Blood Work-Up

A blood test can determine if adequate hormone levels are being secreted in the bloodstream. Depending on when the blood is taken, the doctor can evaluate various aspects of a woman’s menstrual cycle. Different hormone levels may be measured with samples taken at different times of the menstrual cycle. For example, measuring the levels of FSH (follicle stimulating hormone), LH (luteinizing hormone) and estradiol in the first 2-4 days of the menstrual cycle gives an indication of ‘ovarian reserve’, one measure of a woman’s reproductive potential. Another blood sample is generally drawn about 7 days after expected ovulation that measures the progesterone level. An elevated progesterone level indicates that ovulation (the release of an egg) has occurred.

These blood tests can be done at the healthcare provider’s office or in a lab and take only a few minutes. Women should be prepared to have several blood tests taken during their initial work-up.

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Screening for STIs

There are common STIs of which people may not be aware that can affect their fertility. Due to their prevalence and the impact they can have on fertility, screening for and ruling out STIs is one of the first tests a healthcare provider may perform in the workup. Since these diseases are sexually transmitted, both partners should be screened and treated if the results are positive or they can continue to infect each other.

Chlamydia is the most common STI in Canada. It is a bacterial infection that is spread by vaginal, oral or anal sex. Since 1997, rates of chlamydia infection have been steadily rising. Health Canada reports that in 2008, there were 79,006 cases of Chlamydia identified in Canada (237.2 cases per 100,000 population). In women, chlamydia can do permanent damage if not treated and can eventually lead to pelvic inflammatory disease (PID), which is a cause of infertility among women of reproductive age. In men, chlamydia can infect the epididymis (where sperm is stored). This condition, known as epididymitis, causes the testicles to swell during infection that may cause scarring and block sperm passage, which can lead to infertility in some cases.

Chlamydia usually has no symptoms in men or women and goes undetected and untreated in many instances. Determining if chlamydia is present is a simple procedure done in the healthcare provider’s office. By inserting a cotton swab into the tip of a man’s penis, the doctor can capture a bacterial culture to test for chlamydia. In women, a sample of cervical secretions can be analyzed to detect the presence of chlamydia. If a person is infected, his or her current and previous partners should be tested, and treated if they are infected.

Other common STIs for which your healthcare provider may screen you and your partner are ureaplasma and mycoplasma. 

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Questions your Physician May Ask

During the initial evaluation of infertility, in the interest of efficiency, some fertility clinics mail out a questionnaire prior to a scheduled visit. Your physician will ask for information about medical and sexual history as well as information about a person’s social and personal life. Men might be asked about any history of the following:

• Testicular injuries
• Mumps
• Sexually transmitted infections (STIs)
• Surgery
• Allergies
• Exposure to heat
• Exposure to environmental toxins

Some of these questions are often easier to answer in written form than face-to-face.

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