There are so many ways of diagnosing infertility, some more invasive than others. You need not carry out all of the tests especially if your doctor first takes a proper medical history and physical examination. Bear in mind that these tests take a toll on your body, mind, emotions and finances and more so you need to plan! It is not the time to blame anyone or even yourself, nor for you to have regrets, but time to work.

Do your researches on the hospitals that can best handle this, find out costs of diagnosis and treatment; if you are paying out of pocket, save towards it; if you have health insurance coverage, see how much cover if any that you have for fertility tests and treatment. Read as much as you can on pregnancy, bear in mind that there may be no cause, sometimes ‘adoption’ alone is a treatment, for babies to just keep coming.

I hope you know fertility problems can affect a man or a woman, and sometimes both partners, so it is important to support each other as much as possible. Carry out your tests together, the type of tests recommended will take into account your medical, social and sexual history, your finances, age, the duration of infertility, and your physical and gynaecological examination.

It is imperative for you to be open and honest because a solution may be found from just a comprehensive history.

Medical, sexual and social history

Discussing your full medical history along with a physical and gynaecological examination will help your doctor determine the type of tests you should carry out, your treatment options as well as identify what may be causing the fertility problems. Thus, some non-invasive methods can be used to detect the most common causes of infertility, and I would usually advise they be carried out first. We understand that discussing your sex life with your doctor feels uncomfortable or embarrassing. It is worthy of note to remember that whatever you discuss is very confidential.

Did you know some fertility problems may be related to sex?

Questions asked are usually related but not limited to the following:

Age: as the woman age increases to 40 years, her eggs get older, their quantity and quality are less capable of achieving conception as it would in a younger person.
Prior pregnancies: have you had miscarriages, previous births, related complications with the pregnancy; termination of pregnancies, were there any complications?
For a man: have you ever impregnated a woman or had children from previous relationships?
Length of time trying to conceive
Menstrual cycle: your last menstrual period for the past 4 or more months, were they regular or irregular? Do you know when you ovulate? Do you know your most fertile window? Do you experience unusual bleeding in the middle of your cycle?
Sex: how often do you have sex? What position? Any difficulties during sex? For a woman – do you bleed after sex? For a man – any premature or no ejaculation? Erectile dysfunction?
For a woman – Length of time since you stopped contraception, type of contraception/birth control measures you previously used. It can sometimes take a long time for certain types of contraception to stop working, and this may be affecting your fertility
Lactation: any milky discharge when you press your breasts or if your partners suckle?
Vaginal discharge?
Medical conditions: presently or have you had in the past? Including diabetes, hypertension or previous pelvic surgery; history of gonorrhoea, Chlamydia or syphilis infection; or prior injury to the testicles or penis, do you cycle extended periods of time – recreation/exercise; straddle injury, recent high fevers or childhood diseases, such as mumps
Medication: some medication whether prescribed or herbal have side effects which can affect your fertility it is even suspected that some painkillers may temporarily affect fertility in both men and women

After taking the history, your doctor will physically examine your whole body and your genital areas as well as refer you to the lab for blood and urine tests; then for ultrasound and radiology tests if there is the need for these.

The physical examination includes but not limited to:

For women

Weight, blood pressure, waist-hip ratio and Body Mass Index (B.M.I.)
Look for signs of milk production in the breasts
Broad shoulders, hairs on the chin, male pattern abdominal or chest hairs, deepening voice or pimples on the body
Pelvic examination: to check for infection, lumps or tenderness, which could be an indication of fibroid, ovarian tumours, pelvic inflammatory disease or endometriosis

For men

Weight, blood pressure, measure waist-hip ratio, Body Mass Index (B.M.I.)
Your testicles will be examined to look for enlarged veins, warmth, presence or absence of testicles in the sac, any lumps or deformities
Hormone deficiency or anabolic steroid use as indicated by small testes
Your penis is examined for shape, structure, location of the opening, discharge, and any apparent abnormalities
Your groin area is checked for lumps- hernia or undescended testes

After these we may recommend some non-specific lab tests such as:

Random blood sugar
Lipid profile
Chlamydia tests for both men and women
Fertility specific tests for women

A blood sample taken for hormone tests to check if you are ovulating; levels of progesterone, gonadotropins and prolactin and thyroid hormones are measured. Thyroid disorders may cause problems with fertility, menstrual irregularities, and repeated miscarriages.

Ultrasound is performed to look for fibroid and cysts in the uterus and ovaries and also to examine follicles in the ovary. It is also used to check the position of the uterus.

A hysterosalpingogram is a type of X-ray taken of your womb and Fallopian tubes after a special dye has been injected. Hysterosalpingogram will outline the cavity of your womb, and spill into the tubes if they are patent. It will also show abnormalities in the cavity such as bands, or if it is divided; if the dye does not spill into the tubes, it implies the tubes may be blocked.

Laparoscopy involves making a small cut in your lower tummy and a telescope is used to look closely at your womb, Fallopian tubes, and ovaries. A laparoscopy is usually only used if there is a high chance that you have a problem – for example if you have had an episode of P.I.D. in the past.

For an endometrial biopsy, the doctor removes a piece of tissue in the uterine lining. Exams it to see whether eggs have been released; and whether enough progesterone is being produced.

An after sex test may be performed in which the doctor takes a sample of mucous from the woman’s vagina within 12 hours after she and her partner have sex. The test will tell the doctor if the man’s sperm can survive in the woman’s cervical mucus. Checking how well sperms survive after ejaculation or how well they can penetrate an egg are rarely performed because they usually do not change recommendations for treatment.

Examination and tests for men

Evaluating a man’s fertility includes looking for signs of hormone imbalance, such as increased body fat, decreased muscle mass and decreased facial and body hair. The evaluation also includes:

A semen analysis – your semen will be tested to determine whether you have a low sperm count, low sperm mobility or abnormal sperm. This analysis is necessary even if the male partner has fathered a child before. The man is requested to refrain from ejaculation for around 48 hours before the test. A man may need to provide a semen sample on more than one occasion because sperm production can vary over time depending on the man’s activities and stress level.

Males also have an imbalance of hormones, such as testosterone and sometimes prolactin. Did you know that taking steroids for body building could shrink the testes so much so that they are incapable of producing adequate sperms?

Post-ejaculation urinalysis – Sperm in your urine can indicate your sperm are travelling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).

Transrectal ultrasound: this involves inserting a small, lubricated wand into the rectum to check your prostate, and look for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).

Conclusion

Fertility testing can be a lengthy, emotional and expensive process, be prepared. Note that your mindset can influence outcome so develop positive stress coping skills, will go a long way to help. Know what options you have before you visit your doctor. Remember, fertility problems can affect a man or a woman, and sometimes both partners so support each other. Lifestyle, age, genetics, environment play a role, all these effects may not be picked up by tests. There are options, and some causes can be prevented or treated, and a few others are not known.

Please ask your questions, share this posts, and your story if you don’t mind. Contributions and comments are welcome, thank you.

Wishing you good health and happiness,

Dr Nse

Author: Dr. Nse