The Female Work-up (Diagnostic Tests)
To start with your doctor will take your complete history and usually perform a pelvic exam to rule out physical problems. Your doctor may ask you to start [charting your basal body temperature] if you are not already. Your doctor may also perform some basic hormone blood tests. Here is a list of the common blood tests performed.
- FSH (Follicle Stimulating Hormone)
- LH (Lutenizing Hormone)
- Estrogen
- Progesterone
There are also additional tests your doctor may perform, including estradiol, inhibin B, Pooled progesterone, prolactin, thyroid stimulating hormone, testosterone, and (DHEAS) dehydroepian-drosterone sulfate. As part of these tests your doctor may recommend the Clomid challenge test, which includes an FSH & Estrtadiol test a day 3 and an FSH at day 10.
The timing of these tests are very important. Your doctor will not do all the test on one day. Instead you will take each test on a specific day of your cycle. For example, FSH is done on Day 3 and Day 10, while Progesterone is done 7-10 days after your LH surge and LH is tested around ovulation. You can see how charting your cycles and knowing the exact days will be especially helpful.
After the hormone blood tests your doctor may do a few other diagnostic tests depending on your case. Here are some of the diagnostic tests commonly used at this stage in the work-up.
Postcoital Test : This test will tell if you and your partner's cervical mucus and sperm are compatible. During the fertile time of your cycle, the doctor will take a sample of the female's cervical fluid within two hours of intercourse. If the sperm survive and move forward in the cervical fluid, you will know the sperm and cervical mucus are compatible.
Ultrasound : The ultrasound is the only definitive way to tell you have ovulated. This can tell if you have LUFS (Lutenized Unruptured Follicle Syndrome), which looks exactly like you are ovulating in every way except the egg is not released.
Endometrial Biopsy : A few days before your expected period a tiny piece of uterine lining in removed and tested. This test must be timed perfected in order for it to be accurate. This test is the first on the list of diagnostic tests that can be uncomfortable and can cause cramping.
HSG (Hyserosalpingogram) : This will tell if your fallopian tubes are open by injecting dye through the cervix. Blocked tubes and lesions or polyps on the uterine cavity can be found with this method. Similar to this test, is a tuboscopy, where a thin fiber optic telescope if threaded through the fallopian tubes to look at the inside of the tubes.
After these initial diagnostic tests, your doctor may recommend further surgical test. These tests are more invasive and will only be used if the previous tests could not find the problem.
Laparoscopy : This exploratory surgery can detect endometriosis. A tiny cut in make in the navel and a lighted tube is inserted to look at the pelvic region. This is usually done under general anesthesia.
Hysteroscopy : This procedure looks at the inside of the uterus and can tell if you have fibroids.
Falloscopy : This procedure looks inside the fallopian tubes to see if anything is blocking the sperm or embryo from travelling through the tubes.
Finally, your doctor may recommend a chromosome analysis to see if you have any congenital problems that could cause infertility.