Measurement of hormone levels not related to blood or urine may also yield information about infertility. For example, certain conditions that are associated with abnormally high male hormones such as testosterone or cortisonelike hormones can cause infertility. Also follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are two messenger hormones that play essential roles in the delicate ovulation mechanism. If these are presenting slightly reduced or elevated amounts or do not fluctuate appropriately during the month, infertility may result. The hormone prolactin (which plays an important role in breast milk production) may be abnormally elevated and be the cause of infertility. Treatment of this elevated hormone level with the drug bromocryptine will in many cases cure the infertility.
A hysterosalpingogram is a test used to study the uterus and fallopian tubes. It can be done in a hospital or in the office of a radiologist. A speculum is inserted into the vagina and the cervix is grasped with a tenaculum. A dye-injection apparatus is then attached to the cervix, the dye is slowly injected into the uterus and X-rays are taken. Most women feel the injection of the dye to be about as uncomfortable as moderate menstrual cramps. The X-rays show the internal outlines of the uterus and fallopian tubes as the dye fills them. If there is any abnormality in the shape or size of the uterus or a blockage in the fallopian tubes, this may show up on the X-rays.
This test also gives valuable information to a DES-exposed woman prior to a pregnancy. The degree of abnormality of the shape of the uterus is predictive of the chances of premature labor during the pregnancy and will help determine how closely such as woman needs to be monitored during pregnancy.
A postcoital test (PC test) is a painless, simple test that often can yield important information in the evaluation of an infertile couple. This test is done around the time of ovulation. You must come to the physician's office within a specified number of hours after intercourse. A speculum examination is done and a small sample of the cervical mucus and vaginal fluid is taken and examined miscroscopically. This examination will show if the cervical mucus is normal and if the sperm are active and alive. If sperm are alive and active, this is presumptive evidence that sperm antibodies are not a problem.
Laparoscsopy is often the final step in an infertility workup. This is done in a hospital, usually with general anesthesia, although local anesthesia can be used. A small incision is made just below the navel and a long needle is inserted into the abdominal cavity. The abdominal cavity is filled with carbon dioxide gas. The laparoscope, a long, narrow, lighted tube, is inserted into the abdominal cavity to permit viewing of the pelvic organs. Dye is injected into the uterus. The physician can look through the laparaoscope and see whether the dye spills out of the ends of the fallopian tubes, thus determining if the tubes are open or blocked. In addition, laparoscopy can diagnose endometriosis, pelvic adhesions and previous pelvic infections.
