Fertility Tests - Overview

The causes of infertility can be complex and often both partners require treatment. In fact, almost half of all infertile couples have a "male infertility component" making the semen analysis one of the most valuable fertility tests. The fertility specialist will order several tests to rule out the common causes of infertility. The majority of these tests are performed at our Texas fertility clinic location. Reproduction requires that many complex processes occur, including:

Evaluation of Male Infertility

• The male must produce sufficient sperm of acceptable quality to cause fertilization.
• The sperm must be ejaculated into the female's vagina.
• Once ejaculated, the sperm must swim in the cervical mucus into the uterus and to the end of the fallopian tube where fertilization occurs.
• The male gametes (sperm) must be genetically "normal" and able to penetrate and fertilize an egg.
• Please see our page on male infertility

The Female

• The female must produce follicle stimulating hormone (FSH), which causes recruitment,and supports the development, of follicles each of which contains an egg.
• As healthy follicles develop they produce estrogen which helps prepare the endometrium. The lining of the uterus must thicken and become more vascular to accept a developing embryo.
• Progesterone is produced during the luteal phase of the cycle and is necessary to prepare the endometrium. It is first produced by the corpus luteum (the leftover follicle), and later by the placenta to help support a pregnancy.
• The hypothalamus must monitor hormone levels and produce gonadotropin releasing hormone (GnRH), which stimulates the pituitary to produce FSH and LH.
• The uterus must be free of obstruction by fibroids and/or polyps and significant congenital malformations.
• Once the follicles are mature, the hypothalamus must signal the pituitary to release a surge of luteinizing hormone (LH), which causes ovulation.
• The "ovulated egg" must travel unimpeded from the ovary to the end of the fallopian tube where fertilization occurs.
• The egg and sperm combine to produce an embryo. Both gametes must be "genetically normal". The most frequent cause of miscarriage is an unbalanced number of chromosomes. Many of these conditions can be screened in our Texas PGD program.
• Once an embryo is formed, it must implant in the endometrial lining. The implanted embryo is supported by the hormone progesterone produced by the placenta.
• The mother must be physically capable of carrying a pregnancy to term.

Failure of any one of these processes can lead to infertility. The major causes of infertility are categorized according to these biologic steps:

• Male infertility
• Ovarian factor, ovulatory failure
• Uterine factor
• Cervical factor
• Tubal factor
• Luteal phase defect
• Miscarriage
• Endometriosis
• Unexplained infertility

Fertility tests are designed to evaluate each one of these processes and are discussed on our Web site. It is extremely important that all potential causes of infertility are "ruled out", even if one cause is known. It can greatly increase infertility treatment costs if all contributing factors are not identified early in the evaluation.

Male Fertility Tests

• Semen Analysis- The semen analysis determines the quantity and quality of the sperm in the ejaculate.

Female Fertility Tests

• HSG, Hysteroscopy-The hysterosalpingogram and hysteroscopy are used to determine if the uterus is normal and if the tubes are open and unobstructed.
• Day 3 hormone evaluation- The levels of FSH, LH, estrogen and other hormones are determined on day 3 of the menstrual cycle. Women with highly abnormal FSH levels may be candidates for our donor egg program.
• Post coital test- This test examines the characteristics of the cervical mucus and helps determine if the sperm- cervical mucus interaction is adequate.
• Endometrial biopsy- The endometrium must be in "phase" with the reproductive cycle and ready to accept an embryo. The biopsy allows the physician to evaluate the development of endometrial cells.
• Laparoscopy- The laparoscopy allows the physician to visualize the internal reproductive organs and to determine if endometriosis is present. Reproductive specialists often treat conditions during the diagnostic laparoscopy.
• Ultrasound- Ultrasound has many uses including monitoring the development of ovarian follicles, measuring the thickness of the endometrium, confirming a fetal heartbeat and more
• Clomid Challenge Test- This test is used as an assessment of ovarian reserve.

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