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How Doctors Diagnose Infertility

Are you infertile, or just having trouble getting pregnant? If you go to the doctor, here’s how a diagnosis of infertility will happen. “Infertility” is a term that describes when a couple is unable to conceive a child after a year of having sex without birth control. In women who are older than age 35, infertility may be diagnosed with a shorter timeframe of six months of trying to conceive.

The term “infertility” also is used to describe women who are able to get pregnant but who are unable to carry a fetus to term. If pregnancy loss occurs before 20 weeks of pregnancy, it is called a miscarriage or clinical spontaneous abortion. Losses after 20 weeks are called stillbirths. Multiple losses of pregnancy are called repeated or recurrent miscarriage.

If you’ve already been diagnosed with male factor infertility, read What Causes Unexplained Infertility in Men? Damaged DNA in Sperm.

How is Infertility Diagnosed?

Here’s what the medical experts at the National Institute of Health say about diagnosing infertility in both men and women. Health care providers and doctors evaluate men and women differently to diagnose infertility.

Diagnosing Female Infertility

In evaluating a woman’s fertility, a health care provider will ask specific questions about her health history. These include:

  • Prior pregnancies
  • Prior miscarriages
  • The regularity of her menstrual period
  • The presence of pelvic pain
  • Whether she has abnormal vaginal bleeding or discharge
  • Whether she has a history of pelvic infection or previous pelvic surgery

Initial screening will also involve a physical exam including a pelvic exam, a Pap test, and blood tests to look at overall health. The health care provider will look for signs of milk production in the breasts, which suggests a hormone imbalance, and physical symptoms of polycystic ovary syndrome.

A health care provider or doctor may diagnose infertility by also carrying out the following lab fertility tests and evaluations:

A blood test around day 23 of the woman’s menstrual cycle can measure the amount of a hormone called progesterone (pronounced proh-JES-tuh-rohn). This test can tell if ovulation has occurred and if the ovaries are producing a normal amount of this hormone.

Hormone tests. Tests may be performed to measure levels of other hormones that are important for fertility. Other tests may be performed that examine the fallopian tubes and determine if there is blockage that prevents movement of the egg from the ovaries. These include:

X-ray hysterosalpingogram. A health care provider injects a radiographic dye into the cervix to fill the uterus. If the fallopian tubes are clear of blockages, the dye will flow out the end of the fallopian tube into the peritoneal cavity. Movement of the dye is monitored by x-ray fluoroscopy.

Laparoscopy is a surgery in which a small viewing instrument, called a laparoscope, is inserted through a minor cut in the abdomen to examine the female reproductive organs. If the procedure identifies blockages in the fallopian tubes, the blockages can be removed with instruments attached to the laparoscope.

A health care provider may examine the inside of the uterus to look for scarring, uterine fibroids, or polyps. The following procedures are used to examine the uterus:

Transvaginal ultrasound. An ultrasound looks at the internal organs using sound waves. A wand inserted into the vagina applies sound waves to the body. This provides a health care provider a better view of the female reproductive organs, including the uterus and ovaries.

Hysteroscopy. A hysteroscope is a long, thin camera that is inserted through the vagina and into the uterus.

Saline sonohysterogram. In this procedure, a health care provider injects sterile saline into the cervix to fill the uterus. Once the uterine cavity is full, it is easier to see its inner lining. The pelvic organs are visualized with transvaginal ultrasound. It is also possible to see fluid move into the peritoneal cavity at the same time.

Health care providers may test a woman older than age 35 to determine whether her ovaries produce follicles, which normally develop during her menstrual cycles. This type of testing includes performing a transvaginal ultrasound to look at the ovaries and measuring hormones in the blood on certain days of the menstrual cycle.

For more info on these tests for diagnosing infertility, read 3 Fertility Tests to Help Women Know if They Can Conceive.

Diagnosing Male Infertility

The evaluation of a man’s fertility includes looking for signs of hormone deficiency, such as increased body fat, decreased muscle mass, and decreased facial and body hair. The evaluation also includes questions about the man’s health history, including:

  • Past injury to the testicles or penis
  • Recent high fevers
  • Childhood diseases, such as mumps
  • A physical examination of the testes and penis allows for identification of problems, such as1:
  • Infection, signaled by discharge or prostate swelling
  • Hernia
  • Malformed tubes that transport sperm
  • Hormone deficiency as indicated by small testes
  • Presence of a mass in the testicles
  • Varicocele

A health care provider or doctor may also ask a man to provide a sample of semen to assess the health and quality of his sperm. To give a semen sample, the man is requested to refrain from ejaculation for around 48 hours before the test. He then provides a sample by masturbating into a cup or by having intercourse using a special condom (without contraceptive) that collects semen without affecting the sperm. A man may need to provide a semen analysis on more than one occasion because sperm production can vary over time depending on the man’s activities and stress level.

Other tests that doctors use to diagnose infertility in men and women include:

Measurement of hormones in the blood, including testosterone and follicle-stimulating hormone

Biopsy of the testicle. A health care provider uses a needle to extract sperm from the testicle.

Genetic testing. In cases where no or very few sperm are found in the semen, a health care provider may do genetic testing before starting fertility treatments. Testing can identify chromosome abnormalities that may cause the lack of sperm or lead to developmental problems among offspring.

If you have any questions about how doctors diagnose infertility in men and women, please ask your health care provider! I’m not a doctor; I just gather information for people and post it here.

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Source: How is infertility diagnosed? and  What is Infertility?, both on the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development page.

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5 thoughts on “How Doctors Diagnose Infertility”

  1. Thank you for your information, Victory! It’s so important to have resources like yours – I know you have tons of information online about infertility and getting pregnant. I appreciate your sharing it!

  2. Hi Laurie, thank you for that informative post and I would also like to add some other test that can diagnose female infertility which is the Ovarian reserve testing that includes Clomiphene citrate challenge test to test the estrogen levels, the Ultrasonography of ovaries to evaluate the volume of the ovaries and other blood test to determine an ovarian reserve.

    Also some test included to examine male infertility like Scrotal ultrasound that visualized any difficulties in the male reproductive tract and other supporting structures inside the scrotum. Transrectal ultrasound that is inserted in the scrotum to visualized the prostate. Post-ejaculation urinalysis where the presence of the sperm can indicate if the it is traveling backward instead of forward in a man’s urine. Anti-sperm antibody tests that checks for an immune response of a targeted sperm.