Semen Analysis
A specimen of the male partner's semen is obtained in a sterile collection cup, and brought to the laboratory. The best results occur when the male partner abstains for 3 days, and the sample is delivered to the lab within an hour of ejaculation. The sample is evaluated for volume, sperm count, motility (the percent that are swimming), and morphology (the percent that are normally shaped). Although normal values vary between laboratories, a normal count is typically >20 million/ml and normal motility and morphology are >50%. This test is done to rule out male causes and to see if the couple might benefit from treatment such as artificial insemination.
Hysterosalpingogram (HSG)
This is an x-ray test where a dye is injected through the cervix up into the uterus and fallopian tubes, while the doctor watches on a video screen. This test is done some time between the end of the menstrual period and ovulation. In some patients. particularly those with blocked fallopian tubes, it may be somewhat painful. It is useful to determine if the fallopian tubes are open and if the cavity of the uterus is normally shaped. It is not uncommon for couples to conceive following this test.
Postcoital test (PCT, Huhner test)
This test is similar to having a pap smear done, but requires a couple to have intercourse 2 - 8 hours beforehand. It is done at midcycle when the cervical mucous is thin and receptive to sperm. A small sample is removed, placed on a slide and examined with a microscope. If good, it suggests that the cervix is not a barrier to fertilization. If the test is poor, the couple may benefit from insemination.
Transvaginal ultrasound
An ultrasound probe is inserted into the vagina and uterus so the ovaries can be seen on a monitor. This test is used to look for such things as fibroid tumors of the uterus and ovarian cysts and to follow patients on fertility medications and early pregnancies.
Progesterone test
This is a blood test drawn about one week prior to the onset of menses since in a normal cycle. This is when progesterone levels peak. A good level confirms ovulation. This may be used to monitor patients on infertility drugs.
Other blood tests
Most of the other tests are useful if the menstrual cycles are irregular. Proclactin is a pituitary gland hormone that may go up in women with small benign growths of the pituitary gland and on certain medications. Thyroid tests help to determine if ther may be a problem with the thyroid. Testosterone, DHEAS, and 17-hydroxyprogesterone are androgens (male hormones) that may be useful to check in women who also have excessive hair growth.
Laparoscopy
This is a same-day surgical procedure in which a telescope is inserted into the belly button so the pelvic organs can be examined. Using the laser, electrocautery, or other tools, endometriosis and/or scar tissue can be resected. This is usually done under general anesthesis, but in some instances is done under local anesthesia only.
Hysteroscopy
This is a same-day surgical procedure in which a telescope is inserted through the cervix into the uterus. The cavity of the uterus can then be examined, and procedures such as removal of a fiberoid tumor, polyp or scar tissue can be performed. When done for diagnosis, this can often be done in the office under local anesthisia.
