Progesterone Test

This will check if ovulation has taken place. It should be taken 7 days before a period, so for a 28-day cycle it is done on day 21. If a period doesn't come 6-8 days after the test, then it will need to be repeated. A level of 30 nmol/l or more suggests ovulation has occurred.

Semen Analysis

A sample of semen is needed to check the total count, whether the sperms look normal, and if they are motile. It is important to abstain from sex for a few days before the test and to ensure that the sample is transported to the lab without delay when produced.

If the first test is low or borderline, a second sample is requested to see if this was a one-off result - was this the best or worst? More details about abnormalities of the semen analysis are discussed in Male Infertility.

Rubella antibody levels

These are checked to see that immunity is present, as this is a good time to repeat the immunisation if not, rather than risk infection during pregnancy, which can cause fetal defects.

Other Examinations: For Special Circumstances

If the standard battery of tests come back abnormal in some way, further tests may be carried out. These tests can include:

    Pelvic Ultrasound Scan: Many units now carry this out as a part of the initial examination process to check that the uterus appears normal and whether the ovaries have a polycystic appearance. An internal or transvaginal scan is most accurate.

    Diagnostic Laparoscopy and Dye Test: If there is a significant degree of pain with intercourse or painful periods then a laparoscopy might be suggested instead of an HSG. This involves a general anaesthetic and small telescope look through the umbilicus into the pelvis to see if there is anything causing the pain, such as endometriosis. At the same time some dye is injected to check the patency of the tubes. This is also done if an HSG suggests that there might be a problem with the tubes, as an HSG alone can't give all the information and the 'blockage' may just be due to spasm of the tube or inadequate pressure when injecting the dye when you are awake.

    Post-Coital Test: This test involves an examination of the mucus around the cervix shortly after intercourse has taken place. It is like having a smear test, and under the microscope interactions between the sperms and cervical mucus are analysed. It is only rarely used now in the UK, as studies have found it to be poor at predicting infertility, it often gives inaccurate results and adds little to the information obtained by the above tests.

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