Evaluation of female patient
To determine if the female partner has problems concerning ovulation, egg transport, fertilization or implantation, various tests may be administered based on the physician's examination and analysis. They include:
Urinary luteinizing hormone (LH) test - detects the increase of luteinizing hormone that occurs before ovulation. Luteinizing hormone is secreted by the pituitary gland throughout the cycle, but increases mid-cycle to induce the release of the egg (oocyte).
Serum hormone testing - measures the levels of luteinizing hormone, follicle stimulating hormone (FSH), prolactin, progesterone and thyroid stimulating hormone (TSH). Follicle stimulating hormone is produced by the anterior pituitary gland and stimulates the ovary to develop a follice for ovulation. Progesterone hormone is produced after ovulation has occurred and prepares the uterus for pregnancy.
Luteinizing hormone and follicle stimulating hormone are checked for hypothalamic pituitary dysfunction. Prolactin (a hormone that stimulates breast milk production) levels are done to see if an excessive amount has caused hyperprolactinemia, a condition that interferes with ovulation. Progesterone levels are performed to determine if inadequate levels are interfering with the development of the endometrium, the lining of the uterus that prepares embryo implantation. TSH is checked as a measure for normal thyroid function.
Cervical mucus testing - performed at the time of ovulation to see if the quality and consistency of the cervical mucus is adequate for normal sperm function and survival. Cervical mucus permits passage of sperm to the uterus and fallopian tubes and changes in volume and quality at ovulation.
Postcoital testing - assesses the quality and quantity of cervical mucus and the number and motility of the sperm in the mucus at the time of ovulation and after sexual intercourse has occurred.
Hysterosalpingogram (HSG) - an x-ray of the uterine cavity and fallopian tubes using a radiographic dye to detect structural abnormalities of the uterine cavity fallopian tubes, as well as tubal patency.
Diagnostic laparoscopy - a minimally invasive surgical procedure typically performed in an outpatient day surgery setting. It permits direct visual assessment of the uterus, fallopian tubes, ovaries, and lower pelvis. It is particularly useful in diagnosing endometriosis, tubal disorders or pelvic adhesions and generally is performed at the end of a work-up, but may be performed earlier if deemed appropriate by the patient's history and referral diagnosis.
Hysteroscopy - often done in conjunction with a laparoscopy to examine visually the interior of the uterine cavity for scar tissue, adhesions, polyps, tumors, and other abnormalities and to eliminate endometriosis.
Ultrasound - performed seven to nine days after ovulation to reveal the thickness of the uterine lining (the endometrium) and its response to hormonal stimulation.
Endometrial biopsy - used to determine if the endometrium, the lining of the uterus, has responded appropriately for implantation of the embryo. This is obtained as a tiny tissue sample from the endometrium.