Infertility

Tests of Female Fertility

A woman's fertility declines substantially by age 35 and even more so after age 40. Common factors in female infertility include blocked fallopian tubes, polycystic ovary syndrome (PCOS), which can interfere with egg release, uterine fibroids, endometriosis, autoimmune disorders , which produce antibodies against fetal tissue, diabetes, hypothyroidism, eating disorders, excessive smoking, drug, and alcohol use, obesity, and gluten intolerance (celiac disease). The woman's fertility may also be affected by factors such as fluctuating or diminished hormone levels; inconsistent ovulation; or a poor reproductive environment that does not support proper fertilization of the egg, interferes with the sperm's transport, or impairs retention of a fertilized egg. The initial evaluation of a woman's fertility includes a personal and family history with a thorough physical examination. A number of tests can be used to help diagnose the problem and aid in Treatment.

At-home ovulation predictions. 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 to help predict the most fertile days in the woman's monthly menstrual cycle, around the time of ovulation. Body temperature rises just after ovulation and remains elevated for at least 3 days. If the cycle is charted for 3 to 4 months, a pattern can be recognized and intercourse can be timed to occur in the 5 days before the expected temperature rise. This method is not as reliable or accurate as other monitoring techniques, but it is simple and inexpensive.
• Self-examination of vaginal discharge is another method in which ovulation can be predicted at home, but it too is subject to error. When a woman is most fertile, the mucus is stretchy, clear, thin, and slippery. When the 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 the woman is entering her most fertile period.
• 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 aid greatly in determining the cause of infertility. Some examples include:

• Luteinizing hormone (LH)
• Follicle-stimulating hormone (FSH)
• Prolactin (PRL)
• Estradiol
• Progesterone
• Estrogen

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 (dehydroepiandrosterone sulfate is used in producing androgens and estrogens), are also informative.

Imaging procedures. Imaging techniques may be used to determine physical problems that may prevent proper fertilization or sustaining a normal pregnancy. Fiber-optic endoscopy, x-rays, and ultrasound sonograms are used to visualize physical anatomic defects, abnormal growths (such as polyps, abscesses, tumors), scarring (adhesions) of the uterine walls, and infections. The postcoital test is commonly used. This test 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.