Advanced diagnostic techniques can be used to identify the cause of an individuals infertility and indicate the best way to treat it.  Even when no specific problem is identified, todays advanced reproductive techniques may help the childless couple start a family.  This is certainly welcome news for couples who are unable to achieve pregnancy.

In order to understand why pregnancy does not occur, we need to examine the four critical areas which are needed to make a baby – eggs, sperm, fallopian tubes and the uterus.  The tests, which often seem endless, will actually fall into one of these areas.  In 40% of cases, the problem will be with the male, in 40% the female and in 10% both partners will have a problem.  In some cases, about 10%, no cause can be identified (unexplained infertiltiy) even after exhaustive testing.

Before commencing any tests, the doctor will take a detailed medical history from the couple and will also perform physical examinations on both to determine if this can provide any clues as to the cause of the problem.  The doctor will need to find out details about the womans menstrual cycle, as well as any sexual habits and past history of surgery or illnesses, so you should be prepared to answer these questions.  Many clinics provide patients with forms to complete so that they can provide all of this information. A pyhsical examination can also provide the doctor with useful information, as he can look for specific clinical indications, such as abnormal hair growth, exceesively oily skin, or nipple discharge.

However, for the majority of couples, investigations are needed to establish a diagnosis.  These specialised tests constitute the  infertility workup and can be completed efficiently in one month. Timing the proceedures properly during the menstrual cycle is important and the following protocol may be useful.

Day 1                 Bleeding commences, the semen analysis can be carried out at this time
Day 3 – 5           Womans blood hormonal tests for Prolactin, LH, FSH and TSH
Day 5 – 7            Hysterosalpingogram (HSG) x-ray of the uterus and fallopian tubes carried out
Day 11 – 16       Ultrasound scan for ovulation monitoring, this is used for timing  the PCT (postcoital test) during which time the cervical mucus will also be assessed
Day 21               Serum progesterone level measured 7 days after ovulation and this provides information about the quality of the ovulation
Day 20 – 25        A laparoscopy or hysteroscopy with endometrial biopsy can be performed in the same month if deemed necessary

By using this protocol couples can be assured that a possible reason for the cause of infertility, if it exists, will be detected within one month.

The protocol should not stop when a problem is discovered, it is still important to complete the testing, since it is possible that infertile couples may have multiple problems.  Many diseases, such as PID (pelvic inflammatory disease) which can cause the fallopian tubes to block, can be “silent” so that the patient may have no signs or sypmtoms.

A single test abnormality does not necessarily mean that a problem exists and the test may need to be repeated to confirm that it is a persistent problem.

Unfortunately it is common to find that tests are not carried out fully, or sometimes not done at all.  Often treatment is started before coming to a diagnosis.  It is important that a the tests and  most importantly the HSG is carried out.

All couples should be seen together and the first test to be done should be the semen analysis. From the results of the tests and a diagnosis only then can a treatment plan be effectively developed.