Fertility Tests Infertility Evaluation Male Female

Many tests are used to evaluate female fertility by determining several factors:

Are eggs that will fertilize recruited during each ovulatory cycle?
Is the egg ovulated ( released from the ovarian follicle ) regularly each month?
Does the egg travel unimpeded through the fallopian tubes to the site of fertilization?
Once fertilized, can the embryo progress and implant into the lining of the uterus?
Is the endometrium adequately prepared to accept and support the embryo? Once the embryo has implanted, can the pregnancy be maintained to term?

The human reproductive process is very complex. However, for the purpose of evaluation, the most important and basic components include the following:

The infertility evaluation is designed to isolate and test the integrity of each of these components, insofar as that is possible, and to identify any abnormalities that might impair or prevent conception.

Screening Tests

There are several standard screening tests that will be conducted during the infertility workup. Additionally, numerous fertility tests will also be ordered.

Pap Smear and Blood Type

Pap smear screening is recommended for all sexually active women who have a cervix. A blood type, Rh factor, and antibody screening ( in Rh - negative women ) also are recommended, if not already known.

Genetic Testing

The American College of Obstetricians and Gynecologists and the American College of Medical Genetics recommend that screening for cystic fibrosis is available to all couples seeking preconception or prenatal care and that screening should be specifically offered to couples in ethnic or racial groups considered at higher risk for carrying a cystic fibrosis mutation ( Caucasians, particularly those of Ashkenazi Jewish descent ).

Infectious Diseases

All women who are attempting to conceive in whom previous rubella infection or vaccination cannot be documented should be tested for rubella immunity and vaccinated if seronegative. Pregnancy should be delayed for three months following vaccination because of the theoretical risk of the vaccine virus affecting a fetus.

Screening for sexually - transmitted infections ( STIs ) is recommended for all women at moderate to high risk for infection. The CDC recommends screening all pregnant women for syphilis, hepatitis B, and chlamydia; women at high risk for gonorrhea and hepatitis C; and voluntary screening for HIV. Before therapeutic donor insemination and in prospective recipients of donor oocytes or embryos, the American Society for Reproductive Medicine ( ASRM ) recommends STI screening for both partners.

For male partners of women to be inseminated, the ASRM considers HIV - 1 screening mandatory; recommends thorough STI screening to include syphilis, hepatitis B and C, cytomegalovirus antibody, HIV - 1 and HIV - 2, and human T - cell lymphocyte virus ( HTLV ) types I and II; and suggests that screening for chlamydia and gonorrhea also be performed at the discretion of the physician. For recipients of donor oocytes or embryos and their male partners, the ASRM recommends screening for syphilis, hepatitis B and C, CMV, and HIV - 1.

Male infertility contributes to 35% - 45% of infertility cases; therefore, semen analysis is always an appropriate and important initial step in the evaluation of the infertile couple. A frankly abnormal semen analysis is indication for additional evaluation that may be conducted by the gynecologist but is most often performed by a urologist or other specialist in male reproduction. When semen quality is normal, attention turns to the female partner.