After speaking with your physician about your menstrual cycle, past medical/surgical history, and family history, the next step is to perform tests to evaluate for different causes of infertility.
Assessing the Ovaries
With regard to the ovaries, there are two components to evaluate: ovulation and ovarian reserve. Evidence of ovulation can be determined by monthly menstrual cycles, a positive ovulation predictor kit, or elevated progesterone levels in the latter half of a menstrual cycle. If there is no evidence that ovulation has occurred, the cause of infertility could be related to an ovulatory dysfunction.
In some cases, it may be appropriate to test for ovarian reserve. There are many testing options to evaluate ovarian reserve, including an ultrasound or a blood test for follicle stimulating hormone (FSH) and estrogen, or antimullarian hormone (AMH). You and your doctor will determine the most appropriate test for you.
Assessing the Fallopian Tubes
The fallopian tubes and uterine cavity can be evaluated with a hysterosalpingogram (HSG). This imaging test uses a contrast media (fluid) to assess whether the fallopian tubes are open or blocked, and whether the uterine cavity contains polyps or fibroids. If the fallopian tubes are blocked, the reason for infertility would be considered tubal factor. Similarly, if the uterine cavity was abnormal, this would be considered uterine factor infertility.
Assessing the Sperm
A semen analysis is standard when evaluating potential fertility issues in the male partner. An andrologist can examine multiple components of the sperm, including concentration of sperm, percentage of motile sperm, and the shape of the sperm. Abnormal findings indicate male factor infertility.