Special and sophisticated investigations required for the infertile couple:

Once the initial tests have been completed, the doctor usually has a good idea of what may be causing a couple to be infertile. She or he may suggest extra tests to confirm the diagnosis. Alternatively, all tests may be normal, and additional tests may be done to find a cause.

Cultures for Infection

Cultures can identify the type of organism causing an infection. Some of the organisms that may cause infection include Chlamydia, Gonorrhea, Urea-plasma, and Mycoplasma, as well as the organism that causes tuberculosis. Knowing the cause of infection is the first step toward proper treatment.

If there are signs of infection in the cervical mucus tests, cervicitis (inflammation of the cervix) may be interfering with the production of mucus. Cultures may be done to find out what type of infection, if any, is present. Cultures also may be done if an endometrial biopsy suggests endometritis. In men, cultures of the semen are sometimes done as well.

Hysteroscopy

With hysteroscopy, the doctor uses a thin, lighted telescope like tube to examine the inside of the uterus. After the scope is passed through the cervical opening, the doctor inspects the uterus, its lining, and the opening of the tubes into the uterus. Because the procedure allows viewing the uterus itself, and not just an image of it, it can confirm other tests such as hysterosalpingography. Surgical correction like removal of polyps, opening of flimsy adhesion in the opening of the fallopian tubes, or any adhesion in the cavity can be done through hysteroscope.

Imaging Techniques

When the doctor suspects a blockage in the man's reproductive system, imaging techniques such as ultrasound or special X-rays may be used. Ultrasound uses high frequency sound waves to form clear images of the reproductive tract. In a woman, ultrasound also can monitor follicle development to see if ovaries are producing eggs ready for ripening and fertilization. Using a series of ultrasound scans a few days apart, experts have even found that up to 30 percent of women with previously undetermined infertility produce eggs that ripen but never release from the ovaries. Ultrasound can show how thick or receptive the uterine lining is at mid cycle. Pelvic abnormalities or adhesions can be detected as well.

Sperm Antibody Testing

If the doctor suspects an immunological cause for the infertility or, if no cause has been found, then sperm antibody testing may be done. In this test, the semen and sperm are mixed with special substances, such as beads coated with an antibody. The sperm are then checked to see if they bind to the beads.

Sperm Penetration Tests

If the ability of the sperm to fertilize an egg needs to be examined, sperm penetration tests may be done. In these tests, sperm are mixed with specially treated hamster eggs to measure how often penetration of the eggs occurs. (The difference between humans and hamsters is so great that nothing grows from the pen¬etrated egg.) Similar tests can be done with human eggs.