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Houston Fertility Journal

    How is Infertility Diagnosed?

    June 25, 2018 / by Center of Reproductive Medicine   

    Center of Reproductive Medicine


    Infertility is usually tested between a couple when they have been trying to achieve pregnancy for 12 months and the woman is under 35. For women of 35 years of age or older, it is recommended that infertility treatment is sought out at 6 months as she only as so much time left before her ovarian reserve will deplete to the point that pregnancy will not be possible.

    There are a lot of possibilities when it comes to the causes of infertility, but before you start reading up on all of these online, it is important that you get your facts straight. You have come to the right place, and we want to help you understand infertility and what it’s relationship might be to you.

    Let’s take a look at the common causes of infertility, how a specialist will test you and your partner to find a diagnosis, and what you need to do to prepare if you do indeed decide to schedule an appointment with an infertility clinic.

    Common Causes and Infertility Tests

    Around 80% of infertility in couples is due to one of the following issues:

    • Ovulation dysfunction or unawareness
    • Problems with the sperm
    • Fallopian tube blockage or damage

    When a couple goes to an infertility clinic they are tested using a variety of techniques in order to discover if something like the examples of the above is making it difficult to conceive. The majority of tests can be completed within 5 weeks from the initial consultation and then treatment can begin.

    Even if the woman is already aware of a condition that could be hindering her, such as polycystic ovarian syndrome or endometriosis, it is still important that the male partner’s fertility is also tested so you have a full view of what is going on between the two of you.

    The most common tests used to diagnose infertility are:


    • Blood Testing: The following blood tests will help to determine the quality of the woman’s eggs and possibly uncover other existing problems:
    • Prolactin: A pituitary hormone that could rise above normal amounts if a woman has small benign growths within the pituitary gland or is on certain medications.
    • FSH level: A pituitary-gland hormone that could rise above normal levels, usually when menopause is beginning and the ovary is showing signs of age. To accurately test this hormone blood must be drawn on or very close to day 3 of the cycle. High levels usually mean that the ovaries are no longer as responsive to brain signals as they once were and therefore cannot develop follicles for ovulation. In this case, chances for achieving pregnancy are quite slim.
    • Thyroid testing: This is done to check if there is any problem with the thyroid and whether or not there is not enough or too much of the hormone, which can have a major effect on fertility.
    • Testosterone, DHEAS, and 17-hydroxyprogesterone: Androgens, or male hormones, that may be out of balance and can also be checked in women who have more hair growth than usual.
    • Endometrial biopsy: The uterine lining that is connected to the woman’s blood supply and assists in the growth of the fetus and baby is called the endometrial layer. When women have their periods each month they shed this lining. In order to test the health of the endometrial layer, the doctor will take a sample to check the natural progesterone levels and the quality of follicular maturation and how often she ovulates.
    • Transvaginal Ultrasound (TVS): This test involves the use of a plastic ultrasound probe which is inserted into the vagina so that the uterus and ovaries can be seen better and pictures may be taken for the doctor to analyze. During the examination the images will appear on a monitor where the examiner can look closer to search for any fibroid tumors within the uterus or ovarian cysts.  
    • Examination of the ovarian reserve: A woman must have an egg that can be fertilized in order to achieve pregnancy. Not only that, her follicles need to be healthy enough to help the egg mature and to release when the time is right. Fertility doctors can test these things by using a clomiphene citrate challenge test (CCCT), a process that uses a blood analysis to check the woman’s hormone levels, in order to determine how well the ovaries are functioning. The knowledge that comes out of this test will also allow the doctor to learn how likely it is that you could get pregnant without assistance or if treatment is absolutely necessary.
    • Semen Analysis: A lot of people do not realize that infertility in males is just as common as it is in women. The only difference is that there are a lot more possibilities for the cause of infertility in a woman. For men, it is most commonly due to an issue occurring with semen production. Semen analysis is not difficult to perform, and most doctors will want to do one right at the beginning of infertility testing. The process simply consists of the man providing a sample for submission to a lab when it can be analyzed and evaluated. Analysis includes checking sperm count (the number of sperm) and sperm morphology (how the sperm are shaped and their mobility).
    • Hysterosalpingogram (HSG): This test allows the doctor to look into the uterus and fallopian tubes by use of X-rays. It begins with a pelvic exam followed by a catheter going into the uterus. With this visual ability the doctor can accurately check for any abnormalities in the pelvic area that could be causing an issues.
    ** Examples of such abnormalities include: congenital defects, polyps, fibroid tumors, scar tissue and damage to the fallopian tubes
    • Hormone Analysis: Each function in the body depends on a healthy hormonal balance. When hormones are not balanced a lot of issues can arise, including difficulty achieving pregnancy. Testing your hormones can reveal a lot about your overall state of health. Tests are done through blood samples which will be taken at different points in the woman’s menstrual cycle. Through blood analysis the doctor can determine if there is a hormone imbalance, which is treatable. The results of the test will help the doctor to know exactly which type of treatment is most likely to be successful.
    • Sonohysterogram: This is another test that will allow a doctor to better see any possible issues existing within the uterus. Instead of using X-ray technology like in the HSG, the doctor uses a catheter to inject a saline solution into the uterus. This solution will help to distinguish any abnormalities within the uterine wall. This test is usually performed if the doctor had difficulty getting visuals that provide enough insight from the HSG.
    • Evaluation of recurring miscarriages: If you and your partner have experienced multiple miscarriages, your experience will be a little different. There are specific tests that are done to help to determine the cause of these losses. The specialist will want to determine whether the miscarriages were due to chromosomal, hormonal, anatomical, infectious, psychological or blood factors. Depending on the results, the doctor may suggest the use of a gestational carrier, where another woman carries a baby made by the woman’s egg and the male partner’s sperm.

    Symptoms that could mean Infertility


    Often times couples will not experience any real symptoms cluing them into the state of their fertility besides that fact that they cannot seem to get pregnant. In women, constant changes in the menstrual cycle and ovulation could be a sign that something is wrong. Other possible symptoms for women include:

    • Timing of periods changing monthly with bleeding that is heaver or lighter than usual
    • Irregular periods, where periods do not occur each month or occur more than once a month
    • No periods, where a period has never occurred or suddenly has stopped occurring
    • Periods that are extremely painful with back pain, pelvic pain, and debilitating cramping
    • Skin changes, like unusual breakouts and acne
    • Shifts in the sex drive and desire
    • Hair loss or thinning hair
    • Abnormal weight gain
    • White discharge from the nipples that is not related to breastfeeding
    • Pain or discomfort during sexual intercourse

    Possibility indicators for infertility in men include:

    • Changes in hair growth
    • Discomfort, pain, swelling or lumps in the testicles
    • Difficulty keeping an erection or ejaculating
    • Small, firm testicles
    • Change in sexual desire

    Information and Questions you Should be Prepared to Bring to a Specialist


    You can keep trying to looks for symptoms on your own, but you are obviously starting to get concerned for a reason. There is not a whole lot you can determine on your own and it is no use worrying and stressing about something when there are people out there that can give you answers.

    Talking with a specialist does not mean you have committed to treatment yet, it simply is going to help you to understand the position you and your partner are in and how you can make being parents a reality. Before you sit down with a doctor to discuss what could possibly be going on with you and your partner and what you are going to do about it, you want to make sure that you have all of this information:

    • the medications you are taking, including prescriptions, vitamins, minerals, supplements, and anything else that a doctor prescribed to you
    • the patterns in which you and your partner have sex, how often, how long you have been trying to conceive, and if you have tried to get pregnant in the past
    • any changes in your body you have noticed
    • if you have had any surgeries or treatments and what the dates were
    • cancer treatment you have undergone such as radiation or chemotherapy
    • if you smoke and how much, if you drink alcohol and how much, and any illegal drug use you partake in
    • if you or your partner have any history of sexually transmitted diseases
    • genetic disorders you are aware of or chronic illness, such as diabetes or thyroid disease within the family

    It is also wise to write down all of the questions you have so you do not forget when you are face to face and potentially overwhelmed with information. Some examples of the questions you might want to ask are:

    • If my infertility diagnosis comes back unclear, what will we do next to narrow down the possible causes?
    • If the cause of my infertility is determined, can this condition get worse, stay the same, or possibly get better with time?
    • Based on what you know about me and my partner, why sort of tests will we have to undergo and what type of treatment do you think will be necessary for us and why?
    • What are your success rates treating patients like me?
    • What are the possible sides effects for the treatment that you recommend?
    • How many rounds of one type of treatment do you try before moving on to another?
    • What happens if my first treatment is unsuccessful?
    • Is there anything I can do to improve my changes now, during or after my treatment?
    • How much will each cycle of treatment cost and do you have any options for payment assistance?
    • Do you accept insurance or offer payment plans?

    In Conclusion

    You do not have all of the time in the world, and this is something that you want dearly. If you have been trying for long enough to know that something is not right, it is time to turn to the experts for answers. You have all of the information you need to at least sit down with someone and discuss your options, so what are you waiting for? Contact one of our Texas fertility center locations for more information on diagnosing infertility and what an infertility clinic can do for you.

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