Comprehensive Infertility Evaluation

When a patient comes in to our clinic, Dr. Saadat will spend about an hour in the first consultation to review the patient’s history in detail, and determine which of the above causes can the reason for lack of fertility in the couple. We will evaluate the patient’s menstrual history to determine whether or not she is ovulating, review her surgical and past infectious history to see if there is any reason for her to have tubal damage, and speak to the male partner (if applicable) with regards to his prior fertility history to see if there is any need for concern for lack of sperm or low sperm quality Depending on the interview, we can then decide which tests are best to detect the problem and be able to tackle the solution to this problem.

The three most important tests to determine if a female is infertile are:

1. Evaluation of Hormones - To evaluate ovulation, tests of serum progesterone can be done. This will determine if the patient is ovulatory or not. In a case where the patient is not ovulatory, after doing a thorough history, multiple exams can be done, including a test of the FSH and estradiol, to determine whether the patient is entering menopause or perimenopause; tests of thyroid stimulating hormone, to determine if the thyroid is causing the patient not to ovulate; and a test of prolactin, to make sure a hormonal imbalance in prolactin level is the cause for anovulation.

2. Evaluation of Tubal Patency - To determine whether the fallopian tubes are patent (open) or not, a hysterosalpingogram, which is an x-ray that uses dye, is the initial test that is recommended. At times, laparoscopy, which is a surgical procedure to look into the pelvic cavity, may be recommended to evaluate the tubes and treat any problem that exists with the tube.

3. Evaluation of the Uterus - To evaluate the uterus, a hydrosonogram (water ultrasound) may be done to evaluate the uterine cavity to ensure there are no fibroids or polyps in the uterine cavity. A hysterosalpingogram can be substituted for a hydrosonogram to evaluate the uterine cavity.

To evaluate the male partner’s sperm count and quality, a semen analysis is usually recommended. In a semen analysis, four factors are evaluated in the semen, including:

1. The volume of the sperm that was produced.
2. The count of sperm (in general, a count of 20 million is considered to be normal).
3. The motility of the sperm (in general 50% of the sperm should be moving).
4. The morphology (shape or appearance) of the sperm (using different criteria, at least 40-50% of the sperm must be normal in order for the sperm to be considered normal).

In special circumstances, extra evaluation may be needed for patients that suffer from infertility For example, in patients with recurrent pregnancy loss, additional tests may need to be done, including genetic testing to check the parents for any chromosomal abnormalities; testing of the uterus to evaluate any congenital abnormalities, such as uterine septum or bicornuate uterus; and antibody testing to evaluate if there are antibodies present in the maternal serum that may affect pregnancy outcome (these include lupus anticoagulant and anticardiolipin antibodies, as well as other antiphospholipid antibodies). Additional evaluation for the presence of infections such as Chlamydia may be required, as well as ureaplasma and other infectious agents.

Evaluation for infertility may also require other further testing, including testing of antibodies present in the female partner against the sperm of the male partner, which they call antisperm antibodies, as well as the presence of paternal leukocyte antigens, which are present in the mother.

To schedule your infertility consultation with Dr. Saadat, click here, or call (310) 278-7590.