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Female Fertility Testing

When a couple have been unsuccessful at achieving pregnancy after one year, both partners need to go through a comprehensive physical and medical assessment. Tests for female infertility and a semen analysis should start immediately. Because male factors account for approximately 50% of all infertility cases, it is important to examine both partners for possible infertility issues.

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What is the process for female fertility testing?

Ideally, you will have already begun tracking your ovulation through fertility awareness or a fertility monitor. This will provide your reproductive specialists with valuable information about your ovulation. Usually the first question regarding female fertility is whether you are ovulating or not.

The first test performed by fertility specialists usually involves measuring your follicle stimulating hormone (FSH) and luteinizing hormone (LH) in order to establish a baseline. This is normally performed on the third day of your cycle during your first visit.

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Your second visit will occur on the day of the LH surge, which is before ovulation in most cases. During your first cycle, it is common for your fertility specialists to perform the following tests:

• Cervical mucus tests: This involves a postcoital test (PCT) which determines if the sperm is able to penetrate and survive in the cervical mucus. It also involves a bacterial screening.

• Ultrasound tests: This is used to assess the thickness of the lining of the uterus (endometrium), to monitor follicle development and to check the condition of the uterus and ovaries. An ultrasound may be conducted two to three days later to confirm that an egg has been released.

• Hormone tests: These tests are done to assess the various hormone levels that contribute to the reproductive process. These hormone tests include the following:
  • Luteinizing Hormone
  • Follicle Stimulating Hormone
  • Estradiol
  • Progesterone
  • Prolactin
  • Free T3
  • Total Testosterone
  • Free Testosterone
  • DHEAS
  • Androstenedione

If both the semen analysis and the above testing return normal results, there is also additional testing that your fertility specialists may recommend. These tests include any of the following:

• Hysterosalpingogram (HSG): This is an x-ray of your uterus and fallopian tubes. A blue dye is injected through the cervix into the uterus and fallopian tubes. The dye enables the radiologist to see if there is blockage or some other problem.

• Hysteroscopy: This is a procedure that may be used if the HSG indicates the possible presence of abnormalities. The hysteroscope is inserted through the cervix into the uterus, which allows your fertility specialist to see any abnormalities, growths, or scarring in the uterus. The hysteroscope allows the physician to take pictures which can be used for future reference.

• Laparoscopy: This is a procedure that involves the use of a narrow fiber optic telescope. The laparoscope is inserted into a woman’s abdomen to provide a view of the uterus, fallopian tubes, and ovaries. The physician will be checking for endometriosis, scar tissue or other adhesions. It is important to confirm that you are not pregnant before this test is performed.

• Endometrial biopsy: This is a procedure that involves scraping a small amount of tissue from the endometrium just prior to menstruation. This procedure is performed to determine if there is a hormonal imbalance. It is important to confirm that you are not pregnant before this test is performed.

These tests are not mandatory and your fertility specialists will know which tests to recommend in your situation.

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