Testing Female Infertility

If you’re under 35 and have been trying to get pregnant for more than 12 months or are over 35 and have been trying for more than six months without success, it’s time to see a fertility specialist for testing.

Fertility specialists, also referred to as reproductive endocrinologists (REs), can help you figure out why it has been so hard to get pregnant. Find out what’s causing your pregnancy delay by seeing an RE as soon as possible.

In this article we’ll review some of the more common female fertility tests your doctor may order.

Clomiphene citrate challenge test for ovarian reserve
Your ovarian reserve is an estimate of your potential to get pregnant. If your doctor suspects that your ovarian reserve is low, he or she may recommend a clomiphene citrate challenge test (CCCT) to learn more. Here is how the CCCT works:

  1. Your doctor will measure FSH and estradiol levels on day 3 of your cycle.
  2. You will take 100 mg of clomiphene citrate on cycle days 5 through 9.
  3. On day 10, your doctor will measure FSH and estradiol again.

Results of the CCCT may help your doctor identify the next step in the fertility treatment process.

Hysterosalpingogram (HSG) is an x-ray that examines the inside of your uterus and fallopian tubes. This test can help your doctor see if your fallopian tubes are blocked. This test can be very helpful, since blocked tubes are one of the more common causes of infertility. Here is how the hysterosalpingogram process works:

  1. Your doctor injects a dye through the vagina and cervix into the uterine cavity.
  2. Dye fills the fallopian tubes if they are open, but may not enter the tubes if they are blocked.
  3. If the dye spills out into your abdominal cavity, your doctor will know that your fallopian tubes are open.

A hysterosalpingogram can also help your doctor discover any uterine abnormalities, polyps, fibroids, and scar tissue. This procedure may cause mild to moderate cramping.

If pelvic abnormalities are suspected causes of infertility, your doctor may recommend laparoscopy, a minimally invasive surgery. Here is how it works:

  1. Your doctor will insert a laparoscope (a small fiber optic telescope) into your abdomen.
  2. Through small incisions (0.5 cm), your doctor can inspect your fallopian tubes, ovaries, and uterus.
  3. In this procedure, your doctor be able to view and treat pelvic structure abnormalities. He or she can also treat blockages, scar tissue, and other damage.

Recovery from laparoscopy is rather quick, and carries a low risk for developing adhesions (fibrous scar tissue that can cause fertility problems).

Hysteroscopy helps to identify and treat uterine conditions. Here is how it works:

  1. Your doctor inserts a thin hysteroscope (a fiber optic telescope) through the cervix and into the uterus.
  2. During this procedure, your doctor can view your uterine cavity and diagnose fibroids, polyps, scar tissue, and other problems.
  3. Hysteroscopy may be performed in the office while you are awake, or as an operation under general anesthesia.

Saline hysterogram
A saline hysterogram (SHG) is also known as a saline infusion sonogram (SIS), water ultrasound, or sono-hysterogram. Here is how it works:

  1. An SHG takes place during a transvaginal ultrasound.
  2. Your doctor injects saline into your cervix and uterus to observe the walls of your uterus.
  3. This procedure allows your doctor to detect any growths in the uterine walls, like fibroids or polyps.

Endometrial biopsy
An endometrial biopsy can help your doctor identify uterine, menstrual, and hormonal disorders that may be causes of infertility. If you undergo the procedure, here is what to expect:

  1. Your doctor will give you a pregnancy test in order to protect a possible pregnancy.
  2. The biopsy will take place several days before your period starts.
  3. A small sample of tissue will be taken from the endometrium (inner uterine lining) for observation.

Some women experience pain and cramping during and after the procedure.

Cervical mucus test and postcoital test
At times, problems with cervical mucus (CM) can inhibit pregnancy. The cervical mucus test and postcoital test (PCT) can offer your doctor some information on the quality and consistency of your CM. It can also offer information on how your partner’s sperm interacts with your CM. A good time to evaluate your CM is around the time of the LH surge, right before ovulation takes place.

What about insurance?
Some insurance plans cover fertility tests and treatment, and some issues can be easily treated. Treatment may not be as expensive as you think.

Fertility testing can bring comfort
The idea of going through fertility testing may feel overwhelming and invasive. Find a reproductive endocrinologist you trust and express your concerns.

Remember, your doctor had many specialties to choose from and the one they chose was reproductive endocrinology. They have dedicated their careers to helping men and women – like you – realize their dream of becoming a parent and are sensitive to the emotional toll fertility testing and treatment can take.