steps to get a clear understanding of your medical history and recommend various tests.
Though health issues in females are a major reason for infertility, however, in 20-25 % of cases, male factors contribute to infertility. In addition to other factors another 10 % of couples experience male infertility. Hence for a complete evaluation and diagnosis both male and female partners should undergo testing
The anxiety to start with evaluation and treatment is very common in most patients. Your first step should be to meet up with your general gynecologist or physician and perform a series of preliminary tests at the earliest. Make sure that you carry these reports with you to the infertility specialist at your first appointment.
Male Partner Test
A semen analysis is performed at the beginning of the evaluation. The male partner should provide a sample after refraining from ejaculation for at least 48 hours but should have had an ejaculation within 6 days of providing the sample.
Female Partner Tests
Female infertility can be evaluated using these baseline tests
Testing for ovulation
Ovulation occurs between Day 12-Day 18 of a regular menstrual cycle that occurs every 26 to 32 days.
Hormone Testing
On day 3 of the menstrual cycle, blood tests are performed to check for the levels of FSH(Follicle Stimulating Hormone) , E2 (Estradiol) and AMH (Anti-Mullerian Hormone).
Progesterone level
During day 20-22 of a 28 day cycle the serum progesterone level are measured
Clomiphene Citrate Challenge Test (CCCT)
Clomiphene citrate (Clomid), an oral medication, is taken on Day 5- Day 9 of the menstrual cycle an blood tests are performed on Day 3 and Day 10 to measure FSH and E2 levels.
Other Test
Your fertility specialist or gynecologist may recommend additional tests:
Pelvic ultrasound
Pelvic ultrasound is done to give doctor a better idea about uterus and its lining and any other pathologies. the ovary to determine the ovarian reserve and other problems like PCO.
Hysterosalpingogram (HSG, or tubogram)
This test is used to determine if the Fallopian tubes i.e. the tubes that connect the ovaries to the uterus are blocked. The procedure involves injecting dye into the cervix and checking if the dye can flow freely through them. The test is performed under x-ray and helps to check if the tubes are open. It also helps in an examination of the size and the shape of the uterine cavity.
Laparoscopy
Performed as an outpatient procedure, it uses a magnifying scope to look inside the abdominal and pelvic cavity. This procedure helps in the detection of adhesions or endometriosis.
Hysteroscopy
This procedure is performed to check for uterine abnormalities or polyps or scar tissues. The procedure involves inserting a small scope into the uterus through the vagina and cervix to get a clear picture of the inside of the uterus.