Understanding Fertility Problems: The Woman's Evaluation

Understanding Fertility Problems: The Woman’s Evaluation

To help your doctor look for the cause of fertility issues, you will have an evaluation. It will include a medical history, physical exam, and some basic tests. If needed, your doctor may also suggest procedures. These allow him or her to look at your reproductive organs.

Doctor speaking with female patient.
During the evaluation, your doctor will ask about health and lifestyle issues that can affect fertility.

An HSG test shows the uterus and fallopian tubes. They are seen as white on the x-rays.

Medical History

Your doctor will ask about your health and lifestyle. You’ll also be asked about factors that can affect your ability to get pregnant such as how often you have sex, your menstrual cycle and any medications or herbs you take. Be sure to mention any prior pregnancies or surgeries. You should also mention if you’ve had any pelvic infections or sexually transmitted infections.

Physical Exam

A physical exam helps your doctor learn about your health. It includes a pelvic exam to check for swelling, infection, or other problems. Your hormone function is also checked. To do this, your doctor looks at your breast development, body fat, and hair distribution.

Basic Tests

Your evaluation will likely include some basic tests. These include blood tests. In some cases, it also includes tests that check the health of your cervix.

  • Blood tests can be used to check the following factors:

    • FSH, LH, estrogen, and progesterone levels

    • Blood sugar and insulin levels

    • Tests for current or prior pelvic infection

    • Thyroid function

    • Prolactin levels. This is a hormone that affects the production of breast milk. High levels of prolactin can prevent ovulation.

  • Cervical cultures are samples taken from the cervix using a sterile swab. The sample is then sent to a lab and checked for signs of infections that can affect fertility.

  • Postcoital tests are done using a sample of cervical mucus taken a few hours after sexual intercourse. The sample helps show the quality of the mucus, and whether sperm can swim through it. The test is usually done 1 or 2 days before ovulation.

Imaging Tests

Your doctor may recommend that you have imaging tests. These show the reproductive organs in more detail. These tests may be done in the doctor’s office or in a hospital or surgery center. In most cases, they cause little or no discomfort.

  • HSG (hysterosalpingogram). This is an X-ray test. It is used to view the shape of the uterus and make sure the fallopian tubes are open. During the test, a dye called contrast is placed in the uterus and fallopian tubes. The dye makes it easier to see problems on the X-rays.

  • Ultrasound. This uses painless sound waves to make images of internal organs. This can help show problems with the ovaries or uterine lining.

  • Sonohysterogram. This is an ultrasound done with a saline (sterile saltwater) solution placed in the uterus. The saline makes it easier to view the inside of the uterus.

Other Tests

If needed, your doctor may suggest other, less common tests. Some can be done in your doctor’s office. Others are done in a hospital or surgery center. For certain procedures, you’ll be given anesthesia to prevent discomfort.

  • Hysteroscopy. This uses a small, lighted tube called a hysteroscope to view the inside of the cervix and uterus. It is usually done just after menstruation.

  • Endometrial biopsy. This is used to take a small sample of the uterine lining. This can help show problems that may prevent an embryo from implanting. A small suction tube (catheter) is inserted into the uterus to take the sample.

  • Laparoscopy. This is a type of surgery that can help reveal problems on the surface of the reproductive organs. A thin, lighted tube device called a laparoscope is inserted into the body. Your doctor then views the reproductive organs through the scope.