What to Expect

A thorough evaluation of an infertile couple begins with a history and physical exam. We ask all couples planning their first visit to Fertility Center of the Carolinas to fill out a detailed questionnaire and bring it to their first visit. Contact our office at 864-455-HOPE (4673) with any questions.

Before treatment is initiated, there is a certain amount of testing that is required for both the male and female partner. For the male, we recommend a semen analysis be done early in the process since up to 40% of infertility may be due to problems with sperm count or motility. For most couples other tests will include hormone testing to check for certain conditions associated with infertility, assessment of uterine cavity and fallopian tube patency, and assessment of ovulation. Advanced testing might also include laparoscopy and hysteroscopy or the use of ultrasound to evaluate pelvic structures for various defects or endometriosis.

Evaluation of Female Partner

Ovarian function
The menstrual cycle is controlled by the ovary through the cyclic development of eggs or oocytes. Testing ovarian function examines the hormones, estradiol and follicle stimulating hormone (FSH) early in the menstrual cycle. These hormones, along with TSH and prolactin, can help identify problems that might interfere with oocyte development or release.

Testing for ovulation
Urinary LH detection. Using a kit that comes with multiple detection strips, a woman can test daily around the middle of the month to try and detect the Luteinizing Hormone (LH) surge. This usually occurs the day prior to egg release and therefore might also be used to time intercourse or schedule IUI.

Basal body temperature charting. BBT charting requires the woman to measure her morning body temperature before getting up in the morning and recording the value to a 1/10th of a degree on a chart. In ovulatory women, the temperature usually rises after ovulation. This might be helpful in some cases, but cannot be reliably used to time intercourse.

Ultrasound. Ultrasound can be used effectively to check for follicle development and determine endometrial thickness. The vaginal probe ultrasounds give the best images and don’t require the patient to have a full bladder. In ovulation induction cycles, the ultrasound is used to count the number and size of follicles to determine when to release the eggs and to make sure it is safe to do so. At Fertility Center of the Carolinas we have access to the latest technology for ultrasound. Our sonographers are certified for gynecology and pregnancy.

Hormone testing. Progesterone is a hormone produced by the follicle after ovulation and is a sensitive measure of ovulation. It is usually measured around day 21 of a 28 day cycle, near the time of peak secretion from the corpus luteum. Low progesterone levels may require further treatment.

Endometrial biopsy. After ovulation the lining to the womb or endometrium, prepares for implantation of the fertilized egg or embryo. Once the embryo reaches a certain size it is ready to attach to the uterine lining. The endometrial biopsy is a method to evaluate the development of the endometrium or histology. At Fertility Center of the Carolinas we also recommend the evaluation of markers of uterine receptivity. Certain proteins are required for successful pregnancy to occur and might be missing in certain conditions, such as endometriosis, tubal disease or in polycystic ovary syndrome (PCOS). The biopsy requires proper timing and should be performed 8 or 9 days after the LH surge has occurred.

Evaluating fallopian tubes
Hysterosalpingogram (HSG). This test is performed with a radiologist, and can detect whether the fallopian tubes are blocked or open. This test also can be used for evaluation of the uterine cavity. Patients getting an HSG are instructed to take an antibiotic for a day or two prior to the test. The evaluation only takes a few minutes to perform and you will usually be given the results the same day.

Evaluation of the uterine cavity
The uterine lining is where the newly fertilized egg will implant. Disruptions in the lining can occur. Problems with the uterus may include fibroids, endometrial polyps, adenomyosis, scarring, or a uterine septum. While HSG traditionally has been used to evaluate the uterine lining, ultrasound has largely replaced it as a more sensitive and less painful approach. Any abnormalities observed can usually be treated. Hysteroscopy is a procedure in which the inside of the uterus is visualized. The procedure can be done in the office or the operating room and is a valuable way to evaluate and treat problems with the uterine lining.

Blood Testing
In most women, we check the following with blood tests:

  • AMH (anti-mullerian hormone)
  • Testosterone
  • DHEA-S
  • FSH (follicle stimulating hormone)
  • Estradiol
  • TSH (thyroid stimulating hormone)
  • Prolactin
Evaluation of Male Partner

Semen testing
Testing for a man often involves a semen analysis. This analysis is done to assess the amount of sperm, the shape of the sperm, and the way that the sperm move. Blood tests for men measure levels of male reproductive hormones. Too much or too little of these hormones can cause problems with making sperm or with having sex. In some cases, an ultrasound exam of the scrotum may be done to look for problems in the testes.

A low sperm count or abnormal sperm shape or movement can make it difficult for a man to make a woman pregnant. For about one-third of couples unable to have children, male infertility is the reason. A semen analysis can help figure out the cause of male infertility.

When the reason for infertility is not clear, with a normal semen analysis and partner evaluation, the infertility is termed unexplained. Rarely patients with normal semen analyses have sperm that do not function in a manner necessary for fertility. The purpose of the male evaluation is to identify these conditions when present. Identification and treatment of reversible conditions may improve the male’s fertility and allow for conception through intercourse.

Conditions that affect sperm formation
Many different issues can affect the formation of sperm in the testicles. These conditions can lead to sperm that is abnormally shaped or malformed or to low amounts of sperm. Some of the more common issues include:

  • Chromosome defects
  • Diabetes
  • Hyperprolactinemia (overproduction of a hormone called prolactin made by the pituitary gland)
  • Injury to the testicle
  • Insensitivity to hormones called androgens, which include testosterone
  • Swelling of the testicles from infections such as mumps, gonorrhea, or chlamydia
  • Chromosome disorder called Klinefelter syndrome
  • Thyroid problems
  • Cryptorchidism (when one or both testicles are not descended)
  • Varicocele, which is the enlargement of veins in the scrotum; enlarged veins disrupt the blood flow in the testicle and cause an increase in temperature, which negatively affects sperm production. This condition is present in about 40% of men with fertility problems.

Remember that lifestyle, environmental, and age-related factors can also play a role in male infertility.