- The Washington Times - Sunday, March 25, 2001

The battery of infertility tests has changed as reproductive medicine has advanced.

Until recently, patients underwent about a half-dozen tests, says Dr. Paul Gindoff, a reproductive endocrinologist at George Washington University Medical Center. However, with advanced reproductive techniques such as in-vitro fertilization (IVF) becoming so fine-tuned, doctors are advising some couples, particularly those with age factors, to go right to treatment rather than wait out the testing process.

"IVF is working better and better, so it has become sort of a global treatment for many disorders," Dr. Gindoff says. "For younger patients who have time on their side, we may advise them to go through all the tests. However, surgery is done less and less. A laparoscopy used to be given regardless of the situation. Now it is really only done in cases of screening for abnormality."

Indeed, for patients eager to become pregnant, skipping over some of the tests is a timesaver if at least one factor already has been identified during infertility testing, says Dr. Mark Perloe, a reproductive endocrinologist in Atlanta.

Endometrial biopsy and a post-coital test are two tests that also are being performed less often, Dr. Perloe says. In the endometrial biopsy, a small piece of tissue is taken from the uterus at a certain point in a woman's cycle to check the consistency and hormone levels to determine whether they are adequate to support a pregnancy. In the post-coital test, cervical secretions are checked within 24 hours of having intercourse to determine whether sperm can swim in the environment.

"There is really no advantage to doing these tests," Dr. Perloe says. "The only real treatments for infertility are ovulation induction, IVF and artificial insemination, any of which would be recommended treatment for a patient with common fertility problems."

Tests that still should be performed include:

• Blood tests to check for base-line levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), two hormones crucial in the ovulation process. This test should be performed on the third day after the menstrual cycle begins.

Other blood work should check for levels of testosterone and the hormone DHEA (dehydroepiandrosterone), which may indicate polycystic ovarian disease; prolactin; and TSH (thyroid-stimulating hormone).

• Semen analysis that checks the sperm for shape and motility.

• An ultrasound, which can be used to assess the thickness of the lining of the uterus and check the condition of the ovaries and uterus. An ultrasound can reveal some abnormalities in the shape of the uterus and also show egg follicle development, ovarian cysts and uterine fibroids. In some cases, endometriosis can also be detected.

• A hysterosalpingogram (HSG) also should be performed in some patients. In this test, dye is shot through the fallopian tubes and uterus. The dye's path is checked on an X-ray to determine any blockages or abnormalities. This test should be scheduled in the earlier part of a woman's cycle, before ovulation.

Dr. Gindoff says this test which can be quite painful used to be standard but also is being performed less often. Because IVF, which bypasses the fallopian tubes, is being prescribed more often to override such conditions as male factor infertility or poor egg quality, the condition of the tubes becomes insignificant, he says.

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