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Houston Fertility Journal

    Female Infertility Testing and Diagnosis

    September 20, 2018 / by Center of Reproductive Medicine   

    Center of Reproductive Medicine


    Women are often diagnosed with infertility based on how long they have been trying to get pregnant without seeing the results they are hoping for. If she has been trying for at least one year (or for 6 months if she is over the age of 35), she will be diagnosed with infertility. She may also be considered infertile after multiple miscarriages occur. Female infertility is the result of age, physical problems, hormone imbalances or issues, lifestyle, and environmental factors.

    Based on the symptoms and other existing health factors, specialists can often find the cause of infertility and determine the appropriate treatment in order to assist in the woman achieving pregnancy. There are some cases where the issue cannot be identified or the woman’s condition may be so that pregnancy will never be possible. No matter what though, there are always options for a such individuals to make a family.

    About a third of the time, the infertility is due to an issue with the woman’s health. One third is an issue with the man. Sometimes the issue exists in both. In this article we will discuss the types of tests a doctor will do to locate possible infertility within a woman, and the different diagnosis’ and treatment options that will follow.

    Testing and Evaluating Female Fertility

    After the woman has found a fertility clinic of her choosing, her specialist will evaluate her and her partner’s state of health and fertility by way of physical exam and analysis of their medical history. After this information has been collected, they will recommend which diagnostic tests will  be necessary to discover the root of the issue.

    For women, doctors will commonly check the female hormone system, ovarian reserve, pelvis, vagina and cervix for any existing abnormalities. Below are some examples of the tests used to analyze these areas.

    Endocrine System Tests

    All of the hormone-producing glands that are responsible for the body’s growth, metabolism, and sexual development belong to the endocrine system. The tests performed to check this part of the body include:

    • Basal Body Temperature Charting (BBT). BBT charts are used to help determine when the woman’s time of ovulation will occur. Certain information they provide can also indicate the possible existence of ovulation dysfunction. For example, if the body contains high levels of progesterone, the body temperature will be a little higher than usual. A normal BBT will show a very slight increase in temperature between day 10 and 21 of the ovulation cycle. A woman makes her chart by testing her BBT every morning before getting out of bed. If the temperatures that she collects are unusual, this could inform the specialist of an existing issue within the endocrine system.
    • Endometrial Biopsy. The specialist will take a sample of cells from the uterine lining following the ovulation cycle in order to check the health of the endometrium. They are looking for an signs of inflammation, changes that occur during the cycle, and any abnormal changes in hormones. This test is not as commonly performed because it tends to provide little information when it comes to diagnosing infertility.
    • Luteinizing Hormone Testing. The luteinizing hormone is the ovulation-triggering hormone. Ovulation Predictor Kits can be used to check whether or not this hormone is present in the urine. Depending on the levels of the hormone, existing issues within ovulation can be determined.
    • Ultrasonography. This test uses sound waves to analyze the condition of the uterus, ovaries, endometrium, and ovarian follicles. The images taken from these tests can be collected through the woman’s abdomen or vagina. Other possible issues a specialist may discover by way of ultrasonography include:
      • Small follicle size (which could be a sign of polycystic ovarian disease)
      • Lacking in clear follicles
      • Fluid within the follicle sac
      • The thickness of the endometrium

    Ovarian Testing


    The following tests are often used to test a woman’s ovaries and her ovarian reserve:

    • Estradiol Test: The levels of estradiol, a hormone that is produced by the ovary, are tests between 2 to 4 days of the menstrual cycle. High levels of the hormone may be an indicator of ovulation problems. There are many cases, however, of women who have slightly abnormal results with these tests and are still able to achieve pregnancy.
    • Anti-Mullerian Hormone Test: This hormone is made inside of the follicles and can be tested at any point during the menstrual cycle. Anti-Mullerian Hormone levels will decrease with age along with the number of follicles.
    • Follicle Stimulating Hormone Test: This hormone is made inside of the pituitary gland and it’s levels will increase as the number of eggs decrease. Levels are checked between day 2 and 4 of the cycle to check for high levels. If the levels are above 15IU/L the woman it is common that pregnancy will be difficult to achieve.
    • Clomiphene Citrate Challenge Test: This is where the doctor will check the follicle stimulating hormone along with the estradiol levels between day 2 and 4 of the menstrual cycle. Between day 5 and 9, the woman is then gives 100mg of clomiphene citrate, a fertility drug. This will test is decreased ovarian reserve along with the usual information collected from the individual tests.
    • Ultrasound: An ultrasound can be used to check for the existence of small follicles within the ovaries which could indicate a decreased ovarian reserve. If the woman has less than 8 small follicles and the ovaries are smaller than 3 ml in volume it usually indicates that she has a decreased ovarian reserve.

    Ovarian tests are often performed if the woman:

    • smokes cigarettes
    • has a family history of early menopause
    • is showing signs of premature ovarian failure
    • has undergone ovarian or extensive pelvic surgery
    • has experienced recurrent pregnancy loss
    • Laparoscopy. A surgical procedure that uses a thin tube to examine the uterus, fallopian tubes, ovaries, and pelvic surfaces. This procedure can help to determine whether or not ovulation is successfully occurring and, therefore, can be very helpful in assessing the state of a woman’s fertility.
    • Other Endocrinology Tests. There are a few more tests that can indicate abnormal levels of endocrine hormones which can affect fertility in women. These include:
      • Testing the Thyroid Stimulating Hormone to check for diseases within the thyroid gland.
      • Testing the Serum Prolactin, which is produced in large amounts during pregnancy but can create issues during ovulation for a woman who is not with child.
      • Testing for Androgen hormones, like testosterone, which can indicate polycystic ovarian disease.

    Pelvic Disorder Tests


    If the specialist believes their may be in issue within the pelvis or tissue lining the abdomen, uterus, bladder and rectum, they will want to perform tests within the pelvis. Tests that are usually used in these cases include:

    • Ultrasonography and Sonohysterography. Ultrasonography is an imaging technique used by ultrasound to help doctors see the condition and structure of the organs. It helps to detect any abnormalities within the pelvic region that are known to be associated with infertility. A sonohysterography is a similar technique, using an ultrasound to check the inside of the uterus for abnormalities like scar tissue, fibroids or polyps.
    • Hysterosalpingogram. A procedure that determines the condition of the uterus and fallopian tubes where a radio-opaque fluid is injected into the uterus and fallopian tubes and then x-rayed. These images show the shape of the uterus and any existence of fibroids, scar tissue, and fallopian tube damage or blockage.
    • Hysteroscopy. A procedure in which a small telescope is passed through the vagina and into the uterus to check for abnormalities. It can detect the existence of polyps, fibroids, scar tissues and other abnormalities within the uterus.
    • Magnetic Resonance Imaging (MRI). This imaging technique uses a magnetic field and radio waves to take pictures of the organs inside the body. An MRI can help to discover lesions or any other issues inside the pelvis and uterus.
    • Laparoscopy. As mentioned above, a laparoscopy is a surgical procedure using a thin lighted tube to check for abnormalities inside the pelvis.

    Cervix Testing

    In some rare cases, the infertility in the woman is due to the fact that the sperm cannot travel from the vagina to the interior of the uterus and fallopian tubes. This may be because the cervical mucus is not functioning normally or the sperm did not arrive during the right point in ovulation. In order to test for any issues within the cervix, the specialist may perform:

    • An Analysis of History of Sexual Intercourse. The specialist will want to know about the woman’s sexual history with her current partner. They will ask about the timing and frequency of intercourse, as these details are critical for a successful pregnancy to occur. The use of lubricants can interfere with the sperms mobility, so the specialist will also ask if lubricant is regularly used. In addition, they will look for any abnormal pap smears, cervical or vaginal operations, and other surgeries.
    • Sexually Transmitted Disease Testing. The doctor will require STD tests to check for the presence of HIV1, Hepatitis B and C, Syphilis, Chlamydia and Gonorrhea. In some states, a doctor is not allowed to perform intrauterine insemination without performing these tests.
    • Post-Coital Testing. This will test the cervical mucus within a few hours of intercourse in order to determine how the mucus is responding to the woman’s partner’s sperm.
    • Antisperm Antibody Tests. This tests for the possibility of the woman’s immune system making proteins that could be attacking the sperm The man’s sperm may also be checked for the existence of these proteins and whether or not is has the ability or travel through the woman’s cervical mucus.

    Female Infertility Treatment

    The specialist will recommend treatment based on the diagnosis, age, how long the infertility has existed and the personal preferences of the woman. Treatment is not inexpensive, but a good clinic will have payment plan options ready to help you out.

    Some women may find success with their first treatment, but others may go on to needing more or another approach may be recommended. Treatment can either consist of medication, surgery, or sophisticated techniques engineered to help the fertilization process along.

    Fertility Drugs

    Fertility drugs are used to regulate or stimulate the woman’s ovulation cycle and are the main treatment for those with ovulation disorders. Fertility drugs that are commonly used include:

    • Clomiphene Citrate. Taken by the mouth, Clomiphene (Clomid) stimulates ovulation by triggering the pituitary gland to release more FSH and LH to help the ovarian follicle that is containing the egg to grow.
    • Gonadotropins. These treatments are injected in order to stimulate the ovary into producing multiple eggs.


    • Metformin. This hormone is used when it is suspected that the patient is insulin resistant, causing the infertility. This is common in women her are diagnosed with polycystic ovarian syndrome. It helps to improve insulin resistance, helping along the process of ovulation.
    • Letrozole. Similar to Clomid, Letrozole is used to induce ovulation.
    • Bromocriptine. This drug is usually used when ovulation problems exist due to excess of prolactin by the pituitary gland.


    • Laparoscopic or Hysteroscopic Surgery. These are surgeries used to remove or correct abnormalities that are getting in the way of a woman’s ability to get pregnant. Examples are the correction of an abnormally shaped uterus, the removal of endometrial polyps, or the removal of pelvic and uterine adhesions.
    • Tubal Surgeries. This is rare surgery performed if the doctor believes it is possible to correct fallopian tubes that are blocked or filled with liquid.

    Reproductive Assistance

    The two most popular used methods of reproductive assistance are:

    1. Intrauterine Insemination. Where healthy sperm are place inside the woman’s uterus close to the time of her ovulation cycle.
    2. Assisted Reproductive Technology. Where mature eggs are retrieved from the woman, fertilized with her partner’s sperm, and then returned to the uterus after fertilization.

    What Should You Do?

    There are number of reasons why a woman could be diagnosed as infertile. In some cases, the issue can be fixed. In other cases, a good fertility specialist will provide the options necessary to achieve pregnancy due to the woman’s current condition of health. If you think you may be infertile and you are looking for an infertility clinic in Texas, we can help you. For anymore questions or to set up a consultation, please don’t hesitate to contact us here.


    Topics: Health, Infertility Treatment, Signs of Infertility

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