If you are Infertile, What Tests Do You Need?

Infertility is defined as a couple trying to conceive for more than a year and not getting successfully pregnant. Your gyno is likely going to tell you that if you are over the age of 35 and have been trying for over 6 months then it is time to get talking to your gyno about beginning the testing. An initial interview will target your individual gynecologic and health history and direct some testing. The National Institute of Health has also come up with recommended infertility testing. Most testing will be focused on the female, but there is recommended testing for her partner. At the NIH infertility site you can find guidelines from many organizations, such as ACOG which over sees recommendations from all Board Certified Obstetricians and Gynecologists, and other organizations, such as the one that oversees recommendations on in vitro fertilization. The American Society of Reproductive Medicine (ASRM) Practice Committee in the August issue of Fertility and Sterility has issued their set of guidelines for testing a male or a female for infertility. Ovulatory problems account for 40% of infertility and should be tested for first. Knowing your menstrual cycle history seeing if you ovulate by ovulation predictor kits are both home tests for ovulation. If your gyno is not certain there are ovulation tests you should have by her. This can be done by checking blood progesterone levels in the second half of the cycle, ultrasound testing to see if you are developing a follicle and corpus luteum in the ovary, and checking the menstrual cycle by taking a sample of the uterine lining itself in a test called an endometrial biopsy. It is then important to check on ovarian reserve. Blood testing for Follicle Stimulating Hormone (FSH), the Anti-mullerian Hormone level, and estrogen level is helpful. The numbers of eggs you have in reserve can also be judged by giving a clomid challenge test, or using an ultrasound to see early developing eggs. Ultrasound or x ray testing, is used or the use of hysteroscopy is then used to check whether the uterus is healthy for a pregnancy. Finally checking to see if the fallopian tubes are open needs to be done. The check of the fallopian tubes is done with a test called hysterosalpingogram or "HSG" test. This can be done with ultrasound or an x-ray test, but often done with the saline infusion test under ultrasound that is used to test for polyps of the uterus. Some women may have endocrine factors for their infertility and it would be important to have hormone testing such as thyroid gland testing. For women with a history suggesting endometriosis either ultrasound or laparoscopy can be done. Tests such as a biopsy of the endometrium, just to see what hormonal effect it shows, or a cervical mucus check after intercourse are no longer recommended as useful in most cases. After these tests a strategy of treatments can be planned. Many of these tests can be costly, and it is prudent to ask your physician what is cost effective with regards to testing as well. Shopping around for instance can help you save hundreds of dollars, and for an initial evaluation that is often what gynos recommend.


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