Testing for Fertility

Before you make an appointment at the fertility clinic, it could help to known what to expect. Keeping yourself informed about the tests that are prescribed for you will help manage anxiety to a great extent.

In investigating infertility, your doctor might start with the least invasive of procedures and then go on to the most complicated ones, to locate the problem. A physical examination is done first to check for signs of infection or physical abnormalities that may be affecting fertility.

Here are the most common procedures for testing fertility.

Pelvic Ultrasound

Doctors use this painless procedure to determine whether the woman is ovulating, and also to see if there are any problems in the pelvis and ovaries such as ovarian cysts, fibroids, and also check the uterine lining.

Blood Tests

The woman (and in some cases, the man too) may be asked to undergo several blood tests to check hormone production and to measure levels of thyroid, prolactin and androgen.

Semen Analysis

The man is asked to provide a semen sample, usually by masturbating and ejaculating into a specimen jar. This is usually produced at home after abstaining from ejaculation for 2 to 3 days. Lab technicians examine his sperm under a microscope for count, shape, appearance, and movement. The following are considered a normal result:

  • Volume: 2-5 mls.
  • Concentration: more than 20 million per ml.
  • Motility: more than 50% progressively motile
  • Form: more than 30% normal appearance
  • White blood cells: less than 1 million per ml.

Two additional tests may also be used: the ‘swim-up’ test, which allows the percentage of normal sperm to be established, and microscopic photography, which checks the distance the sperm travel.

Post-Coital Test

This procedure evaluates the interaction between cervical mucus and sperm. You and your partner will be asked to have intercourse on a certain day of your menstrual cycle. Within twenty-four hours, your doctor will take a mucus sample for testing. He/ she looks for any antibodies in the mucus that might be impeding the sperm’s progress, and also at how vigorously they move.

Anti-Sperm Antibody Test

Antibodies normally fight infections, but sometimes a man produces antibodies that bind to his own sperm, either reducing the motility or interfering with fertilisation of the egg.

Detecting Anti-sperm antibodies is usually fairly simple as a semen analysis should be able to identify whether the antibodies are present. It is also possible to do an individual test that looks specifically for Anti-sperm antibodies on sperm or, in the woman’s cervical mucus.

Hysterosalpingogram (HSG)

This X-ray procedure allows a doctor to see whether the woman’s Fallopian tubes are open. The doctor injects a dye through the cervix and into the uterus and Fallopian tubes and traces its movement by X-ray.

Endometrial Biopsy

This outpatient procedure is used to assess the texture of the woman’s uterine lining and also determine whether she is ovulating. A catheter is inserted through the cervix and a small sample (biopsy) of the uterine lining removed to check if it has thickened in preparation for a developing embryo. The test can also be used to check for infection and if this is discovered, a D&C (Dilatation and Curettage) of the endometrium under general anaesthetic may be needed.

Laparoscopy

This outpatient surgery performed under general anaesthesia provides a view of the woman’s pelvic organs. Your doctor will be looking for signs of endometriosis or scarring.

In 25 % of cases, more than one factor causes infertility, and some causes are harder to detect than others. In 5 to 10 % of cases, testing reveals no abnormalities at all. Doctors characterize those patients as having unexplained infertility.

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