Understanding Fertility Problems: The Woman’s Evaluation

Woman in exam room talking to healthcare provider.

To help your healthcare provider look for the cause of fertility issues, you will have an evaluation. It will include your health history, a physical exam, and some basic tests. If needed, your provider may also suggest procedures. These allow him or her to look at your reproductive organs.

Health history

Your healthcare provider will ask about your health and lifestyle. You’ll also be asked about factors that can affect your ability to get pregnant. This might be how often you have sex, your menstrual cycle, and any medicines or herbs you take. Be sure to mention any past pregnancies or surgeries. You should also mention if you’ve had any pelvic infections or sexually transmitted infections.

Physical exam

A physical exam helps your healthcare provider learn about your health. It includes a pelvic exam to check for swelling, infection, or other problems. Your provider may also do a Pap test. Your hormone function is also checked. To do this, your provider looks at your breast development, body fat, and hair distribution.

Basic tests

Your evaluation will likely include some basic tests. These include blood tests. In some cases, it also includes tests that check the health of your cervix.

Blood tests can be used to check the following things:

  • Hormone levels. These include FSH, LH, AMH, estrogen, and progesterone, prolactin.

  • Blood sugar and insulin levels

  • Tests for current or past pelvic infection

  • Thyroid function

Cervical cultures are samples taken from the cervix using a sterile swab. The sample is then sent to a lab and checked for signs of infections that can affect fertility.

Imaging tests

Your healthcare provider may recommend that you have imaging tests. These show the reproductive organs in more detail. These tests may be done in your provider’s office or in a hospital or surgery center. In most cases, they cause little or no discomfort.

  • HSG (hysterosalpingogram). This is an X-ray test. It is used to view the shape of the uterus and make sure the fallopian tubes are open. During the test, the healthcare provider puts contrast fluid in the uterus and fallopian tubes. The contrast makes it easier to see problems on the X-rays.

  • Ultrasound. This uses painless sound waves to make images of internal organs. This can help show problems with the ovaries or uterine lining.

  • Sonohysterogram. This is an ultrasound done with sterile saltwater (saline) solution placed in the uterus. The saline makes it easier to view the inside of the uterus.

Other tests

If needed, your healthcare provider may suggest other, less common tests. Some can be done in your provider’s office. Others are done in a hospital or surgery center. For certain procedures, you’ll be given anesthesia to prevent discomfort.

  • Hysteroscopy. This uses a small, lighted tube called a hysteroscope to look at the inside of the cervix and uterus. It is usually done just after your period.

  • Laparoscopy. This is a type of surgery that can help show problems on the surface of the reproductive organs. The provider puts a thin, lighted tube device called a laparoscope into your body. The provider then looks at the reproductive organs through the scope.