Reviewed by: Zhou Mingfang (Beijing Ditan Hospital, Capital Medical University)
Experts say that people under the age of 35 who have not had contraception for 12 months or who have not been pregnant after 6 months of routine sex without contraception need to see a doctor.
What questions may a doctor ask?
It is crucial for couples to test together. The doctor will ask questions about the health and lifestyle of both parties. Like what:
medical history, including any long-term illness or surgery;
Medications taken;
Whether you smoke, drink alcohol, eat a caffeinated diet, or use illegal drugs;
Have you been exposed to chemicals, toxins, or radiation at home or at work.
Doctors also want to know about sexual aspects, such as:
How often to have a sexual life;
history of contraception;
Whether you have a sexually transmitted disease;
Whether there are any problems with sex life;
Whether you have had sex with someone else.
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Doctors also ask questions about the menstrual cycle, such as:
Have you ever been pregnant before?
How often do you have a period in the past year?
Are there irregular periods or one less visit? Is there a little bleeding between periods?
Is there a change in menstrual blood volume? Or is there a large blood clot?
What contraceptive methods have been used?
Have you seen an infertility doctor before? Have you been treated?
There is no single best test for a woman's infertility, and doctors use a variety of methods to look for any possible factors.
1. Cervical smear examination
This test can detect cervical cancer, other cervical diseases, or sexually transmitted diseases. All of these disorders can interfere with pregnancy.
2. Ovulation
Your doctor may ask for a urine test at home to measure luteinizing hormone (LH) levels. This hormone is at a higher level before ovulation. Doctors may also test the level of progesterone hormones in the blood. Elevated progesterone levels indicate ovulation.
3. Thyroid examination
Doctors may also check the thyroid gland, or other hormonal problems, to rule out conditions that can cause missed or irregular ovulation.
To become pregnant, the uterus, fallopian tubes and ovaries are all working properly, and various examinations of the reproductive organs are required. Your doctor may recommend the following tests to determine the health of these organs.
4. Hysterosalpingogram (HSG)
Also known as "salpingogram," this test takes a series of X-rays of the fallopian tubes and uterus. After the doctor injects the liquid dye into the vagina, he takes an X-ray.
Another method, with the help of ultrasound, replaces the dye with normal saline and gas, without radioactivity, and is called hysterosalpingogram.
HSG can help patients understand whether the fallopian tubes are blocked or if the uterus is defective. This test is usually done just after menstruation.
5. Transvaginal ultrasonography
The doctor places an ultrasound "rod" into the vagina and places it close to the pelvic organ. Through sound waves, doctors can see images of the ovaries and uterus to check for ovarian and uterine problems.
6. Hysteroscopy
Doctors use a thin, soft catheter with a camera at the end of the catheter that passes through the cervix into the uterus. Doctors can detect uterine problems and, if necessary, take tissue samples.
7. Laparoscopy
The doctor will make a small incision in the patient's abdomen and insert a tool (including a camera). The procedure can examine the entire pelvis and correct it, such as the detection of endometriosis.
The doctor may ask for other tests to detect fertility problems.
8. Blood test
To measure follicle-stimulating hormone (FSH) levels, FSH stimulates the ovaries to release one egg per month. Elevated FSH levels mean lower fertility in women.
Blood FSH levels are measured early in the menstrual cycle (usually on day 3).
The clomiphene provocation test, which can be done by measuring the FSH level. Patients will take clomiphene on days 5 to 9 of their menstrual cycle.
FSH levels are measured on days 3 (before taking) and 10 (after taking). An increased FSH level means a lower chance of pregnancy.
9. Blood test
Doctors may also recommend blood tests for a hormone called inhibitorY. In women with fertility problems, inhibitory hormone B levels are lower, but experts disagree on whether the test can predict infertility.
10. Check cervical mucus
Another test is called a "post-intercourse test." Doctors will examine cervical mucus after sexual intercourse. Some studies suggest that this test may not be as effective.
11. Endometrial biopsy
The doctor may also recommend an endometrial biopsy. Doctors take some samples of endometrial tissue. However, there is growing evidence that endometrial biopsy is not helpful in predicting and treating infertility.
Other Reminders:
You may not need to perform all of the above tests. Depending on your situation, your doctor will discuss which test is best. After the test, about 85% of couples will have an idea of why they have a hard time getting pregnant.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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