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Several tests and procedures are available for the diagnostic evaluation of female infertility. The primary goal of diagnostic evaluation is to determine the most likely cause of infertility. The Practice Committee of the American Society of Reproductive Medicine recommends diagnostic evaluation of the following factors that may contribute to the cause of female infertility:

• Ovulatory dysfunction
• Cervical factors
• Uterine abnormalities
• Tubal occlusive disease
• Endometriosis and pelvic/adnexal adhesions (adhesions of the uterus or uterine "appenadages" such as the ovaries, Fallopian tubes, or uternine ligaments).

Ovulatory Dysfunction

Diagnostic testing to determine whether infertility may be due to ovulatory dysfunction include:

• Basal body temperature - When a woman is ovulating, her temperature rises. Charting basal body temperature during the course of a cycle can help women pinpoint when they are ovulating and are, therefore, more likely to conceive.

• Measurement of levels of female reproductive hormones:

  • progesterone
  • prolactin
  • thyroid stimulating hormone (TSH)
  • follicle stimulating hormone (FSH)
  • urinary luteinizing hormone (LH)

• Transvaginal ultrasound - In some cases, doctors may recommend serial ultrasound imaging to examine the size and shape of developing follicles in order to determine whether or not a woman is ovulating normally.

• Ovulation response to clomiphene citrate - Clomiphene citrate (Clomid; Serophene; Milophene) is a drug that induces ovulation in women with normal ovulatory function. The absence of ovulation upon challenge with clomiphene citrate can be an indication of ovulatory dysfunction.

Cervical Factors

Your doctor may recommend a postcoital test (a test performed after you have intercourse) to rule out abnormalities in cervical mucous production as a possible cause of infertility. In this test, a sample of cervical mucous is obtained from the woman a few hours after intercourse and is examined under a microscope for the presence of motile sperm. The absence of motile sperm is taken as indirect evidence of abnormal mucous production which may be a contributing underlying factor for the infertility.

Uterine Abnormalities

Although uterine abnormalities are rarely the cause of infertility, nevertheless, it is important to rule this out during the diagnositic work-up for female infertility. Techniques that may be used to detect uterine abnormalities include:

• Hysteroscopy - a diagnostic procedure where a lighted scope called a hysteroscope is inserted through the cervix into the uterus to enable the doctor to view the inside of the uterus.
• Hysterosalpingography - a special X-ray examination of the uterus and fallopian tubes that uses dye and is used primarily to rule out tubal obstruction.
• Ultrasound - a special imaging procedure that uses high-energy sound waves to produce an image of an organ that can be used to detect uterine abnormalities such as myomas (uterine fibroids) and adenomyosis - a benign condition of the uterus in which the mucous membranes lining the inside of the uterus (endometrium) grows into the uterine muscles (myometrium).

Tubal Occlusive Disease

Because tubal occlusive disease (blockage of the fallopian tubes) is a major cause of female infertility, it is very important to rule out this possibility in any woman who presents with infertility. Techniques that can be used to evaluate patency (openness; free of blockages) of the fallopian tubes include: