My first blog entry discussed identifying a fertility problem and some of the issues and specifically testing that each partner might undergo for a clear diagnosis.  To go a bit deeper into diagnosis and tests, let's talk about the semen analysis that is typically performed on the male partner.

Semen analysis

The male partner will ejaculate, often at the doctor's office (though you can use a condom at home and bring in the ejaculate) so that fresh sperm is obtained.  The sperm is then assessed for:

• Volume
• How quickly it changes from gel to liquid form (20 minutes is considered normal)
• Sperm count per millileter
• Sperm morphology (percent of sperm that are normal shape)
• Sperm motility (percent that mnove forward)
• pH (acidity or alkalinity)
• Sign of white blood cells (wbc presence is abnormal)
• Fructose level (since fructose provides the energy to the sperm)

Depending on the findings the male will be considered a "non-contributor" to the infertility problem or further evaluation/treatment will occur.  Some of these findings can determine if artificial insemination, using several collections of sperm that are then evaluated so that the "best of the group" can be introduced during the procedure, is a good fertility treatment option.

As a woman you can expect to see your Obstetrician- Gynecologist ,or you may be sent to an OB/GYN who specializes in fertility.  Your doctor will want to see if you are indeed ovulating or releasing eggs every month.  You may be asked to undergo a hormone evaluation (blood test), ultrasound evaluation of your ovaries and/or use an ovulation home test kit.  Recenty doctors have begun to test hormone levels to see how the ovaries respond to various fertility treatments, by watching changing hormone levels.  If you are indeed ovulating, then the doctor may decide to perform a hysterosalpingogram, which is an x-ray of the fallopian tubes using a dye to check patency of the tubes.  Depending on findings, you could also be asked to undergo a hysterosonography which involves putting a salt solution (saline) into the uterus and then having an ultrasound to see if there are any abnormalities in the uterus, like fibroids.  The doctor may also decide to perform a surgical procedure, a laparoscopy, to visually examine the ovaries, fallopian tubes, uterus and the abdominal cavity.  A fiber-optic telescope is passed into the abdomen, and it allows the doctor to see adhesions or scar tissue that otherwise might not be easily identified.

Final tests might involve seeing how the sperm and eggs interact and whether or not there is an antibody reaction to sperm entering the vagina during intercourse, which could mean that the sperm never survive long enough to enter the cervix and then fertilize the eggs.

Up next: The Treatments