Basal Body Temperature
Developed in the 1930s, the basal body temperature (BBT) test is based on the fact that a woman's body temperature rises with ovulation. Most women have lower readings in the beginning of their menstrual cycles, before ovulation. Then, there is a small rise of 0.5-1 °F just after ovulation. Because this test measures a change that occurs after ovulation, it cannot help predict when ovulation will occur in a given cycle. However, looking at the results for the past few cycles can show a pattern. Ovulation can be anticipated from this pattern.
For this test, a woman should measure her body temperature each morning while she is still in bed and before eating, drinking, smoking, or going to the bathroom. The temperature may be taken with an ordinary thermometer or with a special one designed for this purpose. If you aren't comfortable reading a mercury-based thermometer, buy one of the varieties that offers an instant digital readout. Whichever you choose, however, be prepared to use the same one each day.
Record the temperature carefully. You may find that it helps to keep track on a chart. Your doctor's office may be able to provide one for you. Because a lack of sleep, drinking alcohol, a fever, or any illness or emotional upset can affect your temperature, mark these changes on your chart, too.
Although keeping a BBT chart may prove to be boring or a nuisance but it can provide valuable information. Record your results each day and bring your chart with you for every visit. Not only can it help your doctor determine when or if you are ovulating but a BBT chart also can suggest hormonal problems interfering with conception.
Blood Tests
Blood tests may be done for both partners. Often the purpose is to measure the levels of hormones that play a role in fertility. These tests may be done at the beginning, middle, and end of the menstrual cycle. Some of the wide varieties of hormones that may be tested include:
FSH (follicle-stimulating hormone)
LH (luteinizing hormone)
Prolactin
Progesterone
Testosterone
Thyroid-stimulating hormone
Blood tests also can detect the presence of antibodies to sperm.
Hysterosalpingography
Hysterosalpingography (HSG) is a series of X rays performed to see a woman's reproductive organs. A technician injects a radio opaque dye into the cervix. This dye fills up the uterus and travels up into the fallopian tubes. On an X ray, it reveals any scarring or blocking. Done on an outpatient basis, a HSG helps the doctor find blockages in your tubes and any abnormalities in the uterus such as polyps (small growths in the uterus) or fibroids. Conditions detected by HSG are often confirmed by hysteroscopy, a procedure that allows the doctor to look directly inside the uterus and perform surgical corrections if required.
Laparoscopy
In laparoscopy, a thin, lighted tube (like a telescope) is inserted into a small cut in the abdomen. By look¬ing through the scope, the doctor can inspect the ovaries, tubes, and the outside of the uterus. Laparoscopy can check for endometriosis, blockages in the tubes, and adhesions. Operative procedure if required, can be done in the same sitting.
Post coital Test
The post coital test often is performed along with cervical mucus tests. It is done soon after intercourse, around the time of ovulation. The doctor examines the mucus and checks the number of active sperm cells in the vagina, cervix, and uterine cavity. If the cervical mucus is inhibiting healthy sperm, this will be clear from the test. Tests 2-8 hours after inter¬course can show how well the sperm get through the mucus. Later tests, 12-18 hours after intercourse, can again check how well the sperm survive.
Cervical Mucus Tests
Your doctor will examine the cervical mucus when you are most likely to be fertile, around ovulation. At that time, mucus is abundant, clear, glistening, and slippery. The doctor measures how far the mucus stretches. Mucus that stretches a lot is better for fertilization than mucus that is not stretchy. At other times during the menstrual cycle the cervical mucus is less hospitable to sperm. It is thick and cloudy and does not stretch so easily.
Endometrial Biopsy
In an endometrial biopsy, a small piece of tissue is taken from the lining of your uterus and studied for evidence of ovulation. This biopsy is performed during the last phase of your cycle, 10-12 days after the LH surge (around days 21-26). The result of an endometrial biopsy is usually compared with the BBT and a blood test for progesterone.
By testing the thickness of the uterine lining, the endometrial biopsy shows whether enough proges¬terone is present. If there isn't enough progesterone, this may be called a luteal phase defect. Even though it is linked to infertility and miscarriage, this defect is poorly understood. It can be treated with ovulation drugs or progesterone. For study of ovulation this test is rarely done nowadays as ovulation can be seen perfectly by USG. This is mostly done nowadays to rule out tuberculosis of the endometrium and if dating of endometrium becomes necessary.
Semen Analysis
Semen analysis determines the concentration, normal movement or motility, and percentage of normal sperm cells in semen. Usually, a sample of sperm is collected through masturbation at the lab. Men opposed to masturbation or who cannot perform on demand can use special collection pouches during sex. A sample not produced at the lab should be brought in within 1 hour. The sperm count is conducted by examining the sample under a microscope. The shape of the sperm is another important factor. Most experts believe that abnormally shaped sperm can't fertilize an egg. How well the sperm move also is studied. Keep in mind that sperm production is not always the same, even in the same man. Probably the doctor will want to do the semen analysis at least three times over a 2- to 4-week period. The only exception to this might be if a man has a zero sperm count. When this happens, the doctor could halt the analysis after two tests, instead of prolonging the process.
After the initial investigations if nothing found abnormal, then more sophisticated investigations become necessary.
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