Female Infertility: Treatment, Testing and Diagnosis

If you’ve been unable to conceive within a reasonable period of time, seek help from your doctor for evaluation and treatment of infertility.

Fertility tests may include:

• Ovulation testing: An at-home, over-the-counter ovulation prediction kit detects the surge in luteinizing hormone (LH) that occurs before ovulation. A blood test for progesterone — a hormone produced after ovulation — can also document that you’re ovulating. Other hormone levels, such as prolactin, also may be checked.
• Hysterosalpingography: During hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee), X-ray contrast is injected into your uterus and an X-ray is taken to detect abnormalities in the uterine cavity. The test also determines whether the fluid passes out of the uterus and spills out of your fallopian tubes. If abnormalities are found, you’ll likely need further evaluation. In a few women, the test itself can improve fertility, possibly by flushing out and opening the fallopian tubes.
• Ovarian reserve testing: This testing helps determine the quality and quantity of eggs available for ovulation. Women at risk of a depleted egg supply — including women older than 35 — may have this series of blood and imaging tests.
• Other hormone testing: Other hormone tests check levels of ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes.
• Imaging tests: A pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a hysterosonography (his-tur-o-suh-NOG-ruh-fee) is used to see details inside the uterus that can’t be seen on a regular ultrasound.

Depending on your situation, rarely your testing may include:

• Other imaging tests: Depending on your symptoms, your doctor may request a hysteroscopy to look for uterine or fallopian tube disease.
• Laparoscopy: This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
• Genetic testing: Genetic testing helps determine whether there’s a genetic defect causing infertility.

Treatment

Infertility treatment depends on the cause, your age, how long you’ve been infertile and personal preferences. Because infertility is a complex disorder, treatment involves significant financial, physical, psychological and time commitments.

Although some women need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed.

Treatments can either attempt to restore fertility through medication or surgery, or help you get pregnant with sophisticated techniques.

Fertility restoration: Surgery

Several surgical procedures can correct problems or otherwise improve female fertility. However, surgical treatments for fertility are rare these days due to the success of other treatments. They include:

• Laparoscopic or hysteroscopic surgery: These surgeries can remove or correct abnormalities to help improve your chances of getting pregnant. Surgery might involve correcting an abnormal uterine shape, removing endometrial polyps and some types of fibroids that misshape the uterine cavity, or removing pelvic or uterine adhesions.
• Tubal surgeries: If your fallopian tubes are blocked or filled with fluid (hydrosalpinx), your doctor may recommend laparoscopic surgery to remove adhesions, dilate a tube or create a new tubal opening. This surgery is rare, as pregnancy rates are usually better with IVF. For hydrosalpinx, removal of your tubes (salpingectomy) or blocking the tubes close to the uterus can improve your chances of pregnancy with IVF.

Reproductive assistance

The most commonly used methods of reproductive assistance include:

• Intrauterine insemination (IUI): During IUI, millions of healthy sperm are placed inside the uterus close to the time of ovulation.
• Assisted reproductive technology: This involves retrieving mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a lab, then transferring the embryos into the uterus after fertilization. IVF is the most effective assisted reproductive technology. An IVF cycle takes several weeks and requires frequent blood tests and daily hormone injections.

What to expect from your doctor?

Some potential questions your doctor or other health care provider might ask include:

• How long have you been trying to become pregnant?
• How often do you have intercourse?
• Have you ever been pregnant? If so, what was the outcome of that pregnancy?
• Have you had any pelvic or abdominal surgeries?
• Have you been treated for any gynecological conditions?
• At what age did you first start having periods?
• On average, how many days pass between the beginning of one menstrual cycle and the beginning of your next menstrual cycle?
• Do you experience premenstrual symptoms, such as breast tenderness, abdominal bloating or cramping?