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Comprehensive Infertility Tests

Couples with at least 12 months infertility or who are over the age of 35 should first be assessed by their GP and then referred to an infertility specialist.

Female Investigations
In simple terms, the two most important aspects of a woman's fertility relate to ovarian function and fallopian tube patency.

If a woman has regular periods, it cannot be automatically assumed that she is ovulating (producing an egg) each month.

Ovarian function can be assessed by performing blood tests on Day 3 or 4 of the cycle for FSH (Follicle Stimulating Hormone), LH (Luteinising Hormone) and Prolactin and usually at the time a Blood Group, Rhesus antibodies, sperm antibodies and autoimmune antibodies are performed. Thyroid function tests and androgen levels are also performed in patients with irregular periods.

Although a woman may have normal pituitary function, according to blood tests, transvaginal ultrasound scans during the follicular phase of the menstrual cycle (day 1-14) are most useful in assessing the development of the follicle (egg) and overall ovarian function. Vaginal scans can also detect other pathology such as polycystic ovaries, ovarian cysts, endometriosis in ovaries and polyps in the uterus. At the time of this scan, the thickness of the lining of the uterus is also assessed.

Fallopian tube patency is best assessed by performing a laparoscopy, hysteroscopy and dye studies and/or falloposcopy. The gynaecologist is then able to see the inside of the uterus and the pelvis and can also treat any pathology such as endometriosis, tubal adhesions and uterine polyps.

Falloposcopy is a more recent investigation which actually looks inside the fallopian tubes so that adhesions, narrowing and loss of folds can be assessed. Patients with long standing unexplained infertility, endometriosis and history of pelvic infection are more likely to have tubal disease.
Male Investigations

Male fertility is initially assessed by a semen analysis and culture and if there is an abnormality in the count, motility or morphology of the sperm, then further tests are ordered.

These can include FSH, LH, prolactin and free testosterone which assess pituitary function. With severe male infertility, a blood chromosome test is often done. In addition a DAZ test can be done to detect a specific genetic deletion on the Y chromosome which occurs more often in infertile men.

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