I'm not getting pregnant: tests to do
When pregnancy is late in coming naturally, it is advisable to contact a fertility center (be it hospital or private), directly or on the advice of your doctor or gynecologist. Whichever route is chosen, normally the couple has to undergo some diagnostic tests to check the fertility of both partners and the existence of any problems. The investigations include some routine exams (first level tests) followed, if necessary, by any further investigations (second level tests). Here is a list of specific tests to do if you are unable to get pregnant.
In this article
- First level exams
- Further tests to find out if you are ovulating
- I ovulate but I'm not pregnant
First level exams
In the list of blood tests for female fertility we find:
- Urinalysis or urethral swab to search for the possible presence of infections, in particular from chlamydia and mycoplasma.
- Blood tests for hormone assays, to see if the woman is ovulating (e.g. LH, FSH, AMH) and to evaluate thyroid function (TSH and anti-thyroid antibodies).
Verification of female fertility will proceed with an assessment of the ovarian reserve, which consists of a blood test that tries to identify any hormonal imbalances. The hormones involved are:
- FSH (follicle stimulating hormone),
- AMH (anti-Müllerian hormone),
- LH (from English luteinizing hormone, luteinizing hormone),
- progesterone to check that ovulation has occurred.
Further tests to find out if you are ovulating
Monitoring ovulation and making sure everything is going right is the first thing to do if you are unable to get pregnant.
Basal temperature monitoring
It is done quietly at home, as is done in natural fertility control methods.
A graph showing the daily basal temperature trend can help establish whether a woman ovulates or not, because immediately after ovulation the temperature upon awakening increases by 0,5 - 1 ° C, remaining elevated for the rest of the luteal phase. and then go back down just before menstruation.
Urine test for mid-cycle LH surge
I LH monitoring kit they are commercially available and are an effective method of controlling ovulation in women who have a normal cycle. Similar to pregnancy tests, they consist of a reagent-soaked strip that dips into morning urine. The test can tell the woman if the LH surge has occurred: if so, ovulation usually occurs within the next 24-40 hours, which is also the best time to conceive.
Cervical mucus test
In a normal cycle, the high levels of estrogen produced immediately before ovulation cause a transformation of the cervical mucus, which becomes clear, watery and much more abundant. In addition, it forms filaments 8-10 cm long. This phenomenon is known as filanza or spinnbarkeit and can be detected by a doctor or by the woman herself.
If none of these changes occur, the woman may not ovulate (very unlikely event) or may have a cervical mucus disorder.
Ultrasound examination and follicle tracing
Ultrasound examination is an effective method of viewing the ovaries and uterus. The transvaginal probes mean that the woman does not necessarily have to keep her bladder full in order to visualize the eggs. Ultrasound is used for:
- Identify any abnormalities of the uterus, endometrium or ovaries;
- Determine the ovulatory situation and the time of ovulation;
- Check the effects of any hormonal treatment.
The first step is to perform a baseline ultrasound, usually done on day 2 or 3 of the cycle, to visualize the structure of the ovaries. If the appearance of the ovaries is normal, the basal ultrasound is followed by a second ultrasound between the seventh and tenth day of the cycle, at which time a dominant follicle should be visible.Read also: I'm not getting pregnant, exams for him
I ovulate but I'm not pregnant
Where the tests and monitoring do not reveal any abnormalities in ovulation, other investigations will be carried out.
Tests to evaluate the uterine cavity
This is thethree-dimensional ultrasound, which allows you to suspect the existence of fundic malformations uterus (septa, subsept, arched, saddle uteri) andhysteroscopy, a minimally invasive endoscopic technique that allows to evaluate the uterine cavity, the presence of anomalies or conditions that can interfere with the implantation of the embryo and the characteristics of the endometrium.
In addition to diagnostics, hysteroscopy can be operative to eliminate some of these possible anomalies.
Tubal patency test
These tests make it possible to establish whether the fallopian tubes are free (patent) or closed. The main tests are:
- Hysterosalpingography X-ray examination to study the fallopian tubes, which involves the use of a radiographic contrast medium introduced through the vagina;
- Isterosonosalpingosonografia (ISG) o sonosalpingografia Vaginal ultrasound examination similar to hysterosalpingography. In this case, however, a special contrast agent is used which reflects the ultrasounds. After introduction of the contrast medium through the vagina, a transvaginal ultrasound probe is used. The examination is as accurate as hysterosalpingography but is simpler, less expensive, and less invasive. On the other hand, it allows us to understand only if the tubes are closed and most women suffering from tubal infertility have tubes that are open but not functioning. For this, many gynecologists still prefer to use the ISG.
- Laparoscopy Direct visualization of the ovaries and the outer part of the fallopian tubes through the use of a laparoscope (a thin tube at the end of which is a tiny video camera). The laparoscope is introduced under anesthesia, through a small incision near the navel. The examination can cause discomfort to the patient and swelling; there is a very modest risk of bleeding and intestinal perforation.