Semen Analysis:The semen sample is used to determine whether the male is fertile. This requries a masturbation specimen collected in a sterile container obtained from the laboratory.
Morphology:This test is detailed evaluation of sperm structure and is not done by most labs. In our lab it is the best predictor for sperm function. Even if a semen analysis has been done elsewhere, we may request a repeat in our lab.
Diagnostic Semen Wash:This laboratory procedure accomplishes an extraction of the sperm out of the semen with re-suspension of the sperm in another solution. This diagnostic test is necessary for all IVF and GIFT procedures as well as for other selected indications. It involves a 1 or 2 day scheduling with the lab, collection of the specimen into a sterile container.
Studies:When a male factor problem is not explained by the above studies, hormone evaluations are frequently done. This can include LH, FSH, testosterone, prolactin, and thyroid studies.
Post-Coital Test (PCT):Evaluates the sperm present in cervical mucous after intercourse for motility, quantity and survivability.
Antibody Testing:If there is evidence of clumping of sperm on semen analysis or if no sperm is seen on PCT, the semen is evaluated for antisperm antibodies.
Biopsy:Patients with azoospermia may wish to consider testicular biopsy with cryopreservation of any obtained sperm.
Basal Body Temperature Chart (BBT):Daily recording of a woman's basal body temperature is the simplest method for determining whether or not she is ovulating. Ovulation is suggested if the temperature record is biphasic, i.e., a low phase and high phase, with about a 0.6 F difference.
Follicular Study:Ultrasound is a diagnostic procedure which uses high frequency sound waves to picture structures inside the body. Use of the vaginal probe ultrasound allows the physician to monitor the ovulation process in the ovary during the patient's menstrual cycle. Ultrasound may also detect ovarian endometriosis and fibroids.
Progesterone Level:Occasionally the BBT does not give an accurate picture of whether ovulation is occuring. On occasion, a blood test to evaluate the serum progesterone level is used.
Endocrine Studies: If a woman is not ovulating or has ovulatory dysfunction, it is very helpful for determining why this is occuring. Such endocrine studies usually include Prolactin, TSH, and DHEA-.S. FSH/LH, Estradiol and thyroxin tests may be done in some circumstances.
Post-Coital Test (PCT): The cervical mucous is evaluated after intercourse prior to ovulation to see if the mucous has the appropriate physical characteristics, and to determine if it supports viable, active sperm for a long time. The test is done to three days before expected ovulation (11th to 14th day of a regular 28 day cycle). The couple should have intercourse the evening prior to the appointment. The PCT is usually done as part of the follicular study cycle.
Antisperm Antibody Testing:If the woman has abnormal post-coital tests, the couple may be evaluated for antisperm antibodies. Specific details for this procedure will be discussed with them if this test is indicated.
Endometrial Biopsy, (EBx):The lining of the uterus is sampled to see if it is being properly prepared for implanation of the embryo. It also reflects function of the corpus luteum. The biopsy is done 11-12 days after ovulation.
Uterine and Tubal Factor
Hysterosalpingogram (HSG): A radiopaque dye is injected into the uterus and x-rays are taken to view the shape and the size of the uterine cavity and fallopian tubes. The HSG also detects whether the tubes are open.
Diagnostic Hysteroscopy (Dx Hyst):This diagnostic procedure uses a flexible scope, which permits the physician to look inside the uterine cavity to see whether there are any deformities or tumors distorting the cavity. It is also possible to visualize the corners of the uterus to see if the openings into the tubes are normal. This procedure is usually done in the office. Medication maybe taken two hours prior to the procedure for cramping that may occur with the procedure.
Diagnostic Laparoscopy (Dx Lap): This out-petient surgical procedure, done under general anesthesia, permits the physician to look inside the abdomen to inspect the various abdominal and pelvic organs, including the female organs. This diagnostic procedure is primarily done to see whether there is evidence of endometriosis or pelvic adhesions that could interfere with the transport of the egg from the ovary to the tube and on into the uterus. If endometrial implants and pelvic adhesions are identified, additional procedures such as cautery or laser treatment may be done to destroy the implants and release the adhesions.