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Fertility services

Tests to Diagnose Infertility in women

If you have been unable to get pregnant for more than a year, you may be experiencing infertility. These causes may be related to one or both partners seeking to start a family. It is essential to understand that numerous lifestyle, physical, age or gender-related and hormonal factors contribute to infertility. Medial history, comorbidities, and current medications also play a role; hence, being transparent and open with your fertility specialist is crucial.

While you are already or about to begin your journey to fertility, it’s essential to understand the incidence of infertility. Data highlights that every 3 out of 10 times, the cause of infertility is associated with an underlying problem with the male partner. Every 4 out of 10 times, the female partner may contribute to infertility. In numerous cases, it’s a combination of comorbidities or medical conditions shared by both partners. While our clinical specialists at CReATe Durham Fertility recommend various diagnostic tests for fertility assessment, some causes of infertility may be unexplained.

When should I consult with a fertility specialist?

If you have been unable to get pregnant for more than a year, you should consult a fertility specialist. Through your medical evaluation and diagnostic tests, your fertility specialist will recommend a treatment plan for your reproductive age.

  • Up to 35 years old: Your fertility doctor may recommend conceiving naturally and suggest waiting at least a year before testing or researching treatment options.
  • Between 35-40 years of age: If you have been unable to get pregnant after six months of having unprotected sex, you should consult a fertility specialist.
  • Above 40 yrs of age: Your fertility specialist may advise you to begin testing or treatment immediately. Hence, it’s best to consult one as soon as possible.

Common causes of female infertility

Female infertility may be due to one or more of the following factors:

  • Hormonal imbalances – common factor.
  • Ovarian disorders such as Polycystic ovary syndrome (PCOS), hypothalamic dysfunction, premature ovarian failure, or excessive prolactin contribute to decreased estrogen production. This decrease impacts female fertility.
  • Fallopian tube dysfunction or tubal infertility. This dysfunction might be related to pelvic inflammatory illness, a prior operation affecting the abdomen or pelvis, ectopic pregnancy, or pelvic tuberculosis.
  • Endometriosis occurs when tissue typically develops in the uterus implants and grows elsewhere. This excess tissue growth — and its surgical removal — can induce scarring, which can restrict fallopian tubes and prevent an egg and sperm from joining. It can also interfere with the implantation of the fertilized egg.
  • Uterine or cervical causes include benign polyps or tumors, uterine anomalies at birth, or cervical stenosis.
  • Unexplained infertility - A combination of some factors in both partners may result in unexplained infertility. Age, insulin resistance, lifestyle factors such as smoking or alcohol usage, and comorbidities such as obesity are some contributing factors.

Tests to Diagnose Female Infertility

Post your medical evaluation; your fertility specialist will recommend one or a combination of a few diagnostic tests to understand the underlying causes of your infertility. There are mainly three types of diagnostic tests:

1. Hormone Assessment Tests

Hormones are crucial in our reproduction cycle as they control egg development, ovulation, fertilization, and implantation. Hormone levels can be affected by reproductive age, comorbidities, and past medication or treatment programs. Since any imbalance may lead to infertility, your fertility specialist may order blood tests to assess ovulatory hormones and thyroid and pituitary hormones, which regulate reproductive processes.

Your fertility specialist may also request a blood test to check for Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Estradiol, Progesterone, Prolactin, and other hormones.

2. Ovulation Test

This test uses transvaginal sonography. This test can be invasive (done by inserting a probe in your vagina) or non-invasive (done on the abdomen) to enable your fertility specialist to see if follicles are developing in the ovary. After ovulation, transvaginal sonography can detect whether a follicle broke open and released an egg. This test also examines the uterus and ovaries for abnormalities such as fibroids and ovarian cysts. Depending on the day of ovulation, patients may be encouraged to have timed intercourse- a strategic way of optimizing your fertile window by using medication and guidance from a fertility specialist to stimulate egg production by the ovaries, induce ovulation, and improve chances for natural conception. Your fertility specialist may provide medication to stimulate ovulation if necessary. Your fertility specialist may also request tests for Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Estradiol, Progesterone, Prolactin, Thyroid Stimulating Hormone (TSH), Total Testosterone, and/or DHEA-S.

3. Reproductive Organ Diagnostic Tests (Tubal Status and Uterine Cavity)

Your fertility specialist at CReATe Durham Fertility may recommend these tests to determine whether your fallopian tubes, uterus, and ovaries are healthy for the desired pregnancy. These might range from non-invasive diagnostic testing to invasive surgical treatments to determine the cause of infertility.

Non-invasive reproductive organ diagnostic tests:

  • Ultrasound
    This examination examines your uterus and ovaries to see if your ovarian follicles function optimally. Your fertility specialist can order this test up to 15 days before a woman’s menstrual cycle. Hence it is important to start tracking your menstrual cycles before you start your fertility journey.
  • Sonohysterography (Uterine Cavity Check)
    This diagnostic test checks for intrauterine abnormalities, such as endometrial polyps and fibroids, and the health of your uterus, ovaries, and ovarian follicles. To further understand infertility’s underlying cause(s), your fertility specialist may recommend a hysteroscopy.
  • Hysterosalpingography
    Hysterosalpingography is a non-invasive diagnostic procedure that examines your uterus and fallopian tubes for blockages or other issues. The uterus is injected with an X-ray contrast which assists in evaluating if the cavity is normal and if fluid is spilling out of your fallopian tubes.
  • Hysterosonogram (Tube Check)
    A hysterosonogram is a non-invasive diagnostic test for evaluating the endometrium, the inner lining of the uterus. This is a technique for women who may report excessive or atypical bleeding during their menstrual cycles.

Invasive reproductive organ diagnostic tests:

  • Hysteroscopy
    Hysteroscopy is an invasive diagnostic test that can assist in the diagnosis and treatment of uterine abnormalities such as polyps, fibroids, and adhesions (scar tissue). During this surgical procedure, a lighted telescope-like equipment (hysteroscope) is introduced through the cervix to observe the interior of the uterus.
  • Laparoscopy
    Laparoscopy is another invasive diagnostic tool that your fertility specialist may recommend confirming endometriosis, pelvic adhesions, and other pelvic cavity abnormalities which may contribute to infertility. During this, a surgical technique, a lighted telescope-like tool (laparoscope), is introduced through the abdominal wall into the stomach to explore any abnormalities in the pelvic cavity. Before recommending this test, your fertility specialist will evaluate your medical history, physical and hormonal evaluations, medical risks, financial coverage plans, and past procedures. Please note that laparoscopy is usually not the first line of diagnostic tests recommended to ascertain infertility’s underlying cause(s).