Basic Infertility Workup

In identifying the cause(s) of infertility, there are five basic steps, each of which consists of a number of tests:

• Step One

An evaluation of ovulatory functioning to determine whether the woman is ovulating on a regular basis, whether the luteal phase of the menstrual cycle is functioning properly, and whether the timing of ovulation could be assessed.  Tests of ovulation may include basal body temperature monitoring (which can indicate after the fact that a woman has ovulated), ultrasound testing (which detects the number, size, and shape of the egg follicles, follows the growth of follicles, and identifies whether follicles have collapsed, indicating that ovulation has occurred), and LH2 surge monitoring (which predicts when ovulation will occur).  Luteal phase testing is conducted to assess whether the uterus prepares itself properly to receive and carry a fertilized egg, and may include blood tests to determine hormone levels or an endometrial biopsy to observe the development of the uterine lining.
 
• Step Two

A semen analysis, which will first evaluate the quantity, motility, and shape of sperm.  If initial analysis indicates a low sperm count, abnormal sperm shapes, or low sperm motility, additional analysis may be performed, including penetration tests or the hemizona test.  The hemizona assay test determines whether sperm binding to the zona membrane of the egg is normal while the hamster penetration test, or sperm penetration test, uses hamster eggs to measure the ability of human sperm to fertilize.
 
• Step Three

Tests cervical functioning, using the post-coital test to assess if there is a problem in the interaction between a woman's cervical mucus and her partner's sperm.  A post-coital test necessitates the couple to have intercourse before the woman visits the physicianís office to examine her cervical mucus.
 
• Step Four

Evaluates the woman's reproductive tract and reproductive organs through different means of imaging.  An HSG, for example, is a radiologic study in which dye visible by fluoroscopy is injected into the uterine cavity to determine the shape of the uterus and the potency of the fallopian tubes.
 
• Step Five

Assesses the pelvic environment with laparoscopy, a surgical procedure in which the inner organs are viewed through an instrument resembling a telescope that is inserted through the abdominal wall.