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7.2 Infertility Tests: Evaluation Process For Women


This article is from the Infertility FAQ, by Rebecca Smith Waddell bec@fertilityplus.org with numerous contributions by others.

7.2 Infertility Tests: Evaluation Process For Women

Hormone tests: These are simple blood tests to check if there is a hormonal
imbalance. These tests may include any or all of the following:


luteinizing hormone (LH)
follicle stimulating hormone (FSH)
estradiol (E2)
thyroid stimulating hormone (TSH)
free T3
free thyroxine
total testosterone
sex-hormone binding globulin<BR>

A chart of hormone levels is posted at

Insulin resistance (IR) testing: Insulin resistance is precursor to
diabetes that can cause weight gain and is often seen in those with
PCOS. Testing should be done on overweight infertility patients and
anyone suspected of having PCOS, What happens is that the body starts
producing excess insulin (hyperinsulinemia) in order to keep glucose
levels normal. Testing glucose levels alone won't indicate insulin
resistance until it is fairly advanced -- what's needed is fasting
glucose and insulin levels, or a glucose tolerance test (preferrably
also checking insulin). More info is at
http://www.inciid.org/faq/pcos.html. Pelvic exam: A physical exam to
check for signs of infection as well as obvious physical
abnormalities. Pretty much the standard feet-in-stirrups event.

Abdominal ultrasound: A transducer is passed over the bare skin of the
abdomen in order to view the uterus and ovaries. Cysts, fibroids and
uterine abnormalities may be visible.

Trans-vaginal ultrasound: A transducer wand is inserted into the
vagina to view the cervix, uterus and ovaries. Provides greater detail
than abdominal ultrasound.

Post-coital test (PCT): A sample of cervical fluid is obtained by
gently scraping the cervix within a few hours of intercourse. The
fluid is checked under a microscope to see if motile sperm are
present. Must be done with fertile mucus at ovulation time.

Endometrial biopsy (EMB): Used to "date" the lining in relation to
ovulation and to test for infection or pre-cancerous cells. To date
the lining, the test is generally performed a few days prior to
expected menses. A thin catheter is inserted through the cervix and a
small sample of the uterine lining is removed.

Hysterosalpingogram (HSG): People often call this the dye test. A
catheter is inserted through the cervix and a small amount of dye is
pushed into the uterus while x-rays are being taken (usually
continuous motion as well as a few stills). The shape of the uterus is
observed, as well as how the dye flows through the fallopian tubes.

Laparoscopy: This surgery is usually done under general anesthesia to
look for structural abnormalities, endometriosis and adhesions as well
as possibly repair any problems found. The abdomen is inflated with
carbon dioxide and a scope is inserted through a small incision below
the navel. A second incision just above or below the pubic hairline is
used to insert a tool to help manipulate the organs for better viewing
with the scope. Patients may be able to get a videotape of the

Hysteroscopy: The cervix is dilated just enough to insert a small
scope used for viewing the inside of the uterus. Minor abnormalities
can be fixed during this procedure, which can be done under local or
general anesthesia. Often done in conjunction with a laparoscopy.

Personal experiences with EMBs, HSGs, laparoscopies and hysteroscopies
are posted in the Invasive Infertility Tests FAQ at

Infectious disease testing: Some physicians will test for a variety of
sexually transmitted and other infectious diseases including
ureaplasma, mycoplasma, gonorrhea, chlamydia, syphilis, toxoplasmosis,
rubella (German measles), cytomegalovirus virus, Hepatitis b&c and HIV
I & II.

Immune testing: Some of the tests mentioned below are still
controversial, but more and more doctors are seeing the benefits of
checking into and treating immune disorders which affect fertility.

Lupus (SLE) tests (includes commonly tested for lupus anti-coagulant):

Activated Partial Thromboplastin Time (APTT)
Kaolin clotting time
Platelet Neutralization Assay
Dilute Russel viper venom time
Anti-phospholipid antibodies (APA) tests (includes IgM,
IgG and IgA markers):
Anticardiolipin antibodies (ACA)
Phosphatidic acid

Anti-nuclear antibodies (ANA) tests:


Anti-thyroid antibodies (ATA):

Thyroid microsomal (thyroid peroxidase) autoantibodies

Anti-sperm antibodies (ASA): These can be either autoimmune or
alloimmune. They are a blood test, usually indicated by a specimen at
IUI-time behaving abnormally. If it's autoimmune (the male has them)
then the sperm are healthy looking, but they clump together and make
knots that don't make satisfactory progression in great looking
mucus. If it is alloimmune (the woman has them) then they are usually
healthy looking but mostly dead on arrival or all of the live ones are
incredibly slow. It's at IUI time that most of us get sent for the
full range of tests, but many of us are treated without testing
(testing cost is high, treatment cost is low). Treatment is usually
prednisone for the party doing the antibodies. Dose is dependent on
severity. Prednisone is very inexpensive -- about $5.00/month each.

Alloimmune tests:

Leukocyte Antibody Detection (LAD or HLA sharing)
Natural Killer Cells (CD56+)
Full Reproductive Immunophenotype (include NK cells)
Embryo Toxicity Factor (ETF)

The full Immunophenotype costs around $500 each and several may be
necessary to gauge success of treatment. It is similar to testing that
cancer, AIDS and transplant patients have. It measures all kinds of
things about our immune systems in general and then our Reproductive
Immunologists make some interpretations to apply our results to
reproductive problems.

More information on immune testing can be found on the ICIID
(pronounced inside) web site, http://www.inciid.org/immune.html, and
on Dr. Beer's web site at http://repro-med.net/index.html.

MRI or CT scan: One of these might be done if elevated prolactin is
found. This is to look for a pituitary tumor.


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