What fertility tests can determine female infertility?
Blood tests determine hormone levels at critical points in the monthly cycle. For the reproductive cycle to occur, hormonal balance and timing are essential.
Miscarriage/recurrent pregnancy loss diagnosis
Approximately 25% of all pregnancies result in a miscarriage. Recurrent miscarriage, defined as two or more consecutive miscarriages, is experienced by fewer than one in 20 women. Causes of recurrent miscarriage may arise from abnormalities in the uterus, genes/chromosomes or hormones or by immunological factors. Smoking, obesity and other lifestyle issues can also impact the risk for miscarriage.
The number of viable eggs in a woman’s ovaries is assessed by measuring blood levels of follicle stimulating hormone (FSH) and oestradiol (E2), anti-mullerian hormone (AMH) and inhibin B levels. An ultrasound scan can also be performed to measure the number of tiny follicles (eggs structures) in each ovary.
Approximately 25% of infertility cases are caused by problems with ovulation. Anovulation (when a woman’s ovaries do not release eggs) may be caused by hormone imbalance, diagnosed through blood and urine tests for hormonal levels at certain times in the menstrual cycle.
Uterus and fallopian tubes testing
Structural problems are tested and diagnosed by several minor procedures done in the physician’s office:
- Ultrasound and transvaginal ultrasound: A procedure that involves the use of high-frequency sound waves reflected off body structures to create images of reproductive organs; ultrasound is one of the simplest and least invasive fertility diagnostic tests and can clearly assess some conditions that cause infertility, like ovarian cysts, or polycystic ovaries (PCO), where the ovary contains more than twelve small follicles in the ovary. PCO must be distinguished from polycystic ovarian syndrome (PCOS). PCO occurs in 20-30 percent of the general population and the patient may have no symptoms at all. PCOS is said to occur if the woman has two of the following three conditions: PCO, irregular or infrequent menstrual cycles indicating anovulation, and/or evidence of elevated androgen (male hormone) levels. PCOS is reported in 2-3 percent of Canadian women.
- Sonohysterogram: A transvaginal ultrasound procedure that also fills the uterus with a saline solution to detect endometrial polyps, fibroids, or other problems inside the uterus. It can also check if the fallopian tubes are open by seeing if the saline spills out from the ends of the tubes and collects at the back of the uterus.
- Hysterosalpingography: A dye solution is injected into the uterus to see the contours of the uterus and whether the tubes are open. It is similar to the sono-HSG but generally more uncomfortable because of reaction to the dye solution.
- Hysteroscopy: A surgical procedure in which a small scope (camera) is inserted into the uterus through the cervix to look at the inside of the uterus in order to diagnose polyps, fibroids or adhesions that may be causing infertility. During hysteroscopy, these issues can be surgically removed.
- Laparoscopy: A surgical procedure in which a small camera and small surgical instruments are inserted into the pelvic region through the abdomen via two to five small incisions. This procedure may evaluate and remove endometriosis, adhesions and other scarring, polyps and blockages of the tubes.
A blood test for thyroid stimulating hormone (TSH) and thyroid antibodies is generally done to determine if TSH could be a factor of infertility. Treatment for this issue may include administration of synthroid (thyroid hormone replacement), if needed.
When is infertility testing recommended?
Infertility testing should be pursued if a couple cannot become pregnant after 12 months of regular, unprotected intercourse. An earlier evaluation may be appropriate for women older than 35 who cannot become pregnant after six months of trying.
Early testing may also be appropriate for women who have a history of any of the following:
- Irregular menstrual cycles
- Absent or missing periods, suggesting no ovulation
- Recurrent miscarriages
- Prior abdominal surgery
- Prior cancer treatments
- Suspected problems with the uterus or fallopian tubes
- Ruptured appendix or severe pelvic infection, suggesting blocked fallopian tubes
Risks of infertility tests & diagnosis
The risks associated with infertility tests and diagnosis are very low. Generally, simple blood tests or ultrasounds tests have near no risk.
Minimally invasive procedures, such as laparoscopy or hysteroscopy that involve scopes and cameras inserted into the abdomen, carry the usual low risks of minimally invasive surgery, including:
- Bruising and tenderness in the abdomen
- Risk of infection at the incision sites
- Possibility of an internal organ being pierced by a surgical tool