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Medical Author:

Jairo E Garcia, MD

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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A health care professional will take a complete medical history. Couples may be asked to provide the following information:

• Complete medical history for both the man and the woman
• Whether the woman has never had a child (primary infertility) or have a child and want another (secondary infertility)
• How long has the couple been trying to become pregnant
• History of the woman's previous pregnancies, if any
• How often the couple has intercourse
• A woman's menstrual history
• Current medical treatment for the man and woman

A health care professional may perform a physical examination on both partners, including the following aspects:

• Routine blood pressure, pulse, and temperature
• Height and weight
• Inspection of sexual organs
• Hormone testing
• Woman: Pelvic ultrasound scan to look for masses, cervical mucus testing
• Man: Genital examination, testicle size, hernias

A health care professional will discuss the findings from the medical history and physical examination. Sometimes, a complete infertility evaluation may take up to two menstrual cycles before the factors causing the infertility can be found.

The male partner will be asked to submit a semen sample for a complete semen analysis. Even though a man has fathered a child in the past, he will still be asked to submit a semen sample because his reproductive system may have changed.

The semen sample may be collected at the laboratory (in a private room through masturbation). If a sample is collected at home, it must be collected in a sterile plastic container and delivered to the lab at a body temperature no more than 60 minutes after ejaculation.

Some men cannot produce a semen sample through masturbation. Therefore, the sample can be collected through intercourse, using a special nonspermicidal condom provided by the laboratory. For best results, the semen sample should be collected 3 to 5 days after a period of having no sexual intercourse.

A man may produce no sperm for various reasons. He may produce few sperm or sperm that have defects that prevent them from reaching or fertilizing the egg.

Several conditions may affect a woman's ability to get pregnant. A health care professional will evaluate the entire reproductive system.

The cervix plays a key role in the transport of the sperm after intercourse. Cervical mucus production, amount, and characteristics change according to the estrogen concentration depending on the menstrual cycle.

The uterus is the final destination for the embryo and the place where the fetus develops until delivery. Therefore, the uterus may be associated with primary infertility or with pregnancy problems and premature delivery. Other problems affect the development and function of the uterus (specifically the endometrium or inner layer of the uterus).

Ovaries may not release eggs. Fallopian tubes may be blocked. The doctor will want to evaluate all parts of the reproductive system.

The health care professional may use any of several procedures to examine the woman's reproductive organs:

• Pelvic exam: This is a general physical examination in which the doctor feels the uterus for detectable masses and views the cervix.
• Hysterosalpingogram: This is an imaging study of the uterus and Fallopian tubes after contrast dye has been injected through the cervix. It shows the shape of the uterus and if the Fallopian tubes are open. The dye appears white on an X-ray. This test is usually performed before ovulation so the dye does not disrupt an egg or developing embryo. The woman may be given pain medication before the test because some women experience minor pain.
• Ultrasound: Pelvic ultrasound has become an important tool in the evaluation and monitoring of infertile women. It is a way to detect uterine fibroids, endometrial polyps, ovarian cysts, and other abnormalities in the pelvis from the outside with sound waves. A sonohystogram, or saline infusion sonography (SIS) is a test that combines ultrasound with saline solution injected into the uterus.
• Magnetic resonance imaging (MRI): This is another imaging procedure similar to an X-ray that uses magnetic waves to create images of the internal organs.
• Hysteroscopy: This is a method of directly seeing the interior of the uterus with an instrument.
• Laparoscopy: This is a surgical procedure that allows the doctor to see directly inside the pelvis with tiny instruments inserted through small cuts in the abdomen.
• Endometrial biopsy: This test involves removal of a small piece of tissue from the uterine lining by a catheter inserted through the cervix. This test can help determine whether the menstrual cycle is normal and whether ovulation has occurred.

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