Blood tests that detect hormones secreted from the pituitary gland, the ovary, and the adrenal gland are sometimes recommended in the course of an infertility evaluation. Some of these tests are performed on a specific day of your menstrual cycle. This will be reviewed with you when testing is advised.
A semen analysis is used to examine the quantity and quality of the sperm in a given sample from the male partner. The semen analysis should be preceded by at least two days of abstinence. For the best results, the semen specimen should be freshly collected by masturbation into a sterile container and delivered to the designated laboratory within one hour from the time of collection. During transportation, the specimen should be kept at body temperature (i.e., tucked inside a shirt during cold weather). The specimen should not be refrigerated or heated. You will be given specific laboratory instructions when this test is ordered. It should be noted that medications, viral illnesses, drugs and temperature extremes might alter the results of a semen analysis. If an abnormal result is encountered, it is common to request a second analysis to confirm the findings.
The hysterosalpingogram is a useful test to assess the structure and patency (degree of openness) of the cervical canal, uterine cavity and both fallopian tubes. The gynecologist with a radiology technician present performs the test in a hospital setting. The HSG involves the passage of an iodine-containing dye through the cervix, uterus and tubes. This is monitored by a continuous x-ray called fluoroscopy. Generally, the HSG is performed during the first half of the menstrual cycle, after the period has stopped but before the anticipated time of ovulation. Approximately one hour prior to the test, 600 mg. of ibuprofen (Motrin) or 220 mg. of naproxen (Aleve) should be taken to alleviate mild or moderate cramping that may be experienced during the test. If you have had a problem in the past with tubal infection (such as pelvic inflammatory disease), your doctor may also recommend the use of antibiotics for the HSG test. While the HSG is generally well tolerated by most patients, cramping may be experienced after the test. It is recommended that you report a temperature above 100.4, chills, heavy vaginal bleeding or prolonged, severe pelvic cramping following the HSG to your physician.
Your physician may schedule an ultrasound in the course of your infertility investigation and management. The ultrasound exam is an office procedure that uses high frequency sound waves (not radiation) to view your reproductive organs during various times of your menstrual cycle. The ultrasound is routinely used to observe the ovarian follicle (egg) formation, growth, and ovulation in both spontaneous cycles and cycles induced by fertility medications. In most instances, a transvaginal ultrasound is performed by placing the probe into the vagina to obtain the best view of these structures. Occasionally, a specialized ultrasound procedure called a sonohysterogram is recommended. This test is performed by placing a small catheter into the uterine cavity to infuse a small amount of water while utilizing transvaginal ultrasonography to visualize the contour of the uterine cavity.
Laparoscopy is an outpatient (same day) surgical procedure that is performed in a hospital or surgical center. This procedure is recommended if the reason for the infertility is not identified by the standard evaluation, or if a woman has not conceived after a short course of fertility medication. Laparoscopy can be helpful in identifying the presence of endometriosis or adhesions (scarring) in the pelvis, and to assess the patency (openness) of the fallopian tubes. The procedure takes approximately one hour and is performed under general anesthesia. The abdomen is inflated through a small needle with carbon dioxide gas. A thin laparoscope is inserted through a small incision in the umbilicus (navel). Using a fiber optic light source, pelvic organs are easily visualized. Pictures are sometimes obtained for review after the procedure. You will be able to go home within a few hours and only require a few days to fully recover from the procedure. A post-operative appointment is scheduled approximately one week after the procedure to review the findings, answer questions, and to plan appropriate management with the new information.
Hysteroscopy is an outpatient surgical procedure that is performed in a hospital setting. A thin hysteroscope utilizing a fiberoptic light source is inserted into the uterine cavity through the cervix. This procedure is recommended if other testing or history has suggested the presence of an endometrial polyp, submucous myoma (fibroid), uterine septum or blocked fallopian tubes. Many times during such a procedure, special instruments can be threaded through the hysteroscope to treat these problems. You will be able to return home the same day as the procedure and may experience some mild cramping and bleeding after the procedure. In most cases, you can return to normal activities the next day.
Ovulation Predictor Kit – (OPK)
The use of an ovulation predictor kit is sometimes recommended as it detects the monthly surge of Luteinizing Hormone (LH). This hormone is produced by the pituitary gland in the brain and signals the ovary to release an egg (ovulation). On average, the LH surge (positive test result) precedes ovulation by 24 to 36 hours. Your kit will come with instructions on what day to begin testing for the LH surge. The LH surge will indicate that you are about to ovulate and will optimize the timing for intercourse. It is sometimes used for the timing of post-coital tests and artificial insemination. Ovulation predictor kits can be purchased at your local pharmacy. It is very important to follow the kit’s instructions closely.