Knowing what is causing your problem is an important part of fertility management. If a cause can be identified through investigation then specific treatment can be used to reduce the adverse impact of the particular cause and increase the prospects of successful pregnancy.
There are a wide range of tests which will help uncover the problems preventing pregnancy. These range from quite simple non-invasive tests such as tracking the timing of ovulation through to minor surgical procedures to look inside the pelvis or extract sperm from the testis.
The main aim of the investigation of infertility is to find a cause. However the methods used to assess female reproductive anatomy often coincidentally permit the treatment of a number of causes.
Types of investigations
- Ovulation tests
- Tests of female reproductive organs
- Sperm tests
- Tests of male reproductive organs
- Tests for embryo implantation
- Genetic tests
Ovulation tests
Tests of ovulation are designed to determine if the normal processes are occurring. This usually involves a retrospective assessment of whether ovulation has occurred by hormone testing. Normally the hormone progesterone has been produced as a result of ovulation. Measuring the level of progesterone in the second half of the menstrual cycle will usually confirm that ovulation has occurred. Ultrasound can be used prior to ovulation to see if the cystic structure in the ovary known as a follicle is visible.
Tests of female reproductive organs
Pelvic ultrasound is a useful method of determining if there are no major anatomical problems with the uterus or ovaries. This test can be performed either trough the abdominal wall or more commonly via the vagina - which gives a clearer picture. Ultrasound can be used to determine if the Fallopian tubes are open by a test known as Hystero-salpingo contrast sonography (HyCoSy). An X-Ray test called a hystero-salpingogram (HSG) can determine some uterine abnormalities and asses fallopian tube patency. For most it is wise to assess the female pelvis thoroughly exclude major diseases of the gynaecological organs and confirm fallopian tube patency by laparoscopy, hysteroscopy and fallopian tube patency tests under general anaesthesia.
Sperm tests
Sperm tests assess the number of sperm, their appearance and the ability to move freely. The basic test of sperm is a semen analysis. This involves collection of a semen sample usually by masturbation. A 3 day period of abstinence is recommended prior to providing the sample to be tested. It is also possible to asses sperm production in the testis by testing hormones. The hormones are either those produced in the pituitary gland which drive sperm production or hormones produce in the testis. Ultrasound is useful if the sperm count is quite low.
Tests of male reproductive organs
Ultrasound of the scrotum can assess the testes and adjacent tubes that connect the testis to the penis (epididymus and vas deferens), can give an indication structural abnormalities, blockages, cysts or tumours. This test is easy to perform and apart from embarrassment has no side effects. Ultrasound can also be used to assess the prostate gland and seminal vesicles which are accessory reproductive organs situated inside the body just in front of the rectum. Occasionally an X-Ray test known as a vasogram is carried out to see if the vas deferens is open.
Tests of embryo implantation
The lining of the uterus is assessed by the same tests used to determine if the female reproductive organs are normal (see above). To assess the nature of embryos it is necessary to undergo an IVF treatment so that the embryos can be visually and on occasions genetically tested.
Genetic Tests
Genetic testing is becoming increasing common particularly for the assessment of the causes of severe ovulation and sperm problems as well as recurrent miscarriage.