Knowledge Gap: How is Female Infertility Diagnosed?

Written by Vicky Liu, 4th year Health Sciences co-op student from the University of Waterloo.

Infertility testing can help determine the root cause of infertility. There can be various factors contributing to infertility, including hormonal imbalances, ovulatory disorders, structural issues in reproductive organs, or genetic conditions. Identifying these factors is essential for developing an effective treatment plan. Once the cause of infertility is identified, healthcare providers can tailor treatment plans accordingly. Treatment options may include lifestyle changes, medications, assisted reproductive technologies (ART) such as in vitro fertilization (IVF), intrauterine insemination (IUI), or surgical interventions. In addition, infertility testing can help determine which treatment options are most suitable for the individual's specific situation.

Tests for Women

Initially, your healthcare provider will gather your complete medical and sexual history. Fertility in individuals with a uterus relies on the process of ovulating healthy eggs, which involves intricate hormonal signaling from the brain to the ovary, releasing eggs that traverse the fallopian tube to reach the uterine lining. Diagnosis of fertility issues entails pinpointing any disruptions within these processes. Various tests aid in diagnosing or excluding potential problems.

Pelvic examination

This physical exam involves a thorough assessment by your provider to detect structural abnormalities or indications of disease within the pelvic region.

Blood tests

Hormone levels can be assessed through blood tests to ascertain if hormonal imbalances exist or if ovulation is occurring. Tracking changes in these hormone levels can also help determine the timing and the quality of ovulation. Key hormones that are commonly evaluated in infertility testing can include:

1. Follicle-stimulating hormone (FSH): FSH is responsible for stimulating the growth and maturation of ovarian follicles, which contain eggs. Abnormally high or low levels of FSH may indicate decreased ovarian reserve or poor ovarian function.
2. Luteinizing hormone (LH): This hormone plays a role in triggering ovulation and the release of mature eggs from the ovaries. Abnormalities in LH levels can affect ovulation and fertility.
3. Estradiol: Estradiol is a form of estrogen produced by developing ovarian follicles. Monitoring estradiol levels helps assess ovarian function and follicle development.
4. Progesterone: Progesterone levels rise after ovulation and are essential for preparing the uterine lining for embryo implantation. Low progesterone levels may indicate inadequate ovulation or luteal phase defects.
5. Androgens: Elevated levels of these hormones may be observed in women with ovulation difficulties or polycystic ovarian syndrome (PCOS).
6. Thyroid Function Testing: Thyroid disorders, such as hypothyroidism or hyperthyroidism, can disrupt the menstrual cycle and impair fertility. Blood tests measuring thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3) levels help diagnose thyroid dysfunction and its impact on fertility.
7. Prolactin (PRL): Elevated levels of prolactin, a hormone responsible for milk production, can suppress ovulation and disrupt the menstrual cycle. Blood tests help assess prolactin levels and identify conditions such as hyperprolactinemia, which may contribute to infertility.
8. Anti-Müllerian Hormone (AMH) Testing: AMH is produced by small ovarian follicles and serves as a marker of ovarian reserve. Blood tests measuring AMH levels provide information about the quantity of remaining eggs in the ovaries, helping predict ovarian function and fertility potential. Anti-müllerian levels decline with age as the number of eggs decreases.

Transvaginal (pelvic) ultrasound

Utilizing an ultrasound wand inserted into the vagina, your provider examines the reproductive system for any abnormalities. A pelvic ultrasound examines the size and composition of the uterus and both ovaries. It assesses the condition and dimensions of the ovaries, particularly during infertility treatments. Additionally, it can evaluate a woman's ovarian reserve by counting the number of follicles in both ovaries at a specific phase of the menstrual cycle (antral follicle count).

Hysteroscopy

Hysteroscopy is a medical procedure used to examine the inner lining of the uterus by inserting a thin, lighted scope, known as a hysteroscope, through the vagina and cervix into the uterus. The uterus is then filled with either air or liquid to enhance visibility with the scope. Its purpose is to detect and address issues within the uterine lining. During the procedure, the physician may utilize small instruments to remove growths, take tissue samples (biopsies), or address a blocked fallopian tube.

Sonohysterogram

A sonohysterogram is a diagnostic ultrasound procedure used to examine the female reproductive organs. This test involves the introduction of saline solution into the uterus to enhance ultrasound imaging of its interior. This procedure provides detailed images of the uterine cavity and allows healthcare providers to explore potential factors contributing to fertility issues or recurrent miscarriages.

X-ray hysterosalpingogram (HSG)

A hysterosalpingogram (HSG) is an X-ray examination designed to visualize the interior of the uterus and fallopian tubes. The images generated can reveal any obstructions within the fallopian tubes that could impede the passage of an egg to the uterus or hinder sperm from reaching and fertilizing an egg within the fallopian tube. Additionally, this test can detect abnormalities within the uterine cavity that may interfere with the attachment (implantation) of a fertilized egg.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure utilized to examine a woman's pelvic organs, including the uterus, fallopian tubes, and ovaries. It involves the insertion of a thin tube, which houses a camera, through a small incision in the abdomen. This procedure serves to identify various issues that may impact fertility, such as cysts, scar tissue (adhesions), uterine fibroids, or infections. Additionally, laparoscopy can be employed for therapeutic purposes, such as the treatment of conditions like endometriosis. Typically performed under general anesthesia, laparoscopy offers a comprehensive assessment and potential intervention for pelvic health concerns affecting fertility.

Concluding Thoughts

Overall, infertility testing plays a critical role in diagnosing underlying causes, guiding treatment decisions, and addressing potential health concerns associated with infertility. Naturopathic doctors can play a supportive role in fertility treatment by assisting with laboratory requisitions and analyzing blood test results within the scope of their practice. They can interpret the results to identify potential imbalances or deficiencies that could impact fertility and develop personalized treatment plans accordingly. To learn more about infertility testing, book a complementary discovery call with our experienced naturopath, Dr. Wendy.

References

Healthwise Staff. (2022). Infertility tests. MyHealth.Alberta.ca Government of Alberta Personal Health Portal. https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=aa39523&lang=en-ca#:~:text=Infertility%20tests%20are%20done%20to,blood%20tests%2C%20and%20special%20procedures.