Testing for Infertility When Having Trouble Conceivingby Katlyn Joy
An estimated 6.1 million American couples, or 10 percent of those of childbearing age, are infertile. Infertility is when a couple has not been successful in conceiving after a year of trying. However, if the woman is over the age of 35, help should be sought after six months of attempting to conceive.
Both the man and the woman will need to undergo evaluation for fertility issues. Men are responsible in half of all cases, so it is definitely not just a female problem. According to the American Pregnancy Association, men alone are the factor in infertility in about 30 percent of cases, and male and female factors are combined in another third of infertility cases.
Male Fertility Testing
Besides a general physical examination, a semen analysis is the most common fertility test for males. Sperm is collected in a container and sent to a lab for testing for sperm count, mobility, viability and normality. While half of male infertility cases are treatable, sometimes further testing is required.
Should the sperm count be low, testing will probably be performed to check blood testosterone, follicle stimulating hormone , luteinizing hormone and prolactin levels.
A urinanalysis may be done to check for infection which would result in white blood cells in the urine. Sperm in urine would indicate retrograde ejaculation.
Occasionally more detailed testing is required, such as sperm agglutination where the the sperm is checked for clumping . Another less common test would be hemizona assay, which looks into the ability of sperm to penetrate an egg.
Sometimes a testicular biopsy is performed to determine how well sperm is produced, and vasography checks for leaking of sperm by way of x-ray. Ultrasound may be used to check on any damage involving the male reproductive tract.
Causes of Male Infertility
- Varicocele. The most common problem in male infertility occurs when the veins in the scrotum increase the temperature and reduce sperm production.
- A blockage in the reproductive system
- Low sperm count or abnormally shaped sperm
- Undescended testicle
A woman should be keeping track of her menstrual cycles, and when she seems to be ovulating. A physical examination will be required including a pelvic examination complete with a Pap test and a thorough medical history will be gathered as well. Topics like menstrual history, pregnancy, miscarriages and abortions will be noted, general health issues and medications discussed, as well as the patient's history of sexually transmitted diseases or infections and birth control usage.
Certain tests are routinely performed such as a test to determine if and when ovulation is occurring. Often times a woman is asked to use a home test kit for ovulation which that tests for luteinizing hormone. The test will predict when ovulation is about to occur, and when used alongside charting her basal body temperature daily at the same time, it is a good way to time intercourse to coincide with ovulation.
Another familiar routine for a fertility work up is for women to see the fertility specialist on day 3 of her cycle and to take a test to measure FSH and LH to pinpoint ovulation. The second fertility appointment will be set for when the LH surge is expected, prior to ovulation.
Female Fertility Tests
Cervical mucus test - looks at the cervical mucus to determine if it is problematic in achieving a pregnancy. It is performed following sex, or post-coital mucus test, and will determine if sperm is having a difficult time either penetrating it or surviving in it.
Hormone testing will be done to determine levels of chemicals in the body such as androstenedione, DHEAs, estradiol, FSH, Free T3, LH, prolactin, progesterone, and total and free testosterone.
Ultrasound testing will be performed to observe the thickness of the endometrium or the uterine lining, check the condition of the ovaries, uterus and fallopian tubes and to observe whether an egg is being released.
Next Level Fertility Testing
If these tests indicate problems, the next step will be dependent on the problems found. Sometimes, a simple procedure can clear a blockage, or remedy a hormone imbalance. However, if the preliminary testing reveals normal results further testing will be done. These would include:
- Hysterosalpingogram or HSG. This test consists of x-raying the uterus and fallopian tubes to check for abnormalities or blockages.
- Laparoscopy. This procedure is used to view the uterus, fallopian tubes and ovaries. A thin tube with a camera is inserted through the abdomen and the physician will check for scar tissue, damage, or endometriosis.
- Endometrial biopsy. A small section of the uterine lining is cut and checked for hormonal imbalances.
- Ovarian reserve testing. Tests to make sure the eggs are suitable and capable of producing a pregnancy.
- Genetic testing. Sometimes a genetic issue may be the culprit behind a couple's infertility issues.
For women the most common causes of infertility include advanced age, blockages in the fallopian tubes, and endometriosis. Over one-fourth of couples have more than one problem contributing to their difficulties in conceiving. In over 30 percent of couples, no known cause is determined.
When undergoing testing, couples should be prepared for some time to be invested in the process perhaps several months. Treatment options will be dependent on the cause and the individual health of the couple.
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