Top facts about fertility tests for women

In a recent issue of the journal Fertility and Sterility (Fertil Steril 2012;98:302–7), the Practice Committee of the American Society for Reproductive Medicine (ASRM) provided a critical review of the current methods and procedures for the evaluation of the infertile female.

Here is a brief summary of the recommendations.

1. Don't Wait a Year if You Know You Have a Problem

   Any women who fail to conceive after 12 months or more of unprotected intercourse should be evaluated for infertility. 15% of couples will be infertile.

   However, in women younger than age 35, the evaluation can be started after 6 months of unsuccessful efforts. In patients with irregular or absent menses, known tubal disease, Stage III-IV endometriosis, or known male subfertility, the testing can be done without further delay.

2. A Historical Exam is the First Step Towards Pregnancy

   A careful history and physical examination can identify a specific cause of infertility and help to focus the diagnostic evaluation on the most likely cause(s).

3. Tell Your Doctor About Your Periods

   Your menstrual history can give a strong indication as to whether or not you are ovulating. When the menstrual history is grossly abnormal, no additional evaluation is required to establish a diagnosis of anovulation.

   A properly timed (approximately 7 days before expected menses) progesterone level (> 3 ng/mL) provides reliable objective evidence for recent ovulation. Basal Body Temperature (BBT) charts are tedious, can be inaccurate, and are no longer considered the best or preferred method for documenting ovulation.

4. You May Need More Testing as Treatment Goes On

   In anovulatory infertile women, failure to achieve pregnancy after three to six cycles of successful ovulation induction should be viewed as an indication to perform additional diagnostic evaluation or, if evaluation is complete, to consider alternative treatments. Thyroid tests (TSH) and prolactin (fasting morning) levels are useful for detecting other hormonal imbalances.

5. Ovarian Reserve Numbers Matter

   Ovarian reserve should be assessed in select women at increased risk of diminished ovarian reserve. These include women who:

   • Are over age 35 years
   • Have a family history of early menopause
   • Have a single ovary or history of previous ovarian surgery, chemotherapy, or pelvic radiation therapy
   • Have unexplained infertility
   • Have demonstrated poor response to gonadotropin stimulation
   • Are planning treatment with assisted reproductive technology (ART)
6. There are Many Types of Ovarian Reserve Testing

   Options include cycle day-3 FSH and estradiol, clomiphene citrate challenge test, ultrasound to assess antral follicle count, or serum AMH. Please see my previous blogs for details on ovarian reserve testing.

7. Some Tests Aren't Appropriate Anymore

   There are two tests that, over time, have been shown to be less effective for diagnosing various causes of infertility than other methods. If your doctor orders these tests, question it.

   Histologic endometrial dating is not a valid method for evaluation of luteal function or for diagnosis of luteal phase deficiency. Endometrial biopsy (EMB) should be limited to those in whom specific endometrial pathology (e.g., hyperplasia/ neoplasia, chronic endometritis) is strongly suspected.

   The postcoital test (PCT) is not a valid method for evaluation of cervical factors and should not be included in the evaluation of the infertile female. Routine use of PCT and EMB has not been shown to be beneficial and is no longer recommended as part of the standard evaluation of the infertile female.

8. You'll Need to Have Your Uterus Examined

   Examination of the uterine cavity is an important part of the evaluation of infertile women and can be accomplished using hysterosalpingography, sonohysterography, or hysteroscopy.

9. Testing your Fallopian Tubes is Important

   Evaluation of tubal patency is a key component of the diagnostic evaluation of infertile women. All methods for the evaluation of tubal patency have technical limitations that must be considered when interpreting test results. A second and different test should be considered when the diagnosis remains in doubt.

10. In Some Cases, You May Need Exploratory Surgery

    Laparoscopy may be indicated when there is evidence or strong suspicion of advanced stages of endometriosis, tubal occlusive disease, or significant adnexal adhesions. We do not perform laparoscopy routinely as part of the fertility work up.

If you have experienced trouble conceiving and live in the greater Chicagoland area, please contact InVia fertility to schedule an appointment and let us help you achieve your dreams!