Infertility Tests for Women
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. An evaluation often begins with determining whether and when a woman is ovulating.
At-home Ovulation Prediction
There are three types of at-home methods useful for predicting ovulation.
- 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.
- 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 women's reproductive tracts up to 5 days, the most fertile period is 48 hours prior to ovulation. The BBT 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 (this is called the fern test). Post ovulation, no fern-like appearance will be present because the mucus becomes too thick and less conducive to sperm survival.
Blood tests that measure the levels of various hormones can aid in determining causes of infertility. Examples include:
- Luteinizing hormone (LH)
- Follicle-stimulating hormone (FSH)
- Prolactin (PRL)
- Anti-Müllerian hormone (AMH)
Because changes in pituitary or thyroid function can also affect the menstrual cycle and ovulation, blood tests that measure thyroid function (TSH and/or free T4) and steroids, such as testosterone and DHEA-S, are also informative as high levels of androgens can contribute to infertility.
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 detect abnormal growths (such as fibroids, polyps, abscesses, tumors), scarring (adhesions) of the uterine walls, and infections.