How Is Female Infertility Diagnosed?

So how is female infertility diagnosed? Roughly 40% of all diagnosed infertility stems from the female partner. Because of this fact, both partners should fully participate in diagnostic procedures anytime conception difficulties are present.

The following is for you if:

  • You are just starting to wonder about underlying causes of your inability to conceive;
  • You are not happy with your current diagnostic/treatment plan or practitioner and are wondering which direction to turn;
  • You want an idea of what to expect when you see a fertility specialist.

What Are They Looking For?

The possible causes of infertility are many and varied. If you have been unable to conceive, or for some reason suspect that you may have a problem getting pregnant, understanding how your body works is the first step. While we all think we know everything necessary to get pregnant, there’s nothing like infertility to show you there is a lot more to it than what we were taught in school health class.

Specifically, you’ll want the diagnostic phase to answer these questions:

  • Are you ovulating regularly?
  • Are your eggs able to unite and grow normally with sperm?
  • Are there obstacles to implantation and pregnancy maintenance?

Your practitioner may be looking for the following potential causes of infertility (and not necessarily in this order):

  • Pelvic inflammatory disease
  • Endometrial tissue problems such as endometriosis or underdeveloped uterine lining
  • Polycystic ovarian syndrome (PCOS)
  • Poor egg quality or premature ovarian failure
  • Structural anomalies such as tubal blockage, fibroid tumors, scar tissue or adhesions
  • Cervical factors resulting in mucus problems
  • Hormonal imbalances and irregularities, such as luteal phase defect and hyperprolactinemia
  • Immune system dysfunctions, such as lupus
  • Untreated chronic disease such as diabetes, thyroid disease, and kidney disease
  • Lifestyle, occupational, or environmental factors, including prescription, over-the-counter, or illegal drug use, toxin exposures, stress, and nutrition.

What Will They Do?

Medical History

First and foremost, a complete medical history should be taken. This may be the most thorough such history you’ve ever discussed with a professional.

To be included in your medical history:

  • Pregnancy history, including any miscarriages, voluntary terminations, and live births
  • Your basal body temperature chart, optimally for the previous three consecutive months or more
  • Prior and current illnesses, including sexually transmitted diseases
  • Previous surgeries, hospitalizations and treatments
  • Allergies
  • Prescription and recreational drug use (including alcohol), past and present
  • Measles (rubella) exposures or innoculations
  • DES exposure in-utero
  • Exercise habits
  • Smoking history
  • Sexual activity history
  • Sexual practices, including contraception history, lubricant use, technique and timing
  • Family history of fertility
  • Menstrual history

Following your medical history, your physician may wish to conduct a pelvic examination, including routine PAP test and STD evaluation.

Lab Tests

Next, your physician will most likely measure the levels of several hormones via blood tests or vaginal smears on certain days of your menstrual cycle, specifically:

  • Estradiol (E2): Day of LH surge, as detected by BBT and/or OPK (generally mid-cycle)
  • Total & free testosterone
  • Thyroxine (T4), TSH, Free T3
  • Luteinizing hormone (LH): Day 3 & Day of surge
  • Follicle stimulating hormone (FSH): Day 3 & Day of LH surge
  • Prolactin
  • Progesterone: Day of LH surge

Other tests that may be performed initially include:

  • STD cultures or DNA probe
  • VDRL for syphilis
  • HIV & hepatitis screen
  • Complete blood count (CBC)
  • Urinalysis
  • Fasting insulin
  • Sedimentation (Sed) blood rate
  • Sickle cell screen


If deemed necessary by your own situation, your physician will suggest you next consider one or more diagnostic procedures:

  • Post-coital test
  • Endometrial biopsy
  • Hysterosalpingogram (HSG)
  • Hysteroscopy
  • Exploratory laparoscopy
  • Pelvic ultrasound

Not every patient will need to undergo all of the above testing. It is not possible to accomplish all of the above procedures in less than a few cycles’ time, and some are more invasive than others. As with any medical procedure, make sure you understand your doctor’s reason for suggesting any test and all other specifics before consenting.

If you’re ever in doubt about your own physician’s skill and training, compare your experience with him/her to this list of objectives required of all reproductive endocrinology fellows by the American Board of Obstetrics & Gynecology.