Problems with ovulation account for a quarter of infertility cases, according to the American Society for Reproductive Medicine (ASRM). Ovulation is the process your body conducts to develop an egg suitable for fertilization. Thus, testing the ovaries and the process of ovulation is a good place to start a fertility evaluation.
If a woman has regular cycles, she is most likely ovulating. This can be confirmed by testing progesterone in the blood during the last half of the cycle. Irregular cycles or short luteal phases after ovulation require special attention. Standards for diagnosing poor luteal function have been a controversial topic for decades.
One test will assess the ovaries and their ability to produce healthy eggs. The FSH, estrogen (estradiol) and AMH blood tests are used to evaluate ovarian reserve. The term “ovarian reserve” refers to the reserve of the woman’s ovaries (remaining egg supply) to be able to make babies. The ovarian reserve then is a measure of a woman’s fertility potential in the absence of any other problems in the reproductive tract. This is treated in depth in our sections on FSH, AMH and ovarian reserve.
A basic infertility evaluation should always include an assessment of the uterus. Irregularities in the uterus may cause infertility. Uterine fibroids are a common kind of abnormality that can affect fertility. Fibroids can cause fertility problems when located either within or very close to the uterine cavity or when they are large. Sometimes the uterine cavity itself is distorted.
Other uterine causes of infertility include benign glandular tumors inside the uterus which are called uterine polyps. Scarring of the uterus can occur after miscarriage, though fortunately this is uncommon. Because the uterus and these abnormalities involve soft tissue, these problems cannot be seen on a normal ultrasound or X-ray, so specialized imaging tests may be used in assessment of the uterus. The sections under sonohysterogram and hysteroscopy will treat this area in depth.
When the ovaries release the egg, it travels down the fallopian tubes in order to be fertilized by sperm. If the tubes become blocked or otherwise damaged, sperm cannot fertilize the egg and the embryo cannot settle in the uterus. Tubal problems are responsible for 35 percent of infertility cases, according to the American Society for Reproductive Medicine (ASRM). Infection can cause tubal damage. The most common disease related to tubal function is endometriosis.
Sometimes infertility may be either caused by or subsequently fostered by hormonal problems. Several key hormones may be studied in infertility evaluations. The first and most critical is progesterone. Progesterone levels generally peak about a week after ovulation, and your physician may perform blood tests to measure the progesterone directly in your blood stream.
The second hormone of interest in the study of infertility is follicle stimulating hormone (FSH), which helps control a woman’s menstrual cycle and the production of eggs. The third is Estradiol, an important form of estrogen, is tested to measure a woman’s ovarian function and to evaluate the quality of the eggs.
The fourth reproductive hormone that may be tested is luteinizing hormone (LH), which shows up in urine just before ovulation, and it stimulates your ovaries to release an egg and also to start producing progesterone, a hormone that transforms the uterine environment to receive a fertilized egg.
This is the hormone detected by ovulation prediction tests.
Others commonly tested are prolactin and TSH. In some cases levels of male hormones are an issue.