Infertility : Infertility Tests, Part 2

by Food and Drug Administration (FDA)

(Page 4 of 4)

Still other methods widely used to predict ovulation rely on examinations of the cervical mucus, which undergoes a series of hormone-induced changes at various times in the menstrual cycle. Some versions of these tests require a health professional's expertise. There are, however, versions of them that some women — with a physician's guidance — can learn to do themselves.

Other methods widely used to diagnose female infertility and to monitor therapy include:

Endometrial Biopsy: A long, hollow tube is passed into the patient's uterus late in her menstrual cycle, and a little of the lining is scraped off and examined with a microscope. The examination helps the physician tell whether the development of the egg and of the lining are in proper phase with each other. In most cases, the scraping is done in a physician's office and because it is only very briefly painful no anesthetic is used.

Ultrasound: This technology relies on sound waves to produce images of internal structures. It is used, often in combination with one or more of the tests already discussed, to find the presence or absence of follicles that contain and release the eggs. Ultrasound is also sometimes used to detect abnormalities in the ovaries or uterus.

Hysterosalpingogram: This is an x-ray study of the uterus and fallopian tubes. It is done just after a woman's menstrual period so there is no danger of her being pregnant and thereby exposing the fertilized egg or embryo to radiation.

A dye containing iodine — technically called a contrast medium — is injected through the cervix. It spreads into the uterus and the fallopian tubes, allowing them to be visualized. Among other things, this study often enables the physician to determine if the fallopian tubes are open. It is usually done without an anesthetic in the x-ray department of a hospital or clinic.

Hysteroscopy: The patient's uterus is filled with a liquid or gas, instilled through the cervix. A thin, lighted tube called a hysteroscope that works like a telescope is then inserted into the uterus through the cervix, enabling the surgeon or physician to look directly inside. Many hysteroscopes have a separate channel through which instruments can be passed, often making it possible to immediately correct any abnormalities. Patients undergoing hysteroscopy are usually given an anesthetic, which may be local or general.

Laparoscopy: A laparoscope, like a hysteroscope, is an instrument with a light that works like a telescope. It is slipped into the abdominal cavity through a small incision in or near the navel. For a clearer view of the woman's reproductive tract, the cavity is filled with gas during the procedure, and a colored solution — usually blue — is injected into the uterus and fallopian tubes. A general anesthetic is required. Advanced operative techniques may allow the repair of defects in the reproductive tract to be made at the same time as the examination.

Theirs

Some tests require participation of both partners, as they have to be done after intercourse, which has to take place at the most fertile time in the woman's cycle. During the tests at a doctor's office, 2 to 12 hours after intercourse, several samples of cervical mucus are taken. Laboratory analysis then determines whether sperm and mucus have been able to properly interact.

There are also a variety of tests that are used when the doctor suspects that infertility may be due to the man's forming antibodies against his own sperm or the woman's forming antibodies against them. The exact nature of these immunological problems is not yet well understood, but their detection is sometimes helpful in explaining why a couple is having reproductive difficulty. Some of these tests require the participation of both partners; others either one or the other.

A final word about all infertility tests: It is always best to ask in advance why they are being suggested, what they may show, how definitive they are, what the possible remedies are for any problem they may disclose, and what side effects or complications are possible from a given test. Many of these tests have potential risks as well as potential benefits.

Preventing Reproductive Problems

Many infertile couples wonder why something so easy for most people is so hard for them. Although science cannot fully answer that question, it does know that some reproductive problems are preventable.

Heading the list is damage to the structures that allow sperm and egg to meet, caused by gonorrhea, chlamydia, and other sexually transmitted diseases (STDs). This damage accounts for about 20 percent of all infertility in men and women alike. Use of barrier methods of contraception — condoms for men, diaphragms (with spermicide), or contraceptive sponges for women — can stop many of these infections before they start.

Both women and men who are sexually active should be regularly checked for the possible presence of STDs as these infections often have no symptoms. The longer the delay before antibiotic treatment is started, the greater the risk of impaired fertility. This risk rises the more sexual partners a person has and with the number of times he or she has these infections.

Tobacco, alcohol, and the use of illicit drugs can also diminish the reproductive potential of both sexes, as can the use of steroid drugs for body-building purposes and for enhancing sports performance. So can poor nutrition, rapid weight loss, and either too much or too little body fat. The same goes for excessive rigorous exercise, meaning more than an hour day. While too much exercise is more likely to impair female than male fertility, neither sex can count on escaping its reproductive effects.

Childhood immunizations also have a bearing on future fertility. Immunization against mumps and rubella (German measles) is particularly important because the male who gets mumps in adolescence or later runs a high risk of becoming permanently sterile, and the female who gets rubella while pregnant — particularly early in pregnancy — is at high risk of miscarriage or having a baby with birth defects.

In addition, boys who are born with an undescended testicle, which is fairly common, are more likely than other boys to later have reproductive problems. They are also at a somewhat higher risk for later developing testicular cancer. Undescended testicles can be surgically corrected during childhood.

Girls who don't menstruate by age 16 or are plagued with menstrual problems need to be evaluated by a physician. Neither condition is necessarily an indication of impaired fertility, but it is also true that delaying needed treatment can sometimes make the situation worse.

Choosing a Doctor

Rather than relying on advertisements or affiliations, when choosing a physician for infertility services, it is wise to check on his or her qualifications. The local medical society can usually provide background information on the doctor you are considering consulting.

For women, the right physician will probably be a board-certified obstetrician-gynecologist and may well be one who, besides, has had two years of further training in reproductive endocrinology.

For men, the right doctor will likely be a board-certified urologist with a special interest in infertility. Often, such a urologist has had a fellowship in male reproductive problems in addition to his basic training in urology.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.