Center for Reproductive Medicine

History of Infertility

Questions for the male partner		Questions for the female partner
How long have you been infertile?		How long have you been trying to get pregnant?
Have you ever fathered a child with  your current or previous partners?		Have you had any prior pregnancies in this or in other relationships?
Have you had any medical problems? Any surgeries?		Have you ever had pelvic infections, endometriosis, fibroids, cervical diseases, pelvic or abdominal surgery, or used an IUD? Do you smoke cigarettes?
Are you taking any medications?		Are you taking any medications?
Do you drink alcohol, smoke marijuana or cigarettes? (Note: excessive alcohol and/or marijuana use can lead to lower testosterone levels and can decrease sperm production.)		How old were you when you got your period? Is it regular? How long are your cycles? Have you had any hot flashes?
Have you had any significant environmental exposures? For example, excessive heat exposure (saunas, hot tubs), chemical or radiation exposure?		Did your mother use DES when she was pregnant with you? (Note: DES, or diethylstilbestrol, is a medication given in the 1940s-1960s to prevent miscarriage; women whose mothers took this medication can have abnormalities of the cervix and uterus.)
Do you have any problems with your sexual function? Do you have trouble getting erections or maintaining them? Do you have problems with ejaculation?		What have you used for contraception in the past? IUDs? Oral contraceptive pills? Tubal ligation?
How frequently do you have intercourse?		How frequently do you have intercourse?
Have you had any previous infertility testing and/or treatments?		Have you had any previous infertility testing and/or treatments?

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Infertility Tests

Most couples are very anxious to get started on their evaluations and treatment. Ask your primary care physician or general gynecologist to perform as many preliminary tests as soon as possible before your visit to the infertility specialist.

Male Partner

• Semen analysis to determine sperm count
  At the beginning of the evaluation, the male partner should have a semen analysis. He should avoid ejaculation for 48 hours (but no more than six days) before providing the sample on the day of the test. The sample can either be produced at the Brigham and Women's Hospital Reproductive Endocrine Laboratory in a private lounge or he may bring in the specimen from home in a sterile plastic container. If the sample is brought from home, it cannot be more than one and a half hours old, should not have been exposed to soaps, lubricants, or condoms and must be kept warm (held against the body) until delivery. In either case, the sample should be delivered to the Brigham and Women's Hospital Reproductive Endocrine Laboratory, which is open Mondays through Fridays, 8:00 a.m. to 10:00 a.m. The results are usually available the next day. Semen that contains over 10 million normal sperm is considered adequate.
  

Female Partner

• Testing for ovulation
  Several tests can be done to prove that the woman is producing an egg in her cycle. In a 28-day cycle, ovulation usually occurs on day 14 (day one is the first day of menstruation), but may occur later in women with longer cycles. Usually, ovulation occurs 14 days before the first day of menstruation, so that if a woman has 32 day cycles, ovulation would occur on day 18. In women who are over 40, cycles are often shorter, and sometimes ovulation occurs less than 14 days from the end of the cycle.
  An easy way to test ovulation is with over-the-counter ovulation kits. These often cost around $20, and contain four test strips. About two days before the predicted day of ovulation (day 12 for a 28 day cycle), you should test your urine first thing in the morning. Repeat the test for four days in a row. The day of ovulation, the color of the test strip changes from light blue to dark blue if ovulation has occurred.
  
• Progesterone level.
  Another way to test for ovulation is with a blood test (serum progesterone level), which can be measured in the second half of the cycle (day 20-22 in a 28 day cycle).
  
• Day Three Follicle Stimulating Hormone (FSH) level.
  This is done by testing the blood for FSH on day three of the menstrual cycle. The majority of fertile women have levels less than 10.
  
• Clomiphene citrate challenge test (CCCT).
  This test is recommended for couples with unexplained infertility, and for women over age 35. This is a more sensitive ovulation test than the day three FSH test. An oral medication, clomiphene citrate (Clomid®), is taken on days five to nine of the menstrual cycle. A blood test is performed on day three and day 10 to measure FSH levels. An abnormal test is an elevated level of FSH greater than 15 on either day three or day 10. Abnormal CCCTs are more common in older women.
  
• Progestin challenge test.
  This involves giving a progestin (such as medroxyprogesterone acetate), 10 mg daily for five days, after making sure that the pregnancy test is negative. The test is positive if the woman experiences vaginal bleeding within 14 days of stopping the progestin, indicating that she does have adequate estrogen secretion. If she does not have vaginal bleeding, she has low estrogen secretion from either decreased hormonal secretion by the reproductive portion of the brain (hypothalamus) or premature ovarian failure. Testing the follicle stimulating hormone (FSH) level in the blood can distinguish between these two possible diagnoses (low or normal for pituitary problem; high in premature ovarian failure).
  
• Testing for thyroid function.
  Women with over- or underactive thyroids may have irregularities in their menstrual cycles. Fortunately, it is easy to test for thyroid problems by measuring the blood level of the thyroid stimulating hormone (TSH). A low level suggests an overactive thyroid, and a high level suggests that the thyroid is underactive. Both conditions are easily treated.
  Additional testing that may be ordered by the fertility specialist
  
• Hysterosalpingogram (HSG, or tubogram)
  This is a test to assess if the Fallopian tubes (the tubes connecting the ovaries to the uterus) are open. The test is performed under x-ray and involves injecting dye into the cervix to see if the tubes are open and whether the dye can flow freely through them. The size and the shape of the uterine cavity are also examined in this test. This test is done in the first half of the cycle, immediately after the woman's period has ended, but before ovulation. Antibiotics are routinely given for three days starting the day before the test. The test may be uncomfortable, so taking ibuprofen or Tylenol¨ before the test is recommended. Occasionally, the flushing of the tubes is enough to remove debris and allow a pregnancy to occur in that cycle.
  
• Laparoscopy
  This is an outpatient surgery in which a magnifying scope is used to look inside the abdominal and pelvic cavity. This test is performed if endometriosis or adhesions are suspected. During the laparoscopy, the scar tissue associated with mild to moderate endometriosis can be broken up to allow for passage of eggs and sperm through the tubes.
  
• Hysteroscopy
  In this procedure, a small scope is inserted into the uterus through the vagina and cervix to look at the inside of the uterus. This test is done if uterine abnormalities are seen during the HSG (tubogram) or if scar tissue or polyps are suspected.
  
• Pelvic ultrasound
  An ultrasound may be ordered if enlarged uterine size or ovarian masses are noted on an exam.
  

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