Comprehensive Female Infertility Testing
There are several means of testing to see if a woman is ovulating or producing an egg:
- HISTORY: A careful history can be one of the best tests for the detection of ovulation. A history of regular, cyclic and predictable menses indicates ovulation is present in almost 98% of women. Therefore, in reality there is no need to do any fancy testing to try and document ovulation in regularly cycling women.
- HORMONE TESTING: We can certainly check blood levels of the Progesterone hormone in the second half of the cycle. Women who ovulate, will usually have levels over 3 ng/dl.
- OVULATION PREDICTOR KITS: You can certainly buy these commercial kits and check the urine for the LH hormone rise that occurs 18-24 hours before ovulation. These tests have clear instructions that will assist you in predicting the day you will ovulate. Unfortunately, sometimes the tests could be false and confuse the patient.
- BASAL BODY TEMPERATURE: A method that has been used extensively in the past but that can be very frustrating to the patient. The basal temperature in women undergoes a sustained rise of 0.3 to 0.5 degrees F during the second half of the cycle or the luteal phase. This shift in temperature is due the secretion of Progesterone by the Corpus Luteum. The woman must take her oral or rectal temperature for 5 minutes with a special basal thermometer every morning on awakening before any physical activities. Ovulation occurs just prior to the rise in temperature.
Unfortunately, there may be several instances when ovulatory women exhibit an abnormal BBT chart.
- CERVICAL MUCUS: The cervix is part of the uterus that protrudes into the vagina. Therefore, it is the gateway to the uterine cavity to which it is connected by the cervical canal. This canal is lined by specialized cells (“Columnar Epithelial Cells” that secrete a thick fluid called “the cervical mucus”. Around the time of ovulation the cervical mucus becomes clear, thin and stretchable. This in turn will help sperm travel through the canal on their way to the egg. A simple test done around the time of ovulation is the Postcoital Test. The patient is asked to have intercourse a few hours before her visit to the doctor. A sample of cervical mucus is taken from the cervical opening and checked for clarity, thickness etc. and for the presence of motile sperm.
- ENDOMETRIAL BIOPSY: This test involves taking a tissue sample from the lining of the uterus called the “endometrium”. It helps in evaluating the adequacy of the uterine lining in supporting a pregnancy and can also help determine if ovulation has occurred. Some women suffer from an entity called “Luteal Phase Defect”. These women usually have very short cycles.
- ULTRASONOGRAPHY: Recent advances in ultrasound technology has revolutionized the field of reproductive medicine. This test can be used to diagnose a multitude of problems in the infertile patient, including looking for cysts, fibroids, polyps, swollen & blocked tubes and certainly to monitor follicular development prior to ovulation or during infertility treatment with fertility hormones. The test is performed best through a vaginal approach, whereby a vaginal ultrasound probe is inserted and the pelvic organs, such as the uterus and ovaries visualized.