INFERTILITY IN WOMEN

Infertility Tests
Women-only tests, more varied and extensive, generally begin with a determination of if and when the woman is ovulating.One of the most popular techniques for pinpointing ovulation relies on the typically slight rise in resting body temperature midway in the menstrual cycle, signaling that ovulation has recently occurred. A woman's body temperature fluctuates throughout her menstrual cycle, and she is instructed to record these fluctuations on a chart after taking her temperature each morning before getting out of bed. If the chart--called a basal body temperature or BBT chart--indicates that the woman has been ovulating, it can often be used to predict when ovulation will happen during subsequent menstrual cycles. The couple can then use the information to attempt to time conception. Several urine test kits, approved by the Food and Drug Administration for sale over the counter, can be used by consumers to supplement the temperature chart. Still other methods widely used to predict ovulation rely on examinations of the cervical mucus, which undergoes a series of hormone-induced changes at various times in the menstrual cycle.

Some versions of these tests require a health professional's expertise. There are, however, versions of them that some women--with a physician's guidance--can learn to do themselves. Other methods widely used to diagnose female infertility and to monitor therapy include:
1. Endometrial Biopsy:
A long, hollow tube is passed into the patient's uterus late in her menstrual cycle, and a little of the lining is scraped off and examined with a microscope. The examination helps the physician tell whether the development of the egg and of the lining are in proper phase with each other. In most cases, the scraping is done in a physician's office and because it is only very briefly painful no anesthetic is used.
2. Ultrasound:
This technology relies on sound waves to produce images of internal structures. It is used, often in combination with one or more of the tests already discussed, to find the presence or absence of follicles that contain and release the eggs. Ultrasound is also sometimes used to detect abnormalities in the ovaries or uterus.
3. Hysterosalpingogram:
This is an x-ray study of the uterus and fallopian tubes. It is done just after a woman's menstrual period so there is no danger of her being pregnant and thereby exposing the fertilized egg or embryo to radiation. A dye containing iodine--technically called a contrast medium--is injected through the cervix. It spreads into the uterus and the fallopian tubes, allowing them to be visualized. Among other things, this study often enables the physician to determine if the fallopian tubes are open.It is usually done without an anesthetic in the x-ray department of a hospital or clinic.
4. Hysteroscopy:
The patient's uterus is filled with a liquid or gas, instilled through the cervix. A thin, lighted tube called a hysteroscope that works like a telescope is then inserted into the uterus through the cervix, enabling the surgeon or physician to look directly inside.Many hysteroscopes have a separate channel through which instruments can be passed, often making it possible to immediately correct any abnormalities. Patients undergoing hysteroscopy are usually given an anesthetic, which may be local or general.
5. Laparoscopy:
A laparoscope, like a hysteroscope, is an instrument with a light that works like a telescope. It is slipped into the abdominal cavity through a small incision in or near the navel. For a clearer view of the woman's reproductive tract, the cavity is filled with gas during the procedure, and a colored solution--usually blue--is injected into the uterus and fallopian tubes. A general anesthetic is required. Advanced operative techniques may allow the repair of defects in the reproductive tract to be made at the same time as the examination.