Fertility testing: Fertility testing
Infertility can have many causes and the diagnosis is often not easy. Your gynecologist will usually suggest an observation of your menstrual cycle for a fertility test, as well as further examinations of the hormone balance and your organs. In the following, we introduce you to the most common fertility tests.
What is the purpose of fertility testing?
In order to track down the causes of female infertility, the menstrual cycle is first documented and checked for clues. Then hormone tests can follow by blood tests. Other clues also give physical examinations such as ultrasound. In special cases, the examinations can also be carried out surgically.
Fertility testing by cycle and cervical mucus analysis
If your medical history or other clear indicators do not give a clear first indication, it is very likely that your gynecologist will first suggest the exact analysis of your cycle in addition to the usual ultrasound examinations (see below).
- Cycle observation: In order to get a better understanding of your menstrual cycle and thus also to track down possible fertility problems, most gynecologists recommend first documenting the cycle in more detail. This is often done in the formof joint cycle monitoring. With the help of the basal body temperature method, it is observed whether and when and how regularly ovulation is. This is usually combined with an analysis of your cervical mucus. Your gynecologist uses this data to identify possible disturbances in your cycle that could indicatehormonal, organic, or other reasons for sterility.
- Postcoital test: Another simple and safe examination that is often performed at the beginning of a sterility diagnosis is the postcoital test, which means examination after sexual intercourse. It is performed when ahealthy semen quality of the man (e.g. by asperm examination) and the occurrence of ovulation is ensured. It is checked whether sperm can migrate through the cervical mucus towards the uterus and fallopian tubes. The test measures the composition of the uterine mucus before and after sexual intercourse, ideally around the time of ovulation. The uterine lining is examined about three to twelve hours after sex.
Testing fertility through hormone diagnostics
An examination of the hormone level is only carried out when your gynecologist already has an accurate picture of your menstrual cycle. Then, over the course of a cycle, the production of the various hormones involved in reproduction is measured.
- LH, FSH, estrogens: In particular, attention is paid to the level of follicle-stimulating and ovulation-inducing hormones LH and FSH as well as estrogen levels. They provide initial clues about possiblehormonal disorders.
- Male hormones: Increased testosterone levels or the increased presence of other male hormones may give an indication of the presence ofPCO syndrome.
- Prolactin: Likewise, anelevated prolactin levelcan indicate the PCO syndrome. However, an increased prolactin level can also give indications of other disorders. Thus, in the case of an elevated prolactin level, the visual function should be tested to investigate the possibility of a lump in the pituitary gland. In the case of an elevated prolactin level, the thyroid function is usually examined more closely in order to track down malfunctions.
Testing fertility by examining the genital organs
Another group of fertility tests directly analyzes the genital organs to find, for example, malformations, cysts and growths. The best known are the following studies:
- Ultrasound: An initial physical exam will most likely be a vaginal ultrasound. On the ultrasound image, your doctor may already be able to detect noticeable growths, cysts or other organic impairments of your fallopian tubes, ovaries or uterus.
- Laparoscopyis the most common method of examining the fallopian tubes, ovaries, uterus and the entire rest of the abdomen. Above all, organic damage to the three sexual organs can be found with it. During laparoscopy, carbon dioxide gas is filled into the abdomen under anesthesia via a one-centimetre-long incision under the navel. After that, the doctor inserts the laparoscope. This is a device for endoscopy of the abdominal cavity, which consists of a thin, long metal rod with a built-in lens system and an externally mounted camera. In addition, an ecopian tube endoscopy usually takes place. Laparoscopy is associated with the normal risks that can occur with any surgery.
- Uterine endoscopyis a low-risk examination that can be performed on an outpatient basis. A two to five millimeter thin probe is inserted into the uterus through the cervix. With carbon dioxide gas or a liquid, the uterus is then unfolded. This allows the doctor to detect malformations, adhesions, fibroids or mucosal changes and, if necessary, surgically remove or treat them.
- Echovist: There are different forms of fallopian tube examination. In hysterosalpingocontrast sonography (HSKS), the passability of the fallopian tubes is examined by ultrasound by administering a prepared lactose solution as a contrast agent.
- HSG: In hysterosalpingography (HSG), a contrast agent is also flushed into the fallopian tubes and then X-rays are taken.