Mistaken Identity

Writing a book is a very interesting proposition and there some ups and downs along the way. When Mike (Dr. DiMattina) and I started the project we were in contact with the nice folks at Jones and Bartlett Publishing and Chris Davis, the Publisher, came down to Arlington to meet with us. He is the only member of the team that we have met face-to-face. Everyone else has either been in contact with us by phone or by email. So this afternoon as I reviewed the near final proof of the inside back cover I knew that there was something a bit odd about the biographical information as presented.

As those who know us can see, the photos were reversed. When I spoke to Mike Boblitt on the phone we laughed about it and I told him it was just like working with the medical students or residents. When faced with a 50/50 choice they always seem to guess wrong! So not to fear, in the final edition Dr D and Dr G will have the appropriate photos next to their names...I hope.

So here is the Question of the Day. A pretty basic one but one that we talk about ALL the time with our patients.


9. Which tests are routinely performed on the infertile couple?

The basic infertility evaluation consists of a handful of tests: transvaginal ultrasound, blood tests, an assessment of the fallopian tubes (for the female partner), and semen analysis (for the male partner).

Transvaginal ultrasound allows the physician to assess the appearance of the uterus and the ovaries. During this examination, the physician may discover uterine abnormalities such as fibroids (benign growths of the muscle of the uterus) or uterine polyps (benign growths of the lining of the uterus). Ultrasonography can also identify the location of the ovaries and determine the number of follicles present (antral follicle count), which correlates with the woman’s response to fertility medications. In addition, examination of the ovaries may reveal the presence of abnormal ovarian cysts such as endometriomas, dermoid cysts, or—in rare cases—precancerous and cancerous lesions.

In addition to the routine vaginal ultrasound, an assessment of the fallopian tubes and the uterus cavity is appropriate when the woman is having trouble conceiving. This examination is usually accomplished through a hysterosalpingogram, an x-ray test that is performed under fluoroscopy by either the fertility physician or a radiologist. Although it may sometimes cause mild uterine cramping, the vast majority of patients tolerate this procedure without difficulty. Alternatives to the hysterosalpingogram include laparoscopy and hysteroscopy; these outpatient surgical procedures are described in Questions 10 and 11.

Laboratory tests on the female partner of an infertile couple usually include routine screening tests such as those for blood type, blood count, and rubella immunity. In addition, most physicians perform tests that check the woman’s prolactin and thyroid-stimulating hormone (TSH) levels. Additional reproductive hormone testing for ovarian reserve is usually part of the routine evaluation as well (see Question 9).

Routine testing of the male partner of an infertile couple includes a basic semen analysis evaluating the volume of semen, the concentration of sperm (sperm count), the percentage of moving sperm (sperm motility), and the percentage of normally shaped sperm (sperm morphology). Although some clinics perform additional sperm function tests, such as the acrosome reaction and hypo-osmotic swelling test, the overall benefit of these two tests remains somewhat controversial. Both of these tests attempt to predict the functional ability of the sperm in terms of its ability to fertilize an egg. Ultimately, however, the best evidence of normal sperm function is a recent pregnancy or normal fertilization during a cycle of IVF.

Tests to detect the presence of antisperm antibodies in the blood of the female partner or coating the individual sperm may sometimes be recommended. Female antisperm antibodies may cause infertility that is best treated by IVF. Antisperm antibodies present on the sperm themselves may inhibit normal fertilization. In such cases, collecting a semen sample in media for use in artificial insemination may be considered, but most of these patients pursue IVF with intracytoplasmic sperm injection (ICSI).