When It's Time for Fertility Testing

The Next Phase of Fertility Testing

Once a woman's cycle is evaluated and the sperm specimen is checked out, the next phase of testing will occur about a month later. The tests in the next phase are a little more sophisticated and may include a postcoital test, endometrial biopsy, and a tubal dye test (hysterosalpingogram, or HSG).
The postcoital test involves using a microscope to examine whether the sperm are able to move in the cervical mucus following sexual intercourse. The timing for this test is crucial -- it must be done just before or at the time of ovulation. The timing is vital, as this will help to determine the quality of the sperm-mucus interaction. To achieve this, you may be asked to use the ovulation kit to test for the LH surge, which usually occurs the day before ovulation when the cervical mucus should be most favorable for sperm to move in.
The couple is usually asked to have intercourse late in the evening or in the morning after the LH surge is detected. The woman then goes to her healthcare provider's office for an examination of the cervical mucus for the presence of sperm. The postcoital test helps to determine whether there is sufficient mucus, the quality of the mucus, and whether the sperm can get into and survive in the cervical mucus.
In some cases, your healthcare provider may recommend an endometrial biopsy. This procedure is usually performed after day 21 of your menstrual cycle and involves taking a small piece of tissue from the uterine lining. This test is done to determine if the lining is thick enough for a fertilized embryo to implant.
Women may need to have a hysterosalpingogram (HSG) test as well. This is a tubal dye test that is done just after a menstrual period is over. This test involves using an x-ray and injectable dyes, so it is usually done by a radiologist.
This test will be similar to a pelvic examination (Pap smear). However, a small instrument is placed through the cervix into the lower part of the uterus and some dye is injected. The healthcare provider will follow the dye with a fluoroscope and take pictures as he or she sees the dye go through and out of the end of the fallopian tubes. This enables them to see the contours of the endometrial cavity to see if there may be any abnormalities, such as an abnormally shaped uterus, adhesions, polyps, or fibroids. It can also help to determine whether the fallopian tubes are open and healthy.
While the procedure is fairly quick, it is common to experience some cramping when the dye is injected. Your healthcare provider may give you a mild sedative before the procedure and a pain reliever to help minimize any pain or discomfort. Antibiotics can also be given to help prevent any infections.
If your HSG shows that there is a uterine abnormality, you may need a hysteroscopy. This involves using a hysteroscope, which is a tiny telescope mounted with a fiber-optic light. The hysteroscope is used to examine any uterine abnormalities.
A sonohysterogram is another method of examining the uterus. This involves an ultrasound that uses saline to inflate the uterine cavity to allow for a careful examination of the uterus.
Last reviewed by: Arthur Schoenstadt, MD
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