INFERTILITY TESTS FOR WOMEN
A variety of physical and biochemical techniques have been developed for examining the male and particularly the female reproductive systems. The following is a description of the more common procedures you may encounter. In addition to this there is a routine physical check-up. Bear in mind that the simplest check for infertility is a sperm count, and it is worth getting this done before you start on any of the more elaborate procedures. Although most hospitals will do this routinely, some apparently still don't. One woman recounts:
Before the tests started, I almost ended up undergoing hysterosalpingography, tubal insufflation and laparoscopy before my husband had a sperm count. On my own initiative I asked for these complicated procedures to be delayed until after he had had a simple sperm count. Consequently he was referred for surgery and I was told not to bother with my examinations. . . You would think a hospital would have had the brains to suggest this order of things.
Unfortunately infertility is often seen as primarily a woman's matter.
An unpleasant and unreliable method of diagnosing blocked tubes which has largely fallen out of favour, this involves pumping carbon dioxide inside a woman before she ovulates and is done at an outpatient clinic. She lies on her back with her legs in stirrups, and sometimes under local anaesthetic, a thin tube is inserted into her vagina and up into the cervix. Gas is then pumped in at a carefully regulated pressure. If the gas can pass freely through the fallopian tubes, then it can be heard escaping into the abdominal cavity with a stethoscope. She will experience pain in her shoulders when she sits up, due to the gas, which is said to be harmlessly absorbed into the body later. The test is somewhat inaccurate. It cannot tell whether one or both tubes have let the gas through or whether the tubes are temporarily blocked by a spasm or permanently blocked by something more serious.
But the process of pumping gas through the tubes may clear some very minor blockages and some eighteen per cent of women who have tubal insufflation are thought to be cured by this procedure.
Hysterosalpingography (HSG) This is another unpleasant, uncomfortable outpatient procedure, if not done under general anaesthetic. It is also unreliable. This one entails pumping a radio-opaque fluid (i.e. it shows up on x-ray film) into the uterus and watching its passage through the fallopian tubes and into the abdominal cavity with an x-ray image intensifier scan. The fluid is pumped in with a syringe inserted into the cervical canal. If the woman is awake, this whole process can be painful, and many women are given tranquillisers and painkillers to help them 'relax'. The test should be done in the first half of the menstrual cycle to avoid dosing an egg with x-rays. Results are only about sixty per cent accurate.
As with tubal insufflation it is thought by some that HSG may in itself clear some blockages and may be sufficient to cure infertility in some women.
A relatively old-fashioned procedure now largely superseded by laparoscopy. A fibre optic telescope is passed into the vagina and then out of the top of it, through a small incision, into the abdominal cavity. The telescope, which can be used to take photographs, will give a clear view of the fallopian tubes and ovaries. It is done either under a local or general anaesthetic. When the tube is taken out the hole in the vagina may require a stitch.
Currently the most popular procedure. Under general anaesthetic a tube is inserted through the abdominal wall, usually through the navel, into the abdominal cavity and carbon dioxide pumped in. This clears a space for the insertion of the laparoscope, a long, thin fibre-optic telescope, through a second hole. The laparoscope can be looked through to inspect the state of the various reproductive organs. Blue dye is injected through the cervix. If the fallopian tubes are not blocked the dye will be seen to pass along them. The procedure requires an overnight stay in hospital and, because of the presence of gas in the abdominal cavity, can cause some shoulder pain for a while afterwards. About two in 100 operations develop complications, but diagnostic results are said to be good. The laparoscope can also be used, with various attachments, as an adjunct to surgery. The procedure of laparoscopy may possibly in itself clear some distortions in the fallopian tubes, but this is doubted by some gynaecologists.
Painful, unpleasant and probably unnecessary today. A small sharp instrument is inserted into the womb, usually under local anaesthetic (but sometimes under a general anaesthetic), and a small scraping of the uterine lining is removed. It is performed after ovulation but before the next period has started. Some clinics use a general anaesthetic because of the pain. It is said to be valuable for inspecting the quality of ovulation and the receptiveness of the uterine lining to egg implantation.
A slightly less painful procedure involves inserting a very fine hollow tube into the uterus and sucking out a sample of uterine lining Not a physical diagnostic test but a method of monitoring ovulation. It has the advantage of being physically painless, non-invasive and under the control of the woman. But it can also be tedious, particularly if you have to record the basal temperature for months on end.
You take your temperature by putting a thermometer under your tongue first thing every morning, and recording the reading on a piece of graph paper. At or around ovulation the temperature reading will drop a few tenths of a degree and then rise to a new plateau for the rest of the menstrual cycle. A basal temperature chart can tell you whether or not you are ovulating and will also give an indication of the best time to have intercourse if you want to conceive (i.e. at and around ovulation). Depending on how regular your menstrual cycle is, a basal temperature chart may need to be kept for anything from two months to six months before it is clear whether or not you are ovulating. If by the end of six months no cycle has been observed then ovulation is probably not taking place.
If ovulation is not taking place, it may be necessary to check for hormone disorders by means of biochemical tests. Samples of body fluids are taken to assess the presence, absence and balance of hormones associated with different stages of the menstrual cycle. This is to help determine whether the body hormone system is functioning normally or not.
Testing blood for hormone levels is complicated and difficult and is usually a last resort. Where the menstrual cycle is regular three blood samples within a 28-day period may be adequate to plot the flow of hormones. If periods are irregular or non-existent it may take a lot longer to sort out which hormone levels are associated with which stage of the menstrual cycle.
Urine tests These provide a lot more information than a blood sample about hormone flows, but have to be taken over a 24-hour period. They are prone to error because it is such a nuisance to do. Like a blood test it is complicated and expensive.