Hormone measurements are an important part of an initial work-up. The levels of hormones are measured by sophisticated laboratory equipment. The tests determine that all the levels are within normal limits and in balance.
The hormone tests can also determine whether the woman is ovulating and even whether she is at risk of going into early menopause (ovarian reserve). However, they do not tell us anything about the quality of the egg (oocyte). Blood tests can also help confirm the diagnosis of PCOS.
A progesterone test one week before your anticipated menstruation can confirm whether you have indeed ovulated. These tests do not confirm that the released egg will make it into the tube. The egg may for example get trapped in adhesions that wrap around the ovary. This is something that only a laparoscopy will reveal.
The activity of your thyroid gland will be checked because it helps maintain a regular menstrual cycle and is also important for the normal development of the baby's brain during pregnancy.
As part of a standard screening, blood tests will also be performed to check appropriate immunity against rubella and chickenpox and the presence of HIV, Hepatitis B or C. Other tests may be added to the investigation.
A semen analysis is the most important test to investigate infertility in the male. A sample is best produced after 2 - 3 days abstinence. The analysis will provide a sperm count and an assessment of the forward movement (motility) and of the shape of the sperm (morphology). Usually, the test also includes a check for the presence of sperm antibodies.
A vaginal ultrasound can be used to check that the reproductive organs in the pelvis (ovaries, fallopian tubes, uterus) have a normal anatomy. Physical changes, such as fibroids, polyps, ovarian cysts can be detected easily. The examination will also measure the size of the ovaries and count the number of small follicles present, which is another measure of the ovarian reserve. Most women find a vaginal ultrasound to be a relatively painless and simple procedure.
More recently, it has also become possible to diagnose nodules of endometriosis in the pelvis and on the bowel. Click here to read more.
Dye test with ultrasound
This ultrasound-based test is used to check whether the Fallopian tubes are open ('patent').
It's a relatively simple test which may involve some discomfort for the patient and it needs to be carried out by a specialist in women's ultrasound. To minimise the risk and discomfort, the patient is advised to take antibiotics and Nurofen 2 hours before the procedure. An antibiotic (azithromycine 1 g single dose orally) is also prescribed to be taken before the test. No fasting is required. The test is usually scheduled shortly after the period finishes so that the risk is minimal that the patient may be pregnant.
A 'contrast' fluid is injected into the uterine cavity via a fine plastic tube that is passed through the cervix (neck of the womb). A vaginal ultrasound is performed while the contrast is injected and the ultrasound specialist assesses whether the contrast fluid passes freely through the tubes.
If the dye fails to pass in to the tube it may indicate a blockage or a temporary spasm. The test may enable the doctor to identify the site of a tubal obstruction.
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons.
The procedure allows the specialist to directly inspect the ovaries, fallopian tubes and uterus. The procedure is done under a general anaesthetic, usually as ‘day surgery’. The recovery following the procedure is usually quick.
The telescope is passed through a very small incision (5-10 mm) in the skin of the navel. Abnormalities such as scarring, endometriosis and ovarian cysts can be detected and treated at the same time. The laparoscopy may thus avoid the need for a large cut in the skin to carry out major abdominal surgery. The tubes can also be checked to make sure they are open or 'patent'.
Hysteroscopy and D&C
This test can be carried out at the same time as a laparoscopy. A very fine telescope is inserted through the cervix into the cavity of the uterus. The endometrium can then be inspected as well as the openings of the fallopian tubes into the cavity.
The uterine cavity can be distorted by fibroids, polyps, adhesions and congenital malformations. Most of these can be treated with the hysteroscope.
A 'dilatation and curettage' is performed to take a sample of the endometrial lining. Usually a very small sample is taken (equivalent to 2 grains of rice) and sent to the pathologist to detect chronic inflammation, infection or the presence of pre-cancerous and malignant cells.
The cervix is gently dilated. The endometrium is then lightly scraped off using a curette. This spoon-shaped instrument can be used to obtain a small specimen for microscopic examination and diagnosis, to remove diseased tissue or to treat abnormal bleeding.