How is Fertility Investigated

fertility Investigation

If you have been trying to have a baby without success, you may want to seek medical help. If you are over 35, or if you have reason to believe that there may be a fertility problem, you should not wait for one year of trying before seeing a doctor.

A medical evaluation may determine the reasons for a couple’s infertility.

Usually this process begins with physical exams and medical and sexual histories of both partners.

If there is no obvious problem, like improperly timed intercourse or absence of ovulation, tests may be needed.

Fertility Ultrasound

An ultrasound scan is a widely used, safe and effective tool for evaluating fertility. A fertility ultrasound examination is performed to assess for fertility issues in both men and women.  

For women ultrasound examines the condition of the patient’s

  • uterus (womb) - in particular the presence of polyps or fibroids

  • ovaries

For men ultrasound test examine the condition of the patients

  • Scrotum - in particular for evidence of varicocele or epididymal cysts

The ultrasound procedure can be performed one of three ways depending on your situation:

  • Transvaginal ultrasound scans: During the procedure, a small probe is placed into the vagina. The test helps your doctor to examine the health of your fallopian tubes, ovaries and uterus. Your doctor uses the results to evaluate the thickness of the uterine lining, presence of cysts, tumours and other abnormal growths, which could be causing infertility.

  • Transabdominal ultrasound scans: During the examination, a conducting gel is applied over your skin and a transducer (a small handheld device) is moved over the lower belly. Transabdominal ultrasound examination is commonly performed to examine the health of your fallopian tubes, ovaries and uterus, follicle development, and to detect uterine fibroids, fallopian tube blockage and ovarian cysts.

  • Transrectal ultrasound: This approach is commonly used in men to assess their pelvic organs including the prostate and scrotum.

Infertility Tests for Women

Female infertility can be confirmed with the following tests:

  • Blood tests measure your hormone levels and determine if you are ovulating - these include Luteinising Hormone (LH), Follicle Stimulating Hormone (FSH), oestrogen, Anit-Mullerian Hormone (AMH) which are measured in the first few days of a woman’s cycle

  • Biopsies may be obtained to evaluate the inner lining of your uterus.

  • Ovarian reserve testing may be performed in order to determine the number and quality of eggs ready for ovulation.

  • HyCoSy - a small amount of contrast material (salt water) is injected into the cervix and travels through the uterine cavity and fallopian tubes. Ultrasound then provides detailed and dynamic views of the patency of the tubes and the lining of the uterus.

  • Hysterosalpingography involves obtaining an x-ray image after injecting a contrast material into your cervix which travels up to your fallopian tubes. This can help identify any blockages in your fallopian tubes and will also image the cavity of the uterus.

  • Laparoscopic evaluation involves inserting a thin tube fitted with a camera through an incision in your abdomen, in order to detect any abnormalities in your reproductive organs, such as the ovaries, uterus and fallopian tubes.

Infertility Tests For Men

A diagnosis is often made by your doctor based on the following:  

  • Medical history

  • Complete physical examination

  • Hormone tests including testosterone, LH and FSH

  • Karyotype - analysis of chromosomes

  • Testicular ultrasound: This is an imaging test to diagnose abnormalities of the testicles.

  • Testicular biopsy: A small piece of tissue is removed from the testicle using a sterile needle and sent for evaluation under a microscope to help determine the cause of infertility.

Semen analysis

This is a laboratory test carried out to assess the sperm count, motility (how fast the sperm swim) and morphology (shape of the sperm).The test sample is obtained by ejaculating into a sterile bottle. It is recommended that this is done in an IVF unit - where there will be a specialised andrology unit. Dr Cook will recommend Monash IVF. This can be done at home and brought to the clinic within one hour. Alternatively, the clinic at Monash IVF has a specially dedicated room.