Diagnostic Tests for Female infertility
Female infertility: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Female infertility
includes:
Female infertility Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Female infertility:
- Pregnancy -- Related Home Testing:
- Fertility-related Home Testing:
- Male Fertility Tests
- Menopause: Related Home Testing:
- Vaginal Health: Home Testing:
- Breast Cancer: Related Home Tests:
Female infertility Diagnosis: Book Excerpts
Tests and diagnosis discussion for Female infertility:
For the woman, the first step in testing is to determine if she is
ovulating each month. This can be done by charting changes in morning body
temperature, by using an FDA-approved home ovulation test kit (which is
available over the counter), or by examining cervical mucus, which
undergoes a series of hormone-induced changes throughout the menstrual
cycle.
Checks of ovulation can also be done in the physician's office with
simple blood tests for hormone levels or ultrasound tests of the ovaries.
If the woman is ovulating, further testing will need to be done.
Common female tests include:
Hysterosalpingogram: An x-ray of the fallopian tubes and uterus after
they are injected with dye, to show if the tubes are open and to show the
shape of the uterus. Laparoscopy: An examination of the tubes and other
female organs for disease, using a miniature light-transmitting tube
called a laparoscope. The tube is inserted into the abdomen through a
one-inch incision below the navel, usually while the woman is under
general anesthesia.
Endometrial biopsy: An examination of a small shred of uterine lining
to see if the monthly changes in the lining are normal.
(Source: excerpt from Infertility: NWHIC)
Diagnostic Tests for Female infertility: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Female infertility.
AMENORRHEA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The first thing to do is a pregnancy test, as pregnancy is the most common cause of secondary amenorrhea. If the pregnancy test is negative, referral to a gynecologist may be done at this time. If a specialist is not handy, one may proceed with the workup. A trial of medroxyprogesterone acetate (ProveraŽ) may be done by intermuscular injection or by mouth. If bleeding occurs on withdrawal of the progesterone, then it is established that the uterus is functional. It also establishes that the cervix and vagina are patent. If bleeding does not occur, uterine pathology is likely, and referral to a gynecologist is necessary.
If there is no galactorrhea, a normal response to progesterone, and the patient is a teenager, one may simply discontinue studies at this point and observe for the normal onset of the menstrual cycle.
If the patient with primary amenorrhea has already reached her twenties or if there is definite secondary amenorrhea, then further diagnostic studies should be done. If there is galactorrhea, a serum for prolactin should be done. If that is elevated, a CT scan of the brain should be done to look for a pituitary tumor or hypothalamic tumor. If there is no galactorrhea, one should still order a prolactin, but also order tests for follicle-stimulating hormone (FSH), luteinizing hormone (LH), and serum estradiol. If the FSH and LH are elevated and the estradiol is decreased, primary ovarian failure must be considered. A buccal smear for sex chromogens should be done to rule out Turner's syndrome. Other causes of primary ovarian failure are ovarian agenesis and polycystic ovary syndrome. An elevated free testosterone will support the diagnosis of polycystic ovary syndrome (Stein-Leventhal syndrome).
If the FSH, LH, and estradiol are all decreased, then hypopituitarism should be considered, as well as hypothalamic disorders. Referral to an endocrinologist is wise at this point. When an adrenocortical tumor is suspected, a serum cortisol and cortisol suppression test should be done.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
INFERTILITY, FEMALE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine studies include a CBC, urinalysis, urine culture and colony count, chemistry panel, thyroid profile, VDRL test, and a vaginal smear and culture. Cervicitis should be biopsied and treated. The next logical step is to obtain a specimen of semen from the husband for sperm count.
If the above tests are negative, referral to a gynecologist is in order. If one is not available, further workup can be done, including a serum FSH and LH, serum estradiol, and serum progesterone to determine the presence of pituitary or ovarian causes of ovulatory dysfunction. A hysterosalpingogram can be done. The patient can keep a temperature chart to determine if ovulation occurs. Cervical mucus studies can be done for spinnbarkheit testing and
ferning
, and the presence of significant white cells should be noted. Pelvic ultrasound may be done, and laparoscopy may be necessary to rule out other conditions that may affect fertility. A trial of clomiphene citrate may be given. Endometrial biopsy may also contribute to solving the diagnostic dilemma.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
INFERTILITY, MALE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine laboratory tests include a CBC, urinalysis, chemistry panel, thyroid profile, VDRL test, and sperm count. If there is a urethral discharge, a smear and culture should be done. If the sperm count reveals oligospermia on two separate specimens, referral should be made to a urologist or endocrinologist for further evaluation.
Additional tests that can be ordered include blood tests for LH, FSH, and testosterone. Additional tests of pituitary function may be indicated. Karyotype testing and sperm function tests may be needed. If these are normal, a testicular biopsy may need to be done. Ultrasonography of the testicles may be helpful.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Amenorrhea:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by determining whether the amenorrhea is primary or secondary. If it’s primary, ask the patient at what age her mother first menstruated because age of menarche is fairly consistent in families. Form an overall impression of the patient’s physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
If menstruation began at an appropriate age but has since ceased, determine the frequency and duration of the patient’s previous menses. Ask her about the onset and nature of any changes in her normal menstrual pattern, and determine the date of her last period. Find out if she has noticed any related signs, such as breast swelling or weight changes.
Determine when the patient last had a physical examination. Review her health history, noting especially any long-term illnesses, such as anemia, or use of hormonal contraceptives. Ask about exercise habits, especially running, and whether she experiences stress on the job or at home. Probe the patient’s eating habits, including the number and size of daily meals and snacks, and ask if she has gained weight recently.
Observe her appearance for secondary sex characteristics or signs of virilization. If you’re responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Amenorrhea:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by determining whether the amenorrhea is primary or secondary. If it’s primary, ask the patient at what age her mother first menstruated because age of menarche is fairly consistent in families. Form an overall impression of the patient’s physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
If menstruation began at an appropriate age but has since ceased, determine the frequency and duration of the patient’s previous menstrual cycles. Ask her about the onset and nature of any changes in her normal menstrual pattern, and determine the date of her last menses. Find out if she has noticed any related signs, such as breast swelling or weight changes.
Determine when the patient last had a physical examination. Review her health history, noting especially any long-term illnesses, such as anemia, or use of hormonal contraceptives. Ask about exercise habits, especially running, and whether she experiences stress on the job or at home. Probe the patient’s eating habits, including number and size of daily meals and snacks, and ask if she has gained weight recently.
Observe her appearance for secondary sex characteristics or signs of virilization. If you’re responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Amenorrhea:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The purpose of the focused examination is to screen for abnormal anatomy or development and signs of endocrinopathies. A breast examination should document the presence or absence of galactorrhea which, with hair distribution, should provide an evaluation of normal secondary sexual characteristics (Tanner stage). Palpate the thyroid for enlargement or nodules. A careful pelvic examination is essential to detect any structural abnormalities or lesions. Signs of possible androgenic excess are truncal obesity, hirsutism, acne, male pattern baldness, and clitoral enlargement (Chapter 14.3).
Testing
A. Clinical laboratory tests. Serum or urine human chorionic gonodotropin, thyroid-stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone are usually the only tests required to make a diagnosis (section V). Additional tests for premature ovarian failure should include free thyroxine (T4), thyroid antibodies, morning cortisol, calcium, phosphorus and antinuclear antibody, rheumatoid factor, erythrocyte sedimentation rate, and a complete blood count. Further adrenal evaluation of women who exhibit signs of hyperandrogenism with anovulation (“hyperandrogenic chronic anovulation”) includes fasting serum testosterone, dehydroepiandrosterone (DHEA)-S, and 17-hydroxyprogesterone (17-HP).
B. Other laboratory evaluation. Karotyping is indicated in all women with premature ovarian failure prior to age 30 years or with any physical evidence suggestive of Turner’s syndrome (short stature, web neck, shield-shaped chest, lack of secondary sexual characteristics) (3). Endometrial biopsy should be considered in women with prolonged amenorrhea or with evidence of estrogen or androgen excess to exclude endometrial hyperplasia.
C. Provocative tests
1. Progesterone challenge test. Oral progesterone acetate (10 mg daily for 15 days). A positive test is withdrawal bleeding between days 2 and 7 after finishing medication; alternatively, parenteral progesterone (200 mg) in oil or micronized progesterone 200 mg at bedtime.
2. Estrogen-progesterone challenge test. Oral conjugated estrogen (1.25 mg) or 2 mg estadiol qd for days 1 through 21 with oral progesterone acetate (10 mg) on days 17 through 21. A positive test is withdrawal bleeding between days 2 and 7 after finishing medication.
D. Diagnostic imaging. A coned lateral view of the sella turcica is indicated as a screening examination for galactorrhea if the prolactin level is less than 100 ng/ml. A magnetic resonance imaging scan, which is more sensitive, is indicated for elevated prolactin, abnormal screening x-ray film, or diagnosis of hypothalamic amenorrhea (section V).
Diagnostic assessment
Use the approach outlined in Figure 11.1 to guide diagnosis (1–3).
References
1. Speroff L, Glass RH, Kase NG. Clinical gynecologic endocrinology and infertility, 5th ed. Baltimore: Williams & Wilkins, 1994:401–456.
2. Kiningham RB, Apgar BS, Swenk TL. Evaluation of amenorrhea. Am Fam Physician 1996;53:1185–1194.
3. Scott J, DiSaia P, Hammond C, Spellacy W, eds. Danforth’s obstetrics and gynecology, 7th ed. Philadelphia: JB Lippincott, 1994:665–679.
4. Alper MM, Garner PR. Premature ovarian failure: its relationship to autoimmune disease. Obstet Gynecol 1985;66:27–30.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Secondary Amenorrhea:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Evaluation should always begin with a history and a urine hCG for pregnancy. On physical examination, attention should be paid to darkening of the areola, and evidence of estrogenization of the vagina.
Estrogen sufficiency can be assessed by observing a fern-like pattern of cervical mucous on a slide or by giving medroxyprogesterone for 5 days and looking for withdrawal bleeding. Bleeding suggests suppression of LH surge as seen in functional amenorrhea or polycystic ovary syndrome.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Infertility:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Couples should be encouraged to attempt to conceive (unprotected intercourse) for 1 year before undergoing evaluation. Ovulation usually occurs if there have been spontaneous, regular, cyclic menses, but this can be confirmed by daily measurement of basal body temperature. The sperm count and motility can be ascertained to be adequate only by semen analysis. Male factors account for about 25% of infertility.
Interpersonal issues such as career stress, differences in desire for children (a clue is that one partner only seeks evaluation), or unacknowledged homosexual preference may interfere with effective coitus.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Amenorrhea:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Observe her appearance for secondary sex characteristics or signs of virilization. If you’re responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Amenorrhea:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by determining whether the amenorrhea is primary or secondary. If it's primary, ask the patient at what age her mother first menstruated because age of menarche is fairly consistent in families. Form an overall impression of the patient's physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
If menstruation began at an appropriate age but has since ceased, determine the frequency and duration of the patient's previous menses. Ask her about the onset and nature of any changes in her normal menstrual pattern, and determine the date of her last menses. Find out if she has noticed any related signs, such as breast swelling or weight changes.
Determine when the patient last had a physical examination. Review her health history, noting especially any long-term illnesses, such as anemia, or use of hormonal contraceptives. Ask about exercise habits, especially running, and whether she experiences stress on the job or at home. Ask about the patient's eating habits, including the number and size of daily meals and snacks, and ask if she has gained or lost weight recently.
Observe her appearance for secondary sex characteristics or signs of virilization. If you're responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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