Understanding Fertility Problems: The Woman’s Evaluation

Woman in exam room talking to healthcare provider.To help your doctor look for the cause of fertility issues, you will have an evaluation. It will include a medical history, physical exam, and some basic tests. If needed, your doctor may also suggest procedures. These allow him or her to look at your reproductive organs.

Medical history

Your doctor will ask about your health and lifestyle. You’ll also be asked about factors that can affect your ability to get pregnant such as how often you have sex, your menstrual cycle and any medicines or herbs you take. Be sure to mention any prior pregnancies or surgeries. You should also mention if you’ve had any pelvic infections or sexually transmitted infections.

Physical exam

A physical exam helps your doctor learn about your health. It includes a pelvic exam to check for swelling, infection, or other problems. Your hormone function is also checked. To do this, your doctor looks at your breast development, body fat, and hair distribution.

Basic tests

Your evaluation will likely include some basic tests. These include blood tests. In some cases, it also includes tests that check the health of your cervix.

  • Blood tests can be used to check the following factors:

    • Hormone levels (FSH, LH, AMH, estrogen, and progesterone, prolactin)

    • Blood sugar and insulin levels

    • Tests for current or prior pelvic infection

    • Thyroid function

  • Cervical cultures are samples taken from the cervix using a sterile swab. The sample is then sent to a lab and checked for signs of infections that can affect fertility.

Imaging tests

Your doctor may recommend that you have imaging tests. These show the reproductive organs in more detail. These tests may be done in the doctor’s office or in a hospital or surgery center. In most cases, they cause little or no discomfort.

  • HSG (hysterosalpingogram). This is an X-ray test. It is used to view the shape of the uterus and make sure the fallopian tubes are open. During the test, contrast fluid is placed in the uterus and fallopian tubes. The contrast makes it easier to see problems on the X-rays.

  • Ultrasound. This uses painless sound waves to make images of internal organs. This can help show problems with the ovaries or uterine lining.

  • Sonohysterogram. This is an ultrasound done with sterile saltwater (saline) solution placed in the uterus. The saline makes it easier to view the inside of the uterus.

Other tests

If needed, your doctor may suggest other, less common tests. Some can be done in your doctor’s office. Others are done in a hospital or surgery center. For certain procedures, you’ll be given anesthesia to prevent discomfort.

  • Hysteroscopy. This uses a small, lighted tube called a hysteroscope to view the inside of the cervix and uterus. It is usually done just after your period.

  • Laparoscopy. This is a type of surgery that can help reveal problems on the surface of the reproductive organs. A thin, lighted tube device called a laparoscope is inserted into the body. Your doctor then views the reproductive organs through the scope.

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