In tracing the cause of infertility, a doctor usually begins by asking both partners about their health histories, their use of medications, their sexual histories, and their sexual practices. The man often undergoes a physical examination first. Male infertility is usually related to sperm health or function, which is usually tested with a spermanalysis.

For the woman, testing generally begins with a full physical exam and cervical smear. The doctor then makes sure that she ovulates regularly and assesses whether her ovaries are doing their job of releasing eggs. Having regular menstrual cycles and a biphasic basal body temperature curve usually confirms that ovulation is regular. Blood tests can measure hormone levels.

Fertility Testing

Q. What goes into a fertility evaluation?
A. A standard fertility evaluation includes physical exams and medical and sexual histories of both partners. Men undergo a semen analysis that evaluates sperm count and sperm movement. "We look at the percent that are moving and how they are moving--are the sperm sluggish? Are they wandering?" says Robert G. Brzyski, M.D., Ph.D., associate professor of obstetrics and gynecology at the University of Texas Health Science Center at San Antonio. "Often, it's not possible to identify a specific reason for a sperm disorder," he says. "But there is new recognition that very low sperm or no sperm may be related to genetics--an abnormality of the Y chromosome."

For women, doctors first check to see whether ovulation is occurring. This can be determined and monitored through blood tests that detect hormones, ultrasound examinations of the ovaries, or an ovulation home test kit. "An irregular menstrual pattern would make us suspicious of an ovulation problem, but it's also possible for a woman with regular periods to have an ovulation disorder," Brzyski says.

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The ovaries and uterus may be examined by ultrasound, and a specific test can check for tubal blockage or abnormality in the uterus. In about 80% of couples, the cause of infertility is either a sperm problem, irregular or no ovulation, or blockage of the fallopian tubes. In 15% of couples all tests are normal, and the diagnosis of "unexplained infertility" is made.

What Are the Treatments for Infertility?

Many couples once pronounced "barren" can now produce their own child. Common-sense steps that raise the chances of conception may help.

Couples who want children should have intercourse during the 5 to 6 fertile days of her cycle, which means the 4 to 5 days before she ovulates plus the 1 day of ovulation.

A tip-off to ovulation is that there is a sustained rise in basal body temperature about 1 to 2 days after ovulation. A home testing kit can also be used to detect chemical changes in the urine. A newer device is able to detect ovulation from a single drop of saliva.

If the cause of infertility is that the man doesn't have enough sperm, then attempts should be made to find and treat the sperm problem. If, for example, he has a varicocele, then surgery can sometimes improve the sperm count.

If she does not ovulate, then the cause of her ovulation problem should be found and treated. Sometimes, inducing ovulation with hormones or fertility drugs can quickly result in pregnancy.

The small percentage of couples whose infertility cannot be corrected can try artificial fertilization. In intrauterine insemination or artificial insemination, the woman is injected with carefully prepared sperm from the husband, partner, or a donor. This is the easiest and usually least costly method. In the procedure known as IVF (in vitro fertilization), the egg is fertilized outside the woman's body and then placed in the womb or fallopian tube. In another procedure, called GIFT (gamete intrafallopian transfer), egg and sperm are brought together in a fallopian tube. Both methods are difficult and seldom succeed on the first attempt. They are also costly.

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