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) 455-1600 with any questions about the forms below.
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 the Female Partner
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.
We may recommend a more complete evaluation called the clomiphene citrate challenge test (CCCT) or measure anti-Müllerian hormone (AMH) to more accurately measure ovarian reserve. These tests are often suggested in older women attempting pregnancy or in women with ovulatory dysfunction or amenorrhea.
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 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.
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.
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 polycyctic ovary syndrome (PCOS). The biopsy requires proper timing and should be performed 8 or 9 days after the LH surge has occurred.
Evaluating the 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.
Examination 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.
In most women, we check the following with blood tests:
- AMH (antimullerian hormone)
- FSH (follicle stimulating hormone)
- TSH (thyroid stimulating hormone)
Evaluation of the Male Partner
- Semen analysis
- Hormone testing
- Sperm function tests
- Assessment by an infertility urologist