How to test for female infertility?
20 December 2024How to test for female infertility?
Infertility is a deeply personal and often complex challenge faced by many individuals and couples trying to conceive. For women, the reasons for infertility can vary widely, including hormonal imbalances, ovulation disorders, or structural issues within the reproductive system. Identifying the underlying cause is essential for determining the most effective treatment options. A comprehensive approach to diagnosing female infertility includes a range of tests and evaluations designed to uncover potential issues with accuracy and care. This guide provides an overview of the key diagnostic methods used to assess female infertility.
What is female infertility?
Female infertility is defined as the inability to conceive after:
- One year of unprotected intercourse for women under 35.
- Six months of unprotected intercourse for women 35 and older.
Infertility may result from a range of factors, including problems with ovulation, damage to the fallopian tubes, uterine issues, or age-related fertility decline. Early diagnosis and treatment improve the chances of achieving pregnancy.
Initial consultation: Gathering essential information
Before diving into tests, a fertility specialist will perform a thorough evaluation to understand your medical history, lifestyle, and reproductive health.
1. Medical history
Your doctor will ask questions to identify potential risk factors, such as:
- Menstrual history: Are your periods regular? Are they heavy or painful?
- Previous pregnancies or Miscarriages: Have you experienced difficulties conceiving before?
- Sexual health: Are there any concerns about the timing or frequency of intercourse?
- Medical conditions: Do you have conditions like polycystic ovary syndrome (PCOS), endometriosis, or thyroid issues?
- Family history: Are there known genetic or reproductive health problems in your family?
- Lifestyle factors: Smoking, alcohol consumption, weight, and stress levels are assessed.
2. Physical examination
A physical examination helps detect potential abnormalities in the reproductive organs. Your doctor may check for:
- Signs of hormonal imbalances (e.g., acne, excess hair growth, or weight issues).
- Enlargement or irregularities in the ovaries or uterus.
Diagnostic tests for female infertility
1. Hormonal testing
Hormonal imbalances are a common cause of infertility. Blood tests are conducted to measure key hormones:
- Follicle-Stimulating Hormone (FSH): FSH is a key hormone produced by the pituitary gland. It stimulates the growth of ovarian follicles in women and regulates sperm production in men. High FSH levels in women can indicate diminished ovarian reserve (low number of eggs), while in men, it may signal testicular dysfunction.
- Luteinizing Hormone (LH): LH plays a critical role in triggering ovulation in women and stimulating testosterone production in men. Abnormal high levels can suggest conditions like Polycystic Ovary Syndrome (PCOS) in women, where an imbalance of LH disrupts ovulation.
- Anti-Müllerian Hormone (AMH): AMH is secreted by ovarian follicles and serves as a reliable marker of ovarian reserve. A low AMH level may indicate reduced egg supply, whereas elevated levels are often associated with PCOS.
- Estradiol (E2): Estradiol is a form of estrogen that reflects ovarian function and egg quality. Abnormal estradiol levels can disrupt the menstrual cycle and ovulation.
- Thyroid Hormones (TSH, T3, and T4): Thyroid dysfunction, such as hypothyroidism or hyperthyroidism, can cause menstrual irregularities, anovulation (lack of ovulation), and infertility.
- Prolactin: Elevated prolactin levels, known as hyperprolactinemia, can interfere with ovulation and cause irregular or absent menstrual cycles.
2. Ovulation testing
Ovulation is essential for conception. Tests are performed to determine if ovulation is occurring:
- Progesterone Levels: A blood test performed around day 21 of a 28-day cycle measures progesterone, which rises after ovulation. Elevated progesterone confirms that ovulation has occurred.
- Ovulation Predictor Kits (OPKs): These kits detect the surge in Luteinizing Hormone (LH) that precedes ovulation, helping predict the most fertile days.
- Ultrasound testing: Ultrasound is one of the best available tools to predict and confirm ovulation
3. Ultrasound evaluation
Transvaginal ultrasound provides a detailed view of the reproductive organs. It helps diagnose:
- Polycystic Ovary Syndrome (PCOS): Ultrasound identifies the presence of multiple small follicles (cysts) in the ovaries, a hallmark of PCOS.
- Uterine Abnormalities: Ultrasound detects fibroids (benign tumors), polyps (abnormal tissue growth), or uterine scarring that may interfere with implantation or pregnancy.
- Endometrial Thickness: The thickness of the uterine lining is assessed to ensure it is receptive for embryo implantation.
- Antral Follicle Count (AFC): This evaluation helps assess ovarian reserve by counting the number of follicles visible in the ovaries.
4. Hysterosalpingography (HSG)
HSG is a specialized X-ray to evaluate the uterine cavity and fallopian tubes. A contrast dye is injected into the uterus, and X-ray images are taken to check for:
- Procedure: A contrast dye is injected into the uterus through the cervix. X-ray images track the flow of dye to identify any blockages or abnormalities.
- Tubal Blockages: HSG detects blocked fallopian tubes, which prevent sperm from reaching the egg and hinder fertilization.
- Uterine Shape and Size: Structural abnormalities like a septum (a partition in the uterus), fibroids, or scarring are identified, as they may impact implantation or pregnancy outcomes.
5. Sonohysterography (Saline Infusion Sonography)
This advanced ultrasound technique involves injecting saline into the uterus. It helps visualize:
- Procedure: Saline is gently injected into the uterus, expanding the cavity and allowing detailed imaging of the uterine walls.
- Uterine Polyps or Fibroids: Polyps or fibroids that may cause abnormal bleeding or implantation failure are identified.
- Adhesions or Scarring: Scar tissue inside the uterus, often caused by prior surgeries or infections, can interfere with fertility.
6. Laparoscopy
Laparoscopy is a minimally invasive surgical procedure that provides a direct view of the pelvic organs. A small camera is inserted through a tiny incision near the navel to inspect:
- Procedure: A small incision is made near the navel, and a laparoscope (thin, lighted camera) is inserted to examine the uterus, fallopian tubes, ovaries, and pelvic cavity.
- Endometriosis: Laparoscopy helps identify and treat endometriosis, where tissue similar to the uterine lining grows outside the uterus, causing pain and infertility.
- Pelvic Inflammatory Disease (PID): PID can cause scarring and blockages in the fallopian tubes, hindering egg and sperm transport.
- Adhesions: Scar tissue from previous surgeries or infections may restrict the movement of reproductive organs and reduce fertility.
7. Endometrial biopsy
An endometrial biopsy involves removing a small sample of the uterine lining. It is used to evaluate:
- Endometrial Receptivity: The sample is analyzed to determine if the lining is in the proper phase for embryo implantation.
- Infections: Chronic endometritis, an infection of the uterine lining, can be diagnosed and treated to improve fertility outcomes.
8. Genetic testing
In cases where recurrent pregnancy loss or failed fertility treatments occur, genetic testing can identify:
- Chromosomal Abnormalities: Tests such as karyotyping identify chromosomal issues that may cause miscarriages or hinder conception.
- Carrier Screening: Identifies genetic mutations that could be passed to offspring, causing inherited disorders.
9. Ovarian reserve testing
Ovarian reserve refers to the quantity and quality of a woman’s eggs. Tests include:
- Anti-Müllerian Hormone (AMH): AMH levels provide an estimate of the remaining egg supply.
- Antral Follicle Count (AFC): This ultrasound-based test counts small follicles to evaluate ovarian reserve.
- FSH and Estradiol (Day 2/3 Blood Test): Elevated FSH and abnormal estradiol levels on day 3 of the menstrual cycle may indicate diminished ovarian reserve.
10. Autoimmune testing
Autoimmune disorders can interfere with fertility. Blood tests screen for:
- Antiphospholipid Syndrome (APS): Can cause blood clotting issues, recurrent miscarriages, or implantation failure.
- Thyroid Antibodies: Autoimmune thyroid diseases like Hashimoto’s thyroiditis can disrupt fertility.
- Antinuclear Antibodies (ANA): Associated with autoimmune conditions like lupus,
which reduces chances of pregnancy and increases chances of miscarriages.
11. Cervical mucus testing
Cervical mucus plays a key role in helping sperm travel through the cervix. Tests include:
- Postcoital Test (PCT): Evaluates sperm interaction with cervical mucus after intercourse.
- Cervical Mucus Analysis: Assesses mucus quality, thickness, and sperm penetration ability.
12. Infectious disease screening
Chronic infections can impair fertility and pregnancy outcomes. Tests screen for:
- Sexually Transmitted Infections (STIs): Screening for infections like chlamydia, gonorrhea, and syphilis is essential, as untreated STIs can cause tubal damage and infertility.
- Pelvic Infections: Infections leading to Pelvic Inflammatory Disease (PID) can scar the fallopian tubes and ovaries.
- Uterine Infections: Persistent uterine infections, such as chronic endometritis, may interfere with implantation and embryo development.
Additional tests
Depending on your situation, your doctor may recommend other tests, such as:
- Pelvic MRI: Provides a detailed view of the uterus and surrounding tissues.
- Sperm DNA fragmentation Index (DFI): This test detects quality and integrity of sperm DNA. Increased DFI can lead to poor sperm fertilizing capacity ,thereby causing infertility and possibly increased risk of miscarriage
When to seek testing?
- Women under 35: After one year of trying to conceive.
- Women over 35: After six months of trying to conceive.
- Immediately: If you have irregular cycles, painful periods, or known conditions like PCOS, endometriosis, or pelvic infections.
Conclusion
Testing for female infertility is a journey of discovery that helps identify the obstacles to conception. At Bavishi Fertility Institute, we combine state-of-the-art technology with personalized care to uncover the cause of infertility and guide you toward the best treatment options.
If you’ve been trying to conceive without success, don’t hesitate to seek help. Contact Bavishi Fertility Institute today to begin your journey toward parenthood. Together, we’ll work to make your dreams a reality.
Author bio
Dr. Parth Bavishi
Dr. Parth Bavishi, MD in Obstetrics and Gynecology, brings over 12 years of invaluable work experience to his role as Director of Bavishi Fertility Institute, leading a group of IVF clinics committed to helping couples realise their dreams of parenthood.
Bavishi Fertility Institute is dedicated to providing customised and personalised treatments which are simple, safe , smart and successful. Bavishi Fertility Institute works with success and satisfaction for all at heart. Providing an ideal blend of professional treatment and personalised care.
Dr Parth had special training in infertility at Bavishi fertility Institute, the Diamond Institute, USA, and the HART Institute, Japan.
Dr. Bavishi is a distinguished expert in his field. In addition to his clinical practice, Dr. Bavishi is the author of the acclaimed book, ‘Your Miracle in Making: A Couple’s Guide to Pregnancy,’ offering invaluable insights to couples navigating the complexities of fertility. He loves to empower patients to make the correct choice by education both online and offline.
His exceptional contributions have earned him the prestigious Rose of Paracelsus award from the European Medical Association. Dr Parth has been an invited faculty at many national and international conferences.
Beyond his professional endeavors, Dr. Bavishi is an avid traveller who finds solace in exploring new destinations. He also enjoys engaging his mind with brainy puzzles, always seeking new challenges and solutions outside of the medical realm.
FAQs
Certain lifestyle changes, like maintaining a healthy weight, quitting smoking, and reducing stress, can positively influence fertility and may improve test outcomes.
Most tests, like blood tests and ultrasounds, are non-invasive and painless.Tubal testing Procedures like HSG or laparoscopy may cause mild discomfort, but anesthesia or sedation is often used for invasive tests. Alternative less painful way to test for tubal function is SSG (saline salpingography) using ultrasound and color doppler.
The duration varies but typically ranges from a few weeks to a couple of months, depending on the complexity of the case and the types of tests required. We at Bavishi folllow “one cycle approach” meaning to complete all primary tests in one menstrual cycle.
Even after thorough testing, some cases may still be categorized as “unexplained infertility,” where no specific cause can be identified.
Costs vary by location, clinic, and specific tests performed. Some insurance plans may cover basic evaluations, while others may not. Most insurance in India still does not cover infertility and its treatment.
Most tests are low-risk, but procedures like laparoscopy or HSG may carry minimal risks like infection or allergic reactions to dyes.
In some cases, especially if treatment is delayed, tests may need to be repeated to check for changes in fertility status.
Stress does not usually affect the accuracy of the tests but can influence ovulation and overall fertility.
Infertility often involves both partners. A semen analysis for the male partner is usually recommended alongside female infertility tests to identify combined factors.
While there is no strict age limit, testing is typically more urgent and focused for women over 35 due to age-related fertility decline.
Ahmedabad