First and foremost, a complete medical history should be taken. This may be the most thorough such history you’ve ever discussed with a professional.
To be included in your medical history
• Pregnancy history, including any miscarriages, voluntary terminations, and live births
• Your basal body temperature chart, optimally for the previous three consecutive months or more
• Prior and current illnesses, including sexually transmitted diseases
• Previous surgeries, hospitalizations and treatments
• Prescription and recreational drug use (including alcohol), past and present
• Measles (rubella) exposures or innoculations
• DES exposure in-utero
• Exercise habits
• Smoking history
• Sexual activity history
• Sexual practices, including contraception history, lubricant use, technique and timing
• Family history of fertility
• Menstrual history
Ovulation Tests and Tests of Ovarian Function
Several different tests are used to see if you have been ovulating and to predict when you might ovulate again. Ovulation testing is also used to assess your ability to produce eggs and to determine if your uterus is receptive to pregnancy during the second half of your menstrual cycle (after ovulation and just before your period, known as the luteal phase).
Basal body temperature (BBT) -Taking your BBT (at rest, when you first wake up) and recording it on a chart is a way to document whether you have ovulated and when ovulation has occurred. Your BBT rises at ovulation and remains elevated during the second half of your cycle and throughout pregnancy.
Blood tests are used to measure hormone levels. Blood concentrations of estrogen and luteinizing hormone (LH) rise just before ovulation. High blood concentrations of the hormone progesterone indicate that ovulation has occurred recently. Your physician may also measure other hormones to make sure that your overall endocrine (hormone) function is normal.
Ultrasound is used to track the growth of the follicle, which is the place in the ovary where the egg matures. The follicle grows during the first half of your menstrual cycle (from the beginning of your period until ovulation), which is known as the follicular phase.
This test is performed after day 21 of your menstrual cycle. A small amount of tissue from the endometrium (the lining of the uterus) is removed to see if the uterine lining is thick enough for a fertilized embryo to implant.
Tests of Ovarian Function
This blood test is taken on day 3 of your menstrual cycle (the third day of bleeding). It measures the concentration of follicle-stimulating hormone (FSH), a hormone produced by the pituitary gland that controls the development of eggs. High levels of FSH may indicate that a woman’s ovaries are not working properly; low levels of FSH can prevent a woman from producing eggs. Your physician will interpret your results for you.
Diagnosing Uterine and Other Physical Abnormalities
Several tests can be performed to determine whether the anatomy of the uterus, fallopian tubes, and vagina is normal.
A pelvic exam can reveal many abnormalities, including conditions such as uterine fibroids. Fibroids are benign, muscular tumors in the uterine wall that can contribute to infertility by distorting the uterus, blocking the cervix or fallopian tubes, or interfering with uterine blood supply needed for the embryo to implant and grow.
An HSG is an x-ray of the uterus and fallopian tubes that is usually performed in the first half of the menstrual cycle. Water- or oil-based dyes are used to identify structural abnormalities in the uterus or fallopian tubes.
An ultrasound device is inserted into the vagina to take a “picture” of the pelvic organs.
During this procedure, a hysteroscope (tiny telescope mounted with a fiber optic light) is inserted through the cervix to look inside the uterus and identify abnormalities that may have appeared in an HSG.
This is a surgical procedure, performed under general anesthesia, in which the doctor inserts a small camera and fiber optic light through a small incision in your navel. This allows the doctor to get a clear view of your pelvic cavity, including your ovaries, the outside of your fallopian tubes, and uterus. If certain abnormalities are found, such as adhesions or Endometriosis , a laser mounted on the scope can be used to remove them.