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Infertility

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Tests of Female Fertility

Initial evaluation of a woman's fertility includes a personal and family history along with a thorough physical examination. Several tests can be used to help diagnose any issues and aid in treatment.

At-home Ovulation Prediction 
There are three types of at-home methods useful for predicting ovulation.

  • Basal body temperature (BBT) can be measured at home using a special thermometer that specifically measures temperature between 96o and 100o F to help predict the most fertile days in a woman's monthly menstrual cycle when ovulation occurs. Basal body temperature (taken before getting out of bed) decreases just before ovulation and rises at ovulation, remaining elevated for up to 3 days. If the cycle is charted for 3 to 4 months, a pattern can be recognized and intercourse can be timed accordingly. Though sperm have been shown to remain functional in the female genital tract up to 5 days, the most fertile period is 48 hours prior to ovulation. This method is not 100% reliable, but it is simple and inexpensive.
  • Self-examination of vaginal discharge is another method to predict ovulation but is also subject to error. Prior to ovulation, the mucus is stretchy, clear, thin, and slippery, a necessary environment for the survival and transport of sperm. When mucus can be stretched between the thumb and index finger into a thin strand 2 to 3 inches long, ovulation is about to occur and a woman is entering her most fertile period. If a thin layer is placed on a glass slide, a fern-like appearance is present during ovulation. Post ovulation, no fern-like appearance will be present because the mucus becomes too thick and less conducive to sperm survival.
  • Ovulation predictor kits are the most accurate of the three methods. The test detects an increased level of luteinizing hormone (LH) present in an early morning urine sample 1 to 2 days before ovulation.

Laboratory Tests 
Blood tests that measure the levels of various hormones can aid in determining causes of infertility. Examples include:

Because changes in pituitary or thyroid function can also affect the menstrual cycle and ovulation, blood tests that measure thyroid function (TSH and/or T4) and steroids, such as testosterone and DHEA-S, are also informative.

Imaging Procedures 
Imaging techniques may be used to determine physical problems preventing proper fertilization or maintenance of a normal pregnancy. Fiber-optic endoscopy, x-rays, and ultrasound sonograms are used to visualize anatomic defects, abnormal growths (such as polyps, abscesses, tumors), scarring (adhesions) of the uterine walls, and infections. The postcoital test is commonly used, which evaluates the efficiency of cervical mucus under a microscope. Cervical mucus filters bacteria and enhances the ability of sperm to survive so it can access the upper areas of the reproductive tract.

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