General investigations

When you attend for infertility investigations a full medical history will be taken from both partners. Any medical problems will be referred to an appropriate specialist. You will also be asked about your occupation in case it involves contact with industrial pollutants or radioactive materials. You may also be asked if you have any history of sexually transmitted infection, which may have resulted in obstruction of the fallopian or seminal tubes. In the man, orchitis secondary to mumps after puberty may be significant; in the woman previous pelvic or abdominal surgery may cause fertility problems due to scarring. The woman will be asked about her menstrual cycle. Regular menstruation suggests that ovulation is probably occurring.

Specific investigations

Semen analysis
This is the basic test for male infertility and should be the first investigation carried out. Average values are normally assessed on three samples produced over a number of weeks. Specimens are produced by masturbation after two to three days of abstinence and are examined in the laboratory within one hour. If satisfactory, the man will be assumed to be potentially fertile.

Sperm penetration test
This demonstrates the behaviour of sperm alongside a sample of mucus taken at a fertile time, on a glass slide. It determines if sperm function or mucus hostility is the problem.

Postcoital test
A specimen of aspirated cervical mucus from the woman is examined within six hours of intercourse during the fertile time of the cycle. The ability of the sperm to penetrate the mucus can be observed, as can the quality of the mucus. This test gives confirmation that effective intercourse is taking place.

Hormonal Series:
A series of blood tests taken from the woman throughout the menstrual cycle should show fluctuations in hormone levels. The results may suggest possibilities for treatment. Other endocrine problems such as thyroid deficiency and hyperprolactinaemia (an overproduction of prolactin by the pituitary gland that affects ovulation and breast milk production) should be excluded.

Investigation of tubal patency
Laparoscopy (a procedure where a lighted tube called a laparoscope is inserted into a small incision to carry out an examination) is carried out under general anaesthetic. Watery dye passed through the cervix can be observed to drip out of the ends of the fallopian tubes if they are patent. Further information can also be obtained such as whether the tubes are mobile and free from any scarring and whether there is evidence of pelvic inflammatory disease or endometriosis, which may affect fertility. The ovaries are also examined for any evidence of abnormality.

Hysterosalpingography
Hysterosalpingography is carried out during the first 10 days of the menstrual cycle. Radio-opaque dye is injected through the cervix and an x-ray will reveal whether the fallopian tubes are patent or not and the shape of the uterine cavity.