History and Physical Examination

A thorough history will include information about past surgical history, medical history, exposures to tobacco, alcohol, environmental toxins, a history of sexually transmitted diseases, a careful menstrual history, a history of any past pregnancies, a through review of all organ systems, and any other relevant information. In addition, an equally thorough history of the patient's spouse also will be obtained. The patient also will undergo a thorough physical exam to help investigate and find a treatment for infertility.

Ultrasound Monitoring

The transducer on a transvaginal ultrasound is a long probe that is inserted into the vagina. The ultrasonographer will be able to see the uterus, ovaries, and sometimes the fallopian tubes. The procedure is not painful, and many women prefer it to an abdominal ultrasound for which the bladder must be full.

Semen Analysis

The husband undergoes a semen analysis to assess whether there is adequate sperm number and quality (such as motility, and morphology, or shape). In a normal ejaculation the total volume of semen is between a half and a whole teaspoon. As part of the semen analysis, the technician will determine the number of sperm present in the ejaculate and will look at how well the sperm are moving. A well-developed sperm can propel itself up a woman's reproductive tract at a rate of more than 2 inches an hour.

Hormonal Testing

By performing some basic blood tests – checking prolactin and thyroid levels, for example – a physician can evaluate the hormonal function of a woman trying to conceive. One of the most important hormonal tests is an FSH (follicle stimulating hormone) test. This test can provide information about the quality of a woman's eggs. An abnormal or high FSH level can mean that it will be more difficult for the woman to conceive, while a low or normal value is more reassuring.

Endometrial Biopsy

This procedure involves scraping a small amount of tissue from the endometrium shortly before menstruation is expected. This test can be used to determine if a woman has a luteal phase defect, a hormonal imbalance that may prevent a woman from sustaining a pregnancy because not enough progesterone is produced.

Post-coital Test

This test can provide information about how the cervical mucous and sperm interact. The test must be done within one to two days before or after ovulation. Basal body temperature charts or ovulation predicting kits are very helpful in determining the time of ovulation. A couple should abstain from intercourse for 2 days before ovulation, then have intercourse 2-8 hours prior to the office visit for the post-coital test. A speculum is placed in the vagina, as it would be for a pap smear. A syringe without a needle is then used to remove some mucous from the cervical opening. The specimen is examined under a microscope for the presence or absence of swimming sperm.

Diagnostic Hysteroscopy

Hysteroscopy is an important tool in the study of infertility, recurrent miscarriage or abnormal uterine bleeding. Diagnostic hysteroscopy is used to examine the inside of the uterine cavity. It is helpful in diagnosing intrauterine fibroids, scarring, polyps, congenital malformations and other conditions.

Hysteroscopy is performed by inserting a small fiberoptic probe into the uterine cavity. A small amount of fluid is inserted into the uterine cavity so that the cavity expands and enables the physician to view the internal structure of the uterus. This is a very well tolerated procedure here at CRM. Coming soon: Patients share their CRM hysteroscopy experiences.

Hysterosalpingogram (HSG)

A hysterosalpingogram (HSG for short) is a non-invasive procedure used to detect blockages of the fallopian tubes and disorders or structural problems within the uterus. A small catheter is placed at the cervix and a dye slowly is injected while images are taken with an x-ray machine. The flow of dye through the uterus and out of the tubes is studied and recorded on x-ray film.

Many patients have heard from others that this is a painful test. In the past this was certainly true, but advancements have made this procedure much more tolerable. We are aware of the possibility for discomfort and make every effort to be gentle in carrying out the procedure. Coming soon: Patients share their CRM HSG experiences.

Laparoscopy

This is the most complicated of all the fundamental tests for infertility. It is performed under general anesthesia, most frequently at the end of the infertility survey. In most cases, it is done as an outpatient procedure. Two small incisions, less than the size of your thumbnail, are made in your abdomen, one in your belly button and one in the pubic hairline. Through these incisions, instruments are inserted which enable your physician to observe the pelvic organs. During a laparoscopy, your physician is able to determine if your fallopian tubes are open and detect abnormalities on the surface of the uterus, and pelvis such as adhesions or endometriosis.

Luteinizing Hormone (LH) Monitoring

Measurement of daily blood LH levels is the most reliable predictor of LH surge. Ovulation normally occurs about 12-36 hours after detection of the LH surge. While daily blood testing to determine serum LH levels is inconvenient and costly, simple, inexpensive urinary LH ovulation kits for home use have become readily available and are considered reliable.