infertility tests and diagnosis

Before having infertility testing, be aware of the commitment that's required. Your doctor or clinic will need to determine what your sexual habits are and may make recommendations about changing them. Tests and treatment trial periods may extend over several months. In some infertile couples, no specific cause is found (unexplained infertility).

Evaluation can be expensive and in some cases involves uncomfortable procedures. Many medical plans may not reimburse the cost of fertility treatment. Finally, there's no guarantee — even after all the testing and counseling — that conception will occur.

Tests for men

For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman's vagina and be able to travel to and fertilize the egg. Tests for male infertility attempt to determine whether any of these processes are impaired.

You may have a general physical exam. This includes an examination of your genitals. Specific fertility tests may include:

Semen analysis. Your doctor may ask for one or more semen specimens. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A laboratory analyzes your semen specimen for the health of sperm and the semen fluid.

Hormone testing. A blood test to determine the level of testosterone and other male hormones is common.

Transrectal and scrotal ultrasound. Ultrasound can help your doctor look for evidence of conditions such as retrograde ejaculation and ejaculatory duct obstruction.

Genetic testing. Genetic testing may be done to determine whether there's a genetic defect causing infertility.

Testicular biopsy. This test involves removing samples from the testicle with a needle. The results of the testicular biopsy will tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport.

Other testing. In some cases, other blood or semen tests may be recommended to try to determine why the sperm may not be able to effectively fertilize the egg.

Tests for women

For a woman to be fertile, her ovaries must release healthy eggs. Her reproductive tract must allow an egg to pass into her fallopian tubes and allow the sperm to join the egg for fertilization. The fertilized egg must travel on to the uterus and implant in the lining. Tests for female infertility attempt to determine whether any of these processes are impaired.

You may have a general physical exam. This includes a regular gynecological exam. Specific fertility tests may include:

Ovulation testing. A blood test is performed to measure hormone levels to determine whether you're ovulating, if you have not had positive home ovulation tests.

Hysterosalpingography. Hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee) evaluates the condition of your uterus and fallopian tubes. X-ray contrast is injected into your uterus, and an X-ray is taken to determine if the cavity is normal and ensure the fluid spills out of your fallopian tubes. Blockage or other problems often can be located.

Ovarian reserve testing. This testing helps determine the quality and quantity of the eggs available for ovulation. This approach often begins with hormone testing early in the menstrual cycle.

Other hormone testing. Other hormone tests check levels of ovulatory hormones, as well as thyroid and pituitary hormones that control reproductive processes.

Imaging tests. Pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a hysterosonography (his-tur-o-suh-NOG-ruh-fee) is used to see details inside the uterus that are not seen on a regular ultrasound.

Depending on your situation, rarely your testing may include:

Other imaging tests. Depending on your symptoms, your doctor may request a hysteroscopy to look for uterine or fallopian tube disease.

Laparoscopy. This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. Laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.

Genetic testing. Genetic testing helps determine whether there's a genetic defect causing infertility.

Not everyone needs to have all, or even many, of these tests before the cause of infertility is found. Which tests are used and their sequence depend on discussion and agreement between you and your doctor.