Tests of Female Fertility
A woman’s fertility declines substantially by age 35 and even more so after age 40. Infertility occurs because an egg may not be produced, or once released, it may not get to the womb, sperm may not reach it, or a fertilised egg may fail to develop.
Common reasons for female infertility include blocked fallopian tubes, polycystic ovary syndrome (PCOS, interferes with egg release), fibroids, endometriosis, autoimmune disorders (producing antibodies against fetal tissue), diabetes, hypothyroidism, eating disorders, excessive smoking and alcohol intake, and gluten intolerance (coeliac disease).
A woman’s fertility may also be affected by factors such as fluctuating or diminished hormone levels; inconsistent ovulation; or a poor reproductive environment that does not support proper fertilisation of the egg, interferes with the sperm’s transport, or impairs retention of a fertilised egg.
The initial evaluation of a woman’s fertility includes a personal and family history with a thorough physical examination. A number of tests can be used to help diagnose the problem and aid in treatment.
Initial investigations may include some blood tests, such as measuring the levels of hormones involved in reproduction: luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), oestradiol, and progesterone.
Other measurements which can help include thyroid function tests (TSH and/or FT4) and steriods such as testosterone and DHEA-S (dehydroepiandrosterone sulphate is used in creating androgens and oestrogens).
These tests help to check the health of the pituitary, thyroid and adrenal glands which can themselves affect the menstrual cycle and ovulation. Further investigations may be undertaken in specialist clinics and may include imaging techniques such as ultrasound (US) to look at individual reproductive organs.