Diagnosing Infertility

Problems with fertility may be caused by many things. To figure out what may be causing problems, your doctor will do a fertility evaluation. This may include a review of your medical history, physical exam, blood tests, and other diagnostic tests. The purpose of the evaluation is to find out if you are producing an egg, if the egg can travel to your uterus, and if your partner’s sperm is healthy. The evaluation will help your doctor make a diagnosis and recommend the best treatment.

Medical History and Lifestyle
Your doctor will ask about your:

• Periods
• Past pregnancies
• Birth control history
• Current sexual patterns
• History of medicines
• History of surgeries
• History of sexually transmitted infections (STIs)
• History of health problems and symptoms
• Lifestyle

Physical Exam
Your doctor will examine your:

• Thyroid gland. A gland that feels abnormal may be a sign of a hormone imbalance.
• Face and body for hair growth. Extra hair may be a sign of a hormone imbalance.
• Breasts. Your doctor will look at the size and shape and will also check for discharge, which may be a sign of a hormone imbalance.
• Vagina and other reproductive organs for growths, sores, discharge, and infection. You may also have a Pap smear.

Hormone Tests
Many hormones play a part in ovulation. If hormone levels are too high or too low, there may be problems with ovulation. Hormone levels may be checked with blood samples.

Cervical Mucus Tests
The mucus in your cervix may be tested to see if sperm can travel through it. The mucus may also be tested for infections.

Diagnostic Images of Reproductive Organs
Here are some ways your doctor may look at your organs:

• Ultrasound. An ultrasound will show the thickness of the endometrium, development of eggs, and the condition of the uterus and ovaries. Fibroids and cysts may be detected.
• Hysterosalpingogram (HSG). Guided by X-rays, your doctor will inject dye into the uterus, which may show an unusually shaped uterus, scar tissue, or blockages in the fallopian tubes.
• Laparoscopy (lappa-RAW-skuh-pee). After making a small cut below the navel, your doctor will insert a laparoscope, which is like a tiny telescope. Your doctor will view the uterus, fallopian tubes, and ovaries to check for blocked tubes, scar tissue, and endometriosis.
• Hysteroscopy (hista-RAW-skuh-pee). Your doctor will insert a hysteroscope, which is like a tiny telescope, through the vagina and into the uterus. Your doctor will then check for fibroids, scar tissue, and polyps.

If your doctor finds a problem, minor surgery may be done right away to take care of it.

The Right Diagnosis
Most fertility problems can be diagnosed, and most can be treated with drug therapy or surgery. The right diagnosis will help you get the best treatment.

Cervix (SUR-vix): The lower, narrow end of the uterus that connects to the vagina.
Cysts: Sacs filled with fluid on the ovaries.
Endometriosis (en-doe-me-tree-OHsus): A condition in which tissue that normally lines the uterus grows outside of it.
Fallopian (fuh-LO-pee-un) Tubes: The tubes in which sperm fertilizes an egg after it is released from an ovary.
Fibroids (FY-broidz): Noncancerous growths in the uterus.
Hormones: Chemicals made by the body.
Ovaries (OH-vur-eez): The two glands on the sides of the uterus. They produce eggs and hormones. Ovulation (aw-view-LAY-shun): When the ovary releases a mature egg into a fallopian tube. The egg travels through this tube to the uterus.
Polyps (PAUL-ups): Noncancerous growths in the lining of the uterus.
Uterus (YOU-dur-us): Where a fertilized egg (embryo) grows during pregnancy.

Provided as an educational resource by Merck