Investigations to
discover the cause of a woman's infertility may include:
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Taking a menstrual history, |
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A study of body temperature during the menstrual cycle and/or
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Blood and urine tests to discover whether ovulation is normal,
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Hysterosalpingography |
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Laparoscopy |
Monitoring Ovulation
Body Temperature And
Ovulation
Determining whether
ovulation actually occurs is an important part of an infertility evaluation.
Daily measurements of basal body temperature (temperature of the body at rest),
usually taken immediately on awakening, may be used to determine if and when
ovulation is occurring. A low point in basal body temperature suggests that
ovulation is about to occur, whereas a slight, persistent rise of about 0.5' F.
to I' F. in temperature usually indicates that ovulation has occurred.
Basal body
temperature is not a reliable or precise indicator of ovulation. At best, it
predicts ovulation only within 2 days. More accurate techniques include
ultrasound monitoring and ovulation predictor kits that detect an
increase in luteinizing hormone- LH (a hormone that induces ovulation), which
peaks in the urine 24 to 36 hours before ovulation. Also, levels of the hormone
progesterone in the blood or one of its breakdown products in the urine may be
measured; a marked increase indicates that ovulation has occurred.
Whether ovulation
occurs also can be determined by performing a biopsy: A small sample is
removed from the lining of the uterus 10 to 12 days after ovulation is presumed
to have occurred; the sample is examined under a microscope. If changes that
normally occur in the uterine lining after ovulation are seen, ovulation has
occurred.
Laparoscopy
In this technique, a
laparoscope (a type of viewing tube) is inserted through the abdominal wall to
examine the woman's reproductive organs and determine whether an abnormality,
such as a cyst or tumor, is present. This procedure, which is typically
performed while the woman is under general anesthesia, enables the doctor to
view the uterus, fallopian tubes, and ovaries. The laparoseope also may be used
to remove abnormal tissue if the woman has endometriosis or to break adhesions
in the pelvic cavity.
Hysterosalpingography
This X-ray technique
is used to visualize the uterus and/or fallopian tubes. This test is generally
done shortly after the woman's menstrual period ends. This diagnostic test also
shows congenital abnormalities (birth defects) of the uterus and fallopian
tubes, fibrous masses in the uterus, and adhesions (fibrous bands that connect
normally unconnected structures) in the uterus or pelvis. For reasons not
clearly understood, fertility appears to be slightly enhanced after a normal
hysterosalpingogram. Therefore, the doctor may wait to see if a woman becomes
pregnant after this test has been performed before ordering additional tests of
fallopian tube function.
Hysteroscopy
Hysteroscope is a
viewing tube inserted through the cervix into the uterus. If the
hysterosalpingogram shows an abnormality such as adhesions in the uterus, the
doctor examines the uterus with a hysteroscope. The hysteroscope may be
manipulated to break adhesions during the procedure, thus increasing the
likelihood that the woman will become pregnant.
