The fertility evaluation
If a couple hasn't conceived after a year of trying for a baby with regular unprotected sex, a GP may be able to arrange fertility testing or evaluation for the woman, the man, or both partners.
What does a fertility evaluation involve?
A standard fertility evaluation includes medical and sexual histories of both partners and a physical examination.
The man's sperm will be checked in a semen analysis in a laboratory to assess sperm count, appearance and movement. Often, it's not possible to identify a specific reason for a sperm disorder. Very low sperm or no sperm may be related to genetics - an abnormality of the Y chromosome.
For women, doctors will first check to see whether ovulation is occurring. This may be with blood tests to detect hormones, or ultrasound scans of the ovaries. Irregular menstruation can be a symptom of an ovulation problem, but women with regular periods can also have an ovulation disorder.
If a woman is ovulating, and once the semen analysis is known, doctors then move to a standard test called the hysterosalpingogram (HSG), a type of X-ray of the fallopian tubes and uterus. This test involves placing a radiographic dye solution into the uterine cavity. Then a series of x-rays are taken to see if the dye is flowing through the fallopian tubes normally. If the fallopian tubes are blocked, the dye will be retained in the uterus or fallopian tubes, depending on the location of the blockage.
An alternative called laparoscopy and dye (‘lap and dye’) may be used if there is a history of other conditions, such as pelvic inflammatory disease, previous ectopic pregnancy or endometriosis.
Other tests may be arranged to provide doctors with more information:
Ultrasound scans can check reproductive structures.
Hysterosonography is a type of ultrasound where salt water (saline) is put into the uterus during the scan to help reveal any structural abnormalities or fibroids.
A hysteroscopy is a procedure to examine the inside of the uterus to help diagnose infertility. This procedure involves using a hysteroscope, a narrow tube with a camera that’s inserted into the uterus and that sends images to a computer monitor to be viewed.
Laparoscopy may be arranged if there is a history of other conditions. Doctors can examine the ovaries, uterus, fallopian tubes and abdominal cavity using a special fibre-optic tubular instrument. During laparoscopy, some treatment of conditions such as endometriosis can also be performed.
A less common test is to check the ovarian reserve using hormone levels and measuring how the ovaries respond to different fertility treatments. These tests also assess the availability of eggs and the chances of a healthy pregnancy.