Various tests and procedures can be done to help determine the possible causes of fertility issues. At the Gundersen Health System Fertility Center, we test women at specific times during the menstrual cycle, depending on when a test will provide the most meaningful information.
Below are some of the tests done at Gundersen Fertility Center.
Proof of ovulation
Charting basal body temperature (your waking temperature before getting out of bed in the morning) is one way to track ovulation. In most women, body temperature rises slightly just after the release of an egg (ovulation) and does not fall again until just before the next period starts. This temperature rise is due to the hormone progesterone, which is released from your ovary only after ovulation.
Ovulation predictor kits check for the surge of a specific hormone (LH) that triggers ovulation. A blood test for progesterone can also determine if ovulation has occurred, however, we must do this test on a specific day of the cycle to be accurate. Transvaginal ultrasound may also help determine if ovulation has occurred.
If you do not ovulate on your own, various medications are available to help stimulate the ovaries to develop eggs and cause those eggs to ovulate.
In order for the sperm to unite with an egg in the fallopian tube, the sperm must first get through the woman's cervical mucus in order to travel into the uterus and beyond to the egg. Around the time of ovulation, more mucus is produced and it thins to allow sperm to travel through the cervix easily.
The post-coital test (PCT) can evaluate cervical mucus right before the estimated time of ovulation. Within 2 to 8 hours after intercourse, your doctor collects a sample of your cervical mucus and checks the survival of sperm in the mucus.
When PCT results are poor, many couples will opt for artificial inseminations to bypass the cervix and place the sperm directly into the uterus.
Several organs in the body produce a variety of hormones that can affect the ability to conceive. Blood tests may be ordered to evaluate the function of the ovaries, thyroid gland, pituitary, adrenal gland, or islet cells (insulin producing cells).
Medications can help regulate gland and cell function, or be used to replace deficient hormones.
Ultrasound is a very important part of infertility management. A transvaginal probe inserted into the vagina allows for very accurate imaging of the pelvic organs with little discomfort to you.
With transvaginal ultrasound, we can detect ovarian cysts (including those produced by endometriosis), fibroids or polyps in the uterus, ectopic (tubal) pregnancies and intrauterine pregnancies. Transvaginal ultrasound is also used for monitoring response to medications. We can see the size and number of follicles (special cysts containing developing eggs) as they develop.
Ovarian cysts, endometriosis, uterine fibroids and uterine polyps can all be treated with surgery.
Uterine cavity and fallopian tubes
In a saline infusion sonohysterosalpingogram (SIS), fluid is placed in your uterus through a small tube. Ultrasound is used to view the fluid in the uterus and look for it passing through the tubes. This test is excellent for evaluating the uterine cavity, but is not always reliable to show that the tubes are open. The ovaries are evaluated at the same time.
The hysterosalpingogram (HSG) determines whether a woman's fallopian tubes are open as well as outlining the contour of the uterine cavity. X-ray contrast is used with fluoroscopy to see the uterus and tubes. This test is better at determining if tubes are open, but may not always show certain uterine abnormalities.
While many uterine and tubal abnormalities can be treated by surgery, some cannot. Sometimes the better treatment choice is in vitro fertilization (IVF) when tubes are blocked.
Laparoscopy is a surgical procedure that allows the physician to look inside the pelvis at the reproductive organs. Through this procedure it is possible to diagnose and treat conditions such as endometriosis, scar tissue growth (adhesions), ovarian cysts and uterine fibroids. Laparoscopy is also used to treat ectopic (tubal) pregnancies.
Time, cost and discomfort are minimal compared with traditional surgery. Laparoscopy is performed through a laparoscope–a slender, tubular instrument that is inserted through a small incision in the abdominal wall just below the navel. Other instruments are inserted into the abdomen and pelvis through even smaller incisions in the lower abdominal wall. Much can be done with this procedure, yet the patient returns home that day.
A laser can be used during laparoscopy for cutting tissue or vaporizing abnormal tissue. The tiny beam of intense light treats many problems with minimal bleeding and very little scar tissue. It's routinely used in surgeries for endometriosis and adhesions.
Hysteroscopy also involves the use of a slender, tubular instrument. It is placed through the cervix into the uterine cavity to view the inside of the uterus.
Hysteroscopy is helpful for diagnosing and treating intrauterine (inside of the uterus) fibroids, polyps and scar tissue (Asherman's syndrome). This procedure is also a same day surgery.
For more information about fertility evaluations for women or to schedule an appointment, call Gundersen Fertility Center at (608) 775-2306 or (800) 362-9567, ext. 52306.