TESTS FOR FEMALE INFERTILITY
The Basic Infertility Workup includes physical examinations and medical and sexual histories of both partners. A thorough infertility workup of the couple should be made before any tests are carried out. Tests may be both invasive and non-invasive.
The couple should be asked about their age, previous pregnancies, if any, frequency of intercourse, pain during intercourse and whether they use any lubricants during sex. Use of birth control methods, menstrual history, current and past sexual practices, surgical history and other health issues should be discussed.
Details about any relevant medical diseases that they may suffer from (like diabetes, thyroid hormone deficiency) and whether they take any medicines, either as recreational drugs or for any diseases should be enquired about.
The most important factors controlling pregnancy in a woman are patency of the reproductive tract, mainly the tubes, and regular ovulation or anovulation.
Tubal Patency Tests
Hysterosalpingograhpy (HSG)This is the most widely used and also the most informative test for tubal patency in the investigation for female infertility. A non-irritant radio-opaque dye is injected through the cervix into the uterus. X-rays are taken of the movement of the dye through the uterus, the tubes and then the spillage into the abdominal cavity through the fimbrial end of the tubes. Any block in the passage is shown up in the X-rays.
The advantage of an HSG is that not only does it reveal whether a block is present, it also reveals the position of the block in the reproductive tract, and also the presence of adhesions around the tubes.
LaparoscopyDye injected into the cervix during a laparoscopy procedure can be observed spilling out of the tube if patent. This is a most reliable test as it is directly visualized. Advantage of the test is that any adhesions seen during the procedure can be corrected on the spot. Disadvantages are that it is an operative procedure and requires the patient to be admitted to the hospital for at least one day. It may also not reveal the position of the block inside the tubes.
HysteroscopyBy this method, the inside of the uterus as well as the inner opening of the tube can be directly visualised. Hysteroscopy is usually done together with laparoscopy in the same sitting for a better chance of a pregnancy occurring.
Assessment for Ovulation
Ultrasonography (USG)USG is used for real-time visualization of the gradual growth of the graafian follicles, the number and size of the follicles and the corpus luteum after rupture of the dominant follicle. It is the most commonly used method for diagnosis of ovulation.
Basal Body temperature (BBT)The body temperature is raised by progesterone and is thus higher in the luteal phase of the menstrual cycle than in the follicular phase since the progesteone levels increase after ovulation. The difference in temperature may be between 0.5 - 1 degrees. This change is temperature can be recorded on a temperature chart (shown below) and gives a fair indication of ovulation.
The temperature is recorded from the 1st day of the menstrual cycle. The oral temperature should be taken first thing in the morning while the woman is still in bed, before taking any food or even rinsing the mouth. There may be a sharp drop of about 0.5 degrees just at the time of ovulation. Then the temperature rises and stays more than 1 degree above the pre-ovulation temperature. If pregnancy occurs, it continues to remain high throughout pregnancy. But if pregnancy does not occur, it begins to drop again 2-3 days before the start of the next menstrual cycle.
The BBT can be altered by lack of sleep, stress or fever. It is not very reliable in women with irregular cycles. But its advantage is that it can be done by the couple themselves in the privacy of their home.
The BBT is the basis of the rhythm method of birth control.
Other Tests for Female Infertility