You are here : Home / Understanding Infertility / Infertility Evaluation

Infertility Evaluation

Diagnostic Processes and Procedures To Evaluate Infertility

When a patient comes with infertility concerns for an hour-long consultation. The patient(s) health history will be discussed and a decision will be made how to proceed with an infertility evaluation at that time. If the patient decides to be followed at our center, they will undergo what we call a “Basic Infertility Evaluation”.
Many patients either referred or self-referred. Some have never undergone a complete infertility evaluation. The reason for this is that many physicians approach this haphazardly, checking some things but not others. Like other disease states, in order to find the diagnosis, all the different possibilities must be ruled out.

In 30% of cases, there is more than one problem, and in 30% of cases it involves both the man and women. Therefore all these systems must be checked. There are basically nine steps that are required to become pregnant. These steps are a sequence of events, such that, if there is a disturbance in any part of the sequence, then the entire process fails.

These steps are:

1. Brain sends signals (FSH hormone) to the ovary to begin the ovulation process, and the Ovary begins the maturation of the egg.
2. Ovulation occurs where the egg is expelled from the ovary into the culdesac.
3. The egg has to find the fimbria of the tube.
4. The egg enters the tube where the sperm needs to be waiting, such that, the sperm needs to have proceeded from the vagina  into the cervix, into the uterus then into the tube.
5. The sperm has to fertilize the egg.
6. The egg begins developing and dividing and passes through the tube (7-days).
7. The formed embryo now enters into the uterus.
8. The embryo has to hatch.
9. The embryo has to implant into the lining of the uterus.

The infertility evaluation that we recommend checks each one of these steps. They are listed in accordance with the respective steps above in the sequence. Keep in mind that our goal is always to make our patient’s visits and procedures as comfortable and effortless as possible given the difficult and often frustrating nature of infertility

The first step for the patient is to test her hormone levels on cycle day # 2 or 3 in order to evaluate the ovarian hormones, thyroid function and pituitary function. This is a blood test to see if the hormone levels, that the brain is producing, are normal at the start of the cycle.

This can also give an indication of how the ovary is functioning and able to be stimulated. If the FSH level is elevated, it could indicate that the ovary is already beginning to slow down and/or approaching menopause. If the FSH is elevated, some physicians will proceed with a “Clomid Challenge Test” to see if the ovary is past the point where it can be stimulated by fertility medications.

The only way to see if the ovary is maturing an egg is to do an ultrasound, in sequence, and see if a growing ovarian follicle is present. This is not usually done as part of the basic infertility evaluation. Ovarian resistance is usually encountered in women over the age of 36 years old but can be at any age. This test will also give doctors an indication of whether or not there is urgency in choosing a more aggressive treatment.

In order to know whether ovulation occurs, there should also be a mid-luteal progesterone blood test on cycle days 20-22. This is a blood test done around the 21 st day of the menstrual cycle, to evaluate if there has been ovulation and whether or not there is adequate Progesterone hormone in the Luteal phase. Progesterone is a requirement of the Luteal phase for preparation of the endometrium for implantation of the embryo and for maintenance of the early pregnancy. The progesterone level is increased when ovulation occurs, so this in an indirect test of ovulation. This blood test can evaluate if there has been ovulation and whether or not there is adequate Progesterone hormone in the Luteal phase. Progesterone is a requirement of the Luteal phase for preparation of the endometrium for implantation of the embryo and for maintenance of the early pregnancy.

Knowledge Source

  • Age and Infertility
    Tubal Disease and Infertility
    Endometriosis
    Ovulatory Problems
    polycystic ovaries
    Fibroids

  • Male Factor Infertility
    Oligozoospermia
    Asthenozoospermia
    Teratozoospermia
    Azoospermia
    Immunological infertility

  • Unexplained Infertility
    Hormone Assays
    (AMH) blood test
    Auto-immune
    Semen Analysis
    Semen DNA Fragmentation

  • In Vitro Fertilisation
    Intracytoplasmic Sperm Injection
    IMSI
    Ovulation Induction & Cycle Monitoring
    Auto-immune
    Embryo Freezing
    Embryo Grading

  • Blastocyst
    Testicular Sperm Extraction
    Reproductive Immunology
    Ovulation Induction & Cycle Monitoring
    Eeva™ The Early Embryo Viability Assessment Test

Latest comments


#20 & #21, 14th Main,
HSR Layout, Sector V,
Opp. Agara Lake,
Bangalore - 560034