A physical examination of both the man and the woman will be performed to determine the general state of their health, and to eliminate untreated physical disorders that may be causing the infertility. The couple will be interviewed, separately and together, regarding their sexual habits to determine if intercourse is taking place correctly for conception. If the cause of infertility remains undiagnosed after these examinations, special tests may, be performed.
Investigations to discover the cause of a woman's infertility may include:
Body Temperature And Ovulation
Determining whether ovulation actually occurs is an important part of an infertility evaluation. Daily measurements of basal body temperature (temperature of the body at rest), usually taken immediately on awakening, may be used to determine if and when ovulation is occurring. A low point in basal body temperature suggests that ovulation is about to occur, whereas a slight, persistent rise of about 0.5' F. to I' F. in temperature usually indicates that ovulation has occurred.
Basal body temperature is not a reliable or precise indicator of ovulation. At best, it predicts ovulation only within 2 days. More accurate techniques include ultrasound monitoring and ovulation predictor kits that detect an increase in luteinizing hormone- LH (a hormone that induces ovulation), which peaks in the urine 24 to 36 hours before ovulation. Also, levels of the hormone progesterone in the blood or one of its breakdown products in the urine may be measured; a marked increase indicates that ovulation has occurred.
Whether ovulation occurs also can be determined by performing a biopsy: A small sample is removed from the lining of the uterus 10 to 12 days after ovulation is presumed to have occurred; the sample is examined under a microscope. If changes that normally occur in the uterine lining after ovulation are seen, ovulation has occurred.Laparoscopy
In this technique, a laparoscope (a type of viewing tube) is inserted through the abdominal wall to examine the woman's reproductive organs and determine whether an abnormality, such as a cyst or tumor, is present. This procedure, which is typically performed while the woman is under general anesthesia, enables the doctor to view the uterus, fallopian tubes, and ovaries. The laparoseope also may be used to remove abnormal tissue if the woman has endometriosis or to break adhesions in the pelvic cavity.Hysterosalpingography
This X-ray technique is used to visualize the uterus and/or fallopian tubes. This test is generally done shortly after the woman's menstrual period ends. This diagnostic test also shows congenital abnormalities (birth defects) of the uterus and fallopian tubes, fibrous masses in the uterus, and adhesions (fibrous bands that connect normally unconnected structures) in the uterus or pelvis. For reasons not clearly understood, fertility appears to be slightly enhanced after a normal hysterosalpingogram. Therefore, the doctor may wait to see if a woman becomes pregnant after this test has been performed before ordering additional tests of fallopian tube function.Hysteroscopy
Hysteroscope is a viewing tube inserted through the cervix into the uterus. If the hysterosalpingogram shows an abnormality such as adhesions in the uterus, the doctor examines the uterus with a hysteroscope. The hysteroscope may be manipulated to break adhesions during the procedure, thus increasing the likelihood that the woman will become pregnant.
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