WOMEN’S BODIES: SUBFERTILITY. FINDING THE CAUSE
Most testing can be completed within few months. At the first visit your doctor will take a thorough medical history and will usually carry out on both you and your partner a general physical examination that will also include examining the reproductive system. This may indicate which tests you need. The reason for doing any test, what the test involves, its cost and the results will be fully explained to you: if not, ask.
Some of the following tests may be advised.
Starting a basal body temperature chart This is cheap, easy and no risk. If it shows that you’re ovulating, it’s reassuring and tells you when intercourse is most likely to result in conception.
Sperm count (semen analysis) This is the simplest test, needing only a sample of semen to be sent for examination. You’ll be given instructions on how to collect the specimen. Semen analysis is usually done early and may be repeated two weeks later if the first count is low. Sperm counts that are temporarily reduced, for example by a bout of high fever, will have returned to normal after about three months.
Blood tests for hormones If a woman’s blood contains the hormone progesterone during the second half of her menstrual cycle, that’s strong evidence that she has ovulated.
Hysterosalpingogram (HSG) This is an X-ray of the uterus and tubes, to see whether the shape of the uterine cavity is abnormal or there is tubal blockage.
Laparoscopy This is a surgical procedure in which the uterus, tubes and ovaries are inspected.
Hysteroscopy This is to check the shape and lining of the uterine cavity.
Falloposcopy This is to inspect the interior of the tubes.
Post-coital test (Sims-Huhner test) Within a few hours of having sex during the fertile phase of your cycle, some mucus is taken from the cervix and examined under the microscope immediately to see whether sperm are present and surviving.
Sperm migration test This is also called the mucus penetration test. Mucus from your cervix is collected during the fertile phase. The rate of progress of your partner’s and donor’s sperm through your mucus are compared with their rate of progress through a donor’s mucus.
Not all these tests may be necessary. The result of one test may suggest certain other tests such as looking for sperm antibodies, genetic tests, and biopsy of the testis, ovary or lining of the uterus. If no abnormality is found, it means that the subfertility is due to something we don’t know about reproduction.
Many people are distressed by the intrusiveness of the tests, and by a sense of being judged on their results. One woman expressed her anguish:
There is no inner recess of me left unexplored, unprobed, unmolested. Now when we haw sex I think that what used to be beautiful and very private is now degraded and very public. I take my charts to the doctor like a child bringing home a school report. Did I
do well? Did I ovulate? Did I have sex at the right times?
If you can air these feelings with your partner, doctor, counsellor or others in the same boat, you may feel better about them.
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