Diagnosing Infertilty

Tests and investigations to find the causes of infertility include:

    Levels of Follicle-Stimulating Hormone (FSH)
    Semen analysis
    Post-Coital Test

Ovarian reserve tests

Several tests attempt to determine the level of the ovarian reserve that is, how many eggs there are left in the ovaries. This is an important factor in the fertility of older women. One test measures the levels of Follicle Stimulating Hormone (FSH) in the body. FSH, along with another hormone called Luteinizing Hormone (LH), controls the menstrual cycle.

As the ovarian reserve declines, the body increases production of these hormones, in an attempt to push the last few eggs out of the ovaries. So a high level of follicle-stimulating hormone means that your ovarian reserve is low, and you will likely have difficulty conceiving.

Physical examinations

Physical problems in the female reproductive system can be identified by X-ray. The normal procedure, known as a hysterosalpingogram, involves injecting dye into the uterus. This dye will show up on the X-ray, and you and your doctor will be able to see if the uterus is normal, and identify problems such as blockages in the fallopian tubes.

Two slightly more invasive techniques are also available to identify physical problems in the uterus. In a hysteroscopy, a lens or camera is pushed through the cervix, so that a doctor can look at the inside of the uterus. In a laparoscopy, the camera is inserted through a hole made in the belly. Both procedures are usually carried out under anesthetic a local anesthetic for hysteroscopy, and general anesthetic for laparoscopy.


Ultrasound is another option. The same technology that allows pregnant mothers to see their unborn babies can let doctors visualize the female reproductive system, and so identify problems there. It works by bouncing sound waves off the body, and measuring how long it takes for the echo to come back.

The ultrasound waves will pass through some tissues and be blocked by others, so the timing of the echoes can be fed into a computer, which then builds up a picture of the body underneath the probe. This is basically the same way that bats see, although sound of a different (and inaudible) wavelength is used.
The ultrasound probe (which sends out the ultrasound waves) can either be placed on the abdomen, or inserted into the vagina.

The second technique is, perhaps surprisingly, less uncomfortable. This is because when the probe is placed on the abdomen, there is a problem with the bladder getting in the way. The solution is to drink a lot of water to fill up the bladder, which will move it out of the way.

Post-Coital Test

The post-coital test has a reputation as one of the more invasive elements of reproductive medicine. The aim of the test is to check that it is possible for sperm to pass through the mucus of the cervix. The sperm must be able to pass through the mucus if it is to reach the uterus and then the fallopian tubes, in order to finally fertilize an egg.

Unfortunately, the usual way to test the receptivity is to have a test of the mucus shortly after intercourse. The window of time between intercourse and getting the post-coital test may be as little as 5 hours, and the test has to be performed at a clinic. As if this didn’t bring enough logistical complication and invasion of privacy, the test will only work if the intercourse has taken place near to the time of ovulation.

Useful though the test may be, the awkwardness and regimentation of the procedure reminds one of ancient witch-doctors, producing astrological charts and demanding intercourse and rituals at set times. At least now the rituals are backed by medical science, and so we can have at least some faith in them working.

Semen Analysis

Many forms of male factor infertility can be diagnosed by examining a sample of sperm. From this, a laboratory can diagnose several problems. Insufficient quantity of semen, or low concentration of sperm within the semen, can be easily noticed.

So too can an in appropriate pH of the sperm unless sperm is slightly alkaline, it risks being destroyed by the acidity of the vagina. Other tests can check that a majority of the sperm are alive, and that not too many are misformed or unable to move. If anti-sperm antibodies are in the semen, these can also be identified by a special test.