How is infertility diagnosed?

Health care providers evaluate men and women differently to diagnose infertility.

Evaluating a Woman's Fertility

In evaluating a woman's fertility, a health care provider will ask specific questions about her health history. These include1:

• Prior pregnancies
• Prior miscarriages
• The regularity of her menstrual period
• The presence of pelvic pain
• Whether she has abnormal vaginal bleeding or discharge
• Whether she has a history of pelvic infection or previous pelvic surgery

Initial screening will also involve a physical exam including a pelvic exam, a Pap test, and blood tests to look at overall health. The health care provider will look for signs of milk production in the breasts, which suggests a hormone imbalance, and physical symptoms of polycystic ovary syndrome.

A health care provider may also carry out the following laboratory tests and evaluations1,2:

• A blood test around day 23 of the woman's menstrual cycle can measure the amount of a hormone called progesterone (pronounced proh-JES-tuh-rohn). This test can tell if ovulation has occurred and if the ovaries are producing a normal amount of this hormone.
• Tests may be performed to measure levels of other hormones that are important for fertility.
• Other tests may be performed that examine the fallopian tubes and determine if there is blockage that prevents movement of the egg from the ovaries. These include:
  • X-ray hysterosalpingogram (pronounced HIS-tuh-roh-sal-PING-goh-gram). A health care provider injects a radiographic dye into the cervix to fill the uterus. If the fallopian tubes are clear of blockages, the dye will flow out the end of the fallopian tube into the peritoneal cavity. Movement of the dye is monitored by x-ray fluoroscopy.
  • Laparoscopy (pronounced lap-uh-ROS-kuh-pee) is a surgery in which a small viewing instrument, called a laparoscope, is inserted through a minor cut in the abdomen to examine the female reproductive organs. If the procedure identifies blockages in the fallopian tubes, the blockages can be removed with instruments attached to the laparoscope.

• A health care provider may examine the inside of the uterus to look for scarring, uterine fibroids, or polyps. The following procedures are used to examine the uterus:
  • Transvaginal ultrasound. An ultrasound looks at the internal organs using sound waves. A wand inserted into the vagina applies sound waves to the body. This provides a health care provider a better view of the female reproductive organs, including the uterus and ovaries.
  • Hysteroscopy (pronounced his-tuh-ROH-skoh-pee). A hysteroscope is a long, thin camera that is inserted through the vagina and into the uterus.
  • Saline sonohysterogram (pronounced son-uh-HIS-tuh-roh-gram). In this procedure, a health care provider injects sterile saline into the cervix to fill the uterus. Once the uterine cavity is full, it is easier to see its inner lining. The pelvic organs are visualized with transvaginal ultrasound. It is also possible to see fluid move into the peritoneal cavity at the same time.

• Health care providers may test a woman older than age 35 to determine whether her ovaries produce follicles, which normally develop during her menstrual cycles. This type of testing includes performing a transvaginal ultrasound to look at the ovaries and measuring hormones in the blood on certain days of the menstrual cycle.

Evaluating a Man's Fertility

The evaluation of a man's fertility includes looking for signs of hormone deficiency, such as increased body fat, decreased muscle mass, and decreased facial and body hair. The evaluation also includes questions about the man's health history, including3:

• Past injury to the testicles or penis
• Recent high fevers
• Childhood diseases, such as mumps

A physical examination of the testes and penis allows for identification of problems, such as1:

• Infection, signaled by discharge or prostate swelling
• Hernia
• Malformed tubes that transport sperm
• Hormone deficiency as indicated by small testes
• Presence of a mass in the testicles
• Varicocele

A health care provider may also ask a man to provide a sample of semen to assess the health and quality of his sperm. To give a semen sample, the man is requested to refrain from ejaculation for around 48 hours before the test. He then provides a sample by masturbating into a cup or by having intercourse using a special condom (without contraceptive) that collects semen without affecting the sperm. A man may need to provide a semen sample on more than one occasion because sperm production can vary over time depending on the man's activities and stress level.

Other tests may include1,3:

• Measurement of hormones in the blood, including testosterone and follicle-stimulating hormone
• Biopsy of the testicle. A health care provider uses a needle to extract sperm from the testicle.
• Genetic testing. In cases where no or very few sperm are found in the semen, a health care provider may do genetic testing before starting fertility treatments. Testing can identify chromosome abnormalities that may cause the lack of sperm or lead to developmental problems among offspring.

1. Jose-Miller, A. B., Boyden, J. W., & Frey, K. A. (2007). Infertility. American Family Physician, 75, 849–856. [top]
2. Practice Committee of the American Society for Reproductive Medicine. (2006). Optimal evaluation of the infertile female. Fertility and Sterility, 86 (Suppl 4), S264–S267. [top]
3. Male Infertility Best Practice Policy Committee of the American Urological Association; Practice Committee of the American Society for Reproductive Medicine. (2006). Report on optimal evaluation of the infertile male. Fertility and Sterility, 86(Suppl 4), S202–S209. [top]

Source
How is infertility diagnosed?
Eunice Kennedy Shriver National Institute of 
Child Health and Human Development (NICHD)

Geosalud, August 11, 2013