Basic Infertility Evaluation

At the time of your initial consultation, the doctor will start by taking your history. The doctor will ask you questions about your past and try to get clues as to the cause of your infertility. These questions will encompass your gynecological, medical, surgical, and "lifestyle" history.

A review of fertility related documents from other doctors that you have seen is also important.

A physical exam which may include a pelvic ultrasound may be performed. The ultrasound can help the doctor discover any abnormalities within the uterus, fallopian tubes and/or ovaries. Sometimes evidence of pelvic scarring can be discerned. The doctor can also obtain information regarding the woman's potential for adequate ovarian stimulation for infertility treatment cycles by counting antral follicles.

An assessment of ovarian reserve will be important to determine a woman's remaining egg supply. This is usually done with a Cycle Day 3 (CD3) FSH and estradiol testing along with the ultrasound assessment of ovarian volume and antral follicle counts. The FSH and estradiol is a blood test which can be performed at a lab local to the patient.

Another important test which should be done early in the evaluation process is a semen analysis. If a severe sperm defect is discovered, the testing of the female partner may be modified and therapy can be immediately directed to the problem. About 25% of all infertility is caused by a sperm defect and 40–50% of infertility cases have a sperm defect as a contributing cause.

Some additional blood tests that might be needed for better assessment of the patient and her partner include the CD3 FSH, luteinizing hormone (LH), prolactin, estradiol (E2), progesterone (P4), thyroid stimulating hormone (TSH), HIV, HTLV-I and II and possibly other tests as recommended.

In checking for tubal factors, the patient may be recommended to undergo a hysterosalpingogram (HSG), which is a test done in order to assess the anatomy of the endometrial cavity of the uterus and the fallopian tubes. About 25% of all infertility is due to a tubal factor.

Another test in the assessment process is a saline sonogram which is used to evaluate the uterine cavity. A laparoscopy may also be used for further evaluation of the pelvic cavity. Problems such as endometriosis and pelvic adhesions may sometimes be treated by laparoscopy.