How is infertility diagonized in a woman?

If a woman has an infertility problem, she will be referred to a doctor who specializes in reproductive endocrinology. Her diagnostic tests may include:

• Blood tests and urine tests to check hormone levels.
• A Pap smear to study the health of the cervix.
• Urine tests to evaluate LH surges.
• A basal body temperature test, which checks whether the woman is releasing eggs from her ovaries. A woman's temperature rises slightly during the days she ovulates. The woman will chart her basal body temperature every day for a few months on a graph. She will take her temperature orally or may take her temperature vaginally with a special ultra-sensitive thermometer available at most drugstores.
• An endometrial biopsy, in which the doctor removes a piece of tissue in the uterine lining. Examining this tissue will tell the physician whether eggs have been released and whether the corpeus luteum is producing enough progesterone. This test is often done if the results from the woman's basal body temperature chart are unclear.
• An ultrasound to look for fibroids and cysts in the uterus and ovaries. This test uses sound waves to picture the uterus and ovaries, causes little discomfort, and is very effective.
• A postcoital test, in which the doctor takes a sample of mucous from the woman's vagina. She must have the test during her fertile days and within 12 hours after she and her partner have sex. The test will tell the doctor if the man's sperm can survive in the woman's cervical mucous.

More complex tests include:

• A laparoscopy: If the doctor suspects ovarian or fallopian tube scarring or endometriosis, a woman may undergo a laparoscopy. The doctor makes two small incisions at the pubic bone and navel, and carbon dioxide gas is injected into the stomach to enlarge it.

  Then the doctor inserts a laparoscope, a long tube with lenses and a fiberoptic light, into one incision and a long probe through the other opening in the skin. With the probe, the doctor can view the ovaries, fallopian tubes and uterus to check for scar tissue. In some cases, he may cut away scar tissue discovered during this operation.

  The woman usually has to undergo general anesthesia for the procedure, but the risks of bleeding, infection and reaction to the anesthesia are slight.

• A hysterosalpingogram: This test checks the condition of the woman's fallopian tubes.

  The doctor clamps the cervix and injects a needle filled with dye into the woman's uterus. An X-ray is taken to determine whether the dye passes through the open ends of the fallopian tubes. If the dye emerges from the end of the tubes, they are not blocked.

  The test may also reveal other fertility problems, such as fibroid tumors, structural abnormalities and endometrial polyps. In some cases, the dye actually clears away blockages in the fallopian tubes, and restores the woman's fertility.

  The dye is harmless and is absorbed by the woman's body after going through her tubes. The test may be uncomfortable, but is rarely painful. Unfortunately, it is noted for both false positive and false negative diagnoses.