Several tests performed by your doctor or reproductive endocrinologist will help diagnose the cause for your infertility. We already covered the tests your partner will go through in the section titled “Visiting Your Doctor.”

The tests for you range from very simple in-office tests no more invasive than a PAP smear or ultrasound to surgical procedures.

Post Coital Test
During the Post Coital Test the doctor takes a sample of your cervical mucus. The doctor will examine the cervical mucus under a microscope to determine if it is hospitable to sperm.

Timing is everything with this test; it must be performed four to 10 hours after sex when just prior to, during, or immediately following ovulation (i.e., your fertile period, or the time of your cycle when you should be able to conceive.) Use an ovulation predictor kit to be certain, although you can certainly use other timing methods, including tracking BBT (Basal Body Temperature) and cervical mucus.

Do not:

• Use lubricant during sex

• Douche after sex

• Bathe or swim after sex (a shower is okay)

The doctor will take a small sample of cervical mucus and examine it for:

• Quantity – There should be more plentiful amounts during your fertile period;

• Consistency and clarity – It should be very thin and clear and also very stretchy, almost rubbery;

• Ferning – Under a microscope, the doctor should see a fern-like pattern in the dried cervical mucus, indicating the presence of estrogen without progesterone hormones;

• Cellularity – Few cells, other than sperm, should be present.

If any of these factors show problems, this could be the reason you are having difficulty conceiving. The doctor may recommend artificial insemination by means of intrauterine insemination in order to bypass the cervix all together.

However, the number one reason this test fails is poor timing; if the test was not done four to 10 hours after intercourse or was not done while you were ovulating, then the cervical fluid may not show a favorable environment for sperm to survive, swim and fertilize an egg. If this is suspected to be the case, a second test should be performed at the time of ovulation.

Other causes for an unfavorable cervical environment include:

• Infection or irritation. If this is the cause, testing will show white blood cells in the mucus.

• Procedures performed on the cervix to treat an abnormal Pap smear, such as freezing or laser treatment.

• Medications. Clomid (generic: clomiphene) a fertility drug used to treat infertility caused by anovulation, can have adverse affects on cervical mucus. If your doctor prescribes the drug or increases your dosage, he should perform a post-coital test to be sure the cervical environment is still hospitable to sperm.

Ultrasound
Most people think of ultrasounds as a non-invasive, painless procedure performed on pregnant women in order to see the unborn baby. True, an ultrasound can determine the gender, size (give or take 2 pounds), and often the general health of a fetus, but it can also give a doctor information about why you haven’t been able to conceive yet.

Your doctor will use an ultrasound to evaluate the condition of your ovaries and fallopian tubes, and check for cysts, tumors and uterine fibroids. He will be looking for Polycystic Ovarian Syndrome, endometriosis, and anything else that may be impairing your ability to get pregnant. An ultrasound can show the doctor if your eggs are developing properly and are being released from the ovaries and if the endometrial lining thickens sufficiently to permit implantation.

An endometrial biopsy is used to detect cancerous cells, precancerous cells, infections or any abnormalities that may be affecting your ability to conceive. The doctor inserts a thin catheter, called a pipelle, into the uterus and uses it to draw out cells for testing.

You may experience mild to intense cramping during and after the test. The doctor may recommend you take ibuprofen, such as Motrin or Advil, before and after the test to minimize cramping, or he may offer a prescription painkiller. You may have minor bleeding following the test.

You should take a pregnancy test prior to an endometrial biopsy since the procedure may terminate a very early pregnancy.

Hysteroscopy
A hysteroscopy is an out-patient procedure performed that will allow your doctor to spot abnormalities in the uterus such as:

• fibroid tumors

• polyps

• scar tissue

A hysteroscope is a very thin telescope with a camera on the end that can enter the cervix with no dilation. The uterus is expanded by means of saline solution or carbon dioxide, permitting the doctor to view the inside on a television monitor in the office. Minor cramping may result from the introduction of saline or carbon dioxide into the uterus, but the procedure is not considered especially painful.

Falloposcopy
Cleared by the U.S. FDA (Food and Drug Administration) in 1997 for use to diagnose fallopian tube blockages in women trying to conceive, falloposcopy is regarded as a relatively new and complicated procedure. However, since nearly 35 percent of all female infertility cases are related to fallopian tube damage, this procedure may be invaluable in determining the cause of infertility. Your doctor will probably order less invasive tests first, however, including an ultrasound.

Because the fallopian tubes are located so deep within the reproductive system, past diagnostic procedures carried a 40 percent rate of false diagnoses. The STARRT Falloposcopy procedure, patented by Conceptus, Inc., shows a much greater accuracy rate.

The procedure takes about 45 minutes and is performed with local anesthesia or intravenous sedation. Another benefit of the test is that tubes can be repaired at the same time, with the same equipment, if the doctor finds any abnormalities. Tubal repair can take as long as two hours and your doctor will use a general anesthesia. If abnormalities are found but the tubes cannot be repaired, your doctor will discuss the possibility of in vitro fertilization with you and your partner.

Similar to a hysteroscopy, a falloposcopy views the inside of the fallopian tubes by means of a camera inserted into the body. It enters through a catheter that travels through the cervix and uterus and finally, into the fallopian tube. A fiber optic endoscope with a camera on the end is then inserted through the catheter, so the doctor can view images on a television monitor in the office.

Risks include infection and bleeding, so your doctor may prescribe an antibiotic as a preventative measure.

Laparoscopy
Laparoscopic surgery is an advance in medical technology which permits diagnostic surgery through a very small incision, into which a thin instrument (laparoscope) is inserted in order to take pictures of the abdomen. Carbon dioxide is used to expand the abdomen, permitting the doctor with a clear view of the uterus, cervix, and ovaries and fallopian tubes on a television monitor in his office or in the operating room.

Doctors in the late 20th century commonly recommended this diagnostic procedure in couples trying to conceive. Today, however, other procedures are recommended first. Although laparoscopy is simpler and safer than traditional surgery with a full-size incision, it is still surgery, and often performed under general anesthesia. Rarely does a laparoscopy turn up any abnormalities not spotted by other fertility screening tests.

Hysterosalpigogram (HSG)
According to the Advanced Fertility Center of Chicago, a hysterosalpigogram is a common infertility diagnostic procedure that is helpful in detecting tubal infertility. Since 25 percent of all infertility is caused by tubal abnormalities, this test may be an important one. Less invasive than a laparoscopy, top fertility clinics makes it part of its basic fertility screens.

The test is performed in the radiology department of the fertility clinic, hospital or medical center between days six and 13 of the patient’s menstrual cycle.

Dye is injected into the uterine cavity, through the vagina and cervix. If the fallopian tubes are normal, the dye should spill out into the abdominal cavity. If there is a tubal blockage, the dye will stop at that point. The X-rays will be available for evaluation that day.

An HSG test also detects:

• uterine anomalies

• polyps

• fibroid tumors

• uterine scar tissue

• tubal defects

• scar tissue around the fallopian tubes

One way to increase your odds of conceiving quickly is to make sure you are having sex during the most fertile part of your cycle — the days just before, during and after ovulation.

Because sperm can live in the body for up to five days, but an unfertilized egg dies after 24 hours, you increase the odds of having sperm and egg meet by having sex just prior to ovulation. But how do you know when you are ovulating?

If your periods are very regular, and come consistently anywhere from 21 to 35 days apart, you can also use our ovulation calculator to predict when you are fertile.

But by tracking the physical signs of fertility, you will get more exact results, even if your cycle varies slightly each month. You can track your fertility by charting your Basal Body Temperature (BBT), Cervical Fluid, and Cervical Position.

Basal Body Temperature
BBT is the temperature of your body before any activity—your body’s baseline temperature. Your BBT rises slightly on the day of ovulation and remains elevated until just before your next period starts. To track your BBT, take your temperature orally with a BBT thermometer (they sell for about $10 at any drug store) every morning before you get out of bed and chart the results. A BBT thermometer only registers temperatures between 96 to 100 degrees F. and can detect very slight changes in your temperature. Most women have a BBT of 96 to 98 degrees normally before ovulation and 97 to 99 after ovulation.

Cervical Fluid
Cervical fluid, sometimes called cervical mucus, is produced by the lining of a woman’s cervical canal and varies in consistency, color, and amount based on where you are in your monthly cycle.

As you get closer to your time of ovulation, your cervical mucus will change in order to better permit the transfer of sperm into your cervix.

To get a good sample of your cervical mucus at any time, place your fingers (make sure they are clean) inside your vagina. When you pull your fingers out, examine the sample you’ve obtained, noting its consistency and color.
Immediately after menstruation, you will have several “dry days,” where there is very little fluid at all.  What is there may be white or opaque and thick and sticky. As you approach mid-cycle, you will note more moistness, and the fluid will be thin, and possibly cloudy. If you hold some between your fingers, it will be slightly stretchy.
In the few days just before ovulation, which is when you are most fertile, your cervical fluid will be copious, thin and transparent. It will be very stretchy, almost the consistency of egg whites.

Just as your cervical fluid changes throughout your cycle, so does the position of your cervix in order to facilitate the transportation of the sperm and fertilization of the egg during your fertile time. Monitoring the position of your cervix is another way to track your ovulation times. Using these three methods combined will give you the most accurate results.

Begin by checking your cervical position at the end of your period, and check it daily until you reach your time of ovulation. You should do this at the same time each day, and in the same position each time. You can check your cervical position while sitting on the toilet, or it may be easier to place on foot on the toilet and keep one on the floor. Move your middle finger all the way up into your vagina until you hit your cervix, which will feel like a rounded cylinder.

At the beginning of your cycle, your cervix will be low and easier to reach. During ovulation, it will rise to a higher position, and may even be difficult to reach with your middle finger. It will drop back down to a place where it is easier to touch after you ovulate.

Author: Dawn Allcot

Going into labor prematurely is a fear many pregnant women feel, especially those who have faced premature labor before. Premature labor is defined as labor that starts between the 20th week of pregnancy, when the cervix to begins opening earlier than it should.

There are many signs of premature labor. If caught early enough most are premature labor is painless and it can normally be stopped with treatments that include bed rest, fluids and medications that calm and relax the uterus. The signs of premature labor include:

• Contractions or tightening of the uterus in a noticeable pattern
• Lower abdominal cramping that may feel like period cramping
• Increased pressure in your pelvis or vagina
• Increased discharge
• Leaking of fluid
• Vaginal bleeding
• Decreased fetal movement

If you are further than your seventh month or past your 30th week of pregnancy your baby will more than likely survive with a short stay in the NICU. If born before your 30th week of pregnancy your baby could survive, but will probably need an extensive stay and extra care in the NICU.

If you have signs of premature labor you should call your doctor or midwife immediately to describe to them what is going on. They will either instruct you to come in and be seen, or to lie down and see if the signs fade.

If you have to go to the hospital you will be prepped as if you are in labor, given a gown, and an IV will be started. You will also be hooked up to monitors and will probably have your cervix checked for dilation. If you are in labor and it isn’t too late to stop it, then you may be given medications to stop the contractions. On rare occasions you may be hospitalized for the remainder of your pregnancy, which could be days, weeks or months in duration.

If labor has progressed and cannot be stopped, you will probably be given steroids to help your baby’s lungs quickly mature giving your baby a better chance of survival outside the womb. You will then need to deliver your baby and trust the hospital, your doctor and the NICU staff to take care of both of you until you can both go home.

As the third trimester weeks crawl by, many pregnant women look for any sign that labor is impending. One of these signs is the loss of the mucus plug. Many women don’t even know what the mucus plug is, or what they should look for. They only know that the loss of it signifies that SOMETHING is happening after months of waiting.

What Is the Mucus Plug?
The mucus plug is exactly what it sounds like. It is a concentration of mucus that is deposited in the opening of the cervix to block germs and bacteria from entering the uterus.

During pregnancy, the mucus is clear and would look much like a woman’s normal vaginal discharge. However, as the cervix begins to thin out and blood is released, there will be some blood deposited onto the mucus plug. As a woman’s cervix opens she will begin to lose the plug, either in bits of stringy, blood tinted mucus over a period of time, or all at once. This can happen up to two weeks before labor actually begins.

The loss of the mucus plug should not be confused with a woman’s bloody show which occurs during labor as a woman begins bleeding prior to delivery. The bloody show will be obviously different than the mucus plug as it is mostly blood and very little or no mucus.

When Should You Call Your Doctor?
Generally there is no need to call your doctor or midwife when you begin to lose your mucus plug, assuming it is clear or just has a little blood showing. Of course, if you feel any concern or have any questions, don’t hesitate to contact them. You can also mention it to your provider at your next visit. You should definitely contact your provider if the mucus becomes extremely bloody or you continue to experience discharge. It could be a sign that labor has started, or it could also possibly be a sign of a complication like placenta previa or of a placental abruption.

In most pregnancies, at about 37 weeks, your doctor or midwife will begin checking your cervix for effacement, dilation and station. She will then report back to you the results. For first time moms this can be confusing. If you don’t know what effacement, dilation and station are, then when your provider reports that you are, “One centimeter, 25%, -2,” you may feel very confused. Below are explanations of each stage of your body’s preparation for delivering your baby.

Effacement
Prior to pregnancy and in the first and second trimester, as well as much of the third trimester, your cervix is long and thick. As labor nears it begins to shorten and thin out. This action is referred to as effacement. As your cervix begins to efface, the plug keeping the entrance to the uterus sealed is released. This is called your mucus plug and it may contain some blood.

Effacement is generally measured in percentages by doctors and midwives. When you have an exam your provider will tell you that it is anywhere from 0% to 100% which means not effaced at all to completely effaced and thin. When it is completely effaced it becomes a part of the uterine wall, allowing the baby to pass through.

Dilation
Until you are late in your third trimester, your cervix should stay tight and closed with no dilation. Dilation is the process of the mouth of the cervix opening and widening, which allows your baby to pass through. This is measured in centimeters. For most of your pregnancy it should be 0 centimeters. In order to deliver your baby your cervix needs to stretch open to 10 centimeters. As the cervix dilates, some people describe cramping and pressure, similar to what you would feel during menstruation.

If you begin dilating in the second trimester or at a rapid rate before the last month of your pregnancy it can be a sign of premature labor. If this is the case your doctor or midwife will advise you on what to do next.

Station
When your provider tells you about your baby’s station, she is referring to how far down his head has come into your pelvis. If your baby has dropped, but has not yet settled into your pelvis to begin his decent, it is measured in centimeters as a negative station. This negative measurement goes from -3 to -1. Once your baby has settled into your pelvis, but before he starts his descent to the birth canal, it is referred to as a zero (0) station. Once your baby starts heading towards the cervix, it is referred to as a positive station from 1 to 3. During this time it is likely that you will feel an increase of pressure and pain in your pelvic bone and vaginal area.

It is good for a mom-to-be to know where her baby is positioned and how her body is cooperating in the weeks leading up to delivery. Some doctors will check you but not relay any information to you unless you ask. If you want to know and are not told, or if you are not offered a cervical check, ask your provider to tell you or to check you so that you are aware

When a woman believes she might be pregnant, the quickest way to find out is via a urine test, either at the doctor’s office or by purchasing an over-the-counter pregnancy test from a drug store. Once a woman confirms she is pregnant she should make an appointment with her doctor or midwife for a pelvic exam and pap smear.

Once a woman is about six weeks pregnant, or four weeks after conception, a doctor can tell if she is pregnant by doing a pelvic exam. In the pelvic exam, the doctor will check for the size of the ovaries, fallopian tubes and uterus, and can tell by the size how far the pregnancy has developed. During the pelvic exam, the doctor will also check the cervix for a hint of blue coloring which appears when a woman is pregnant.

At one of the first appointments during the first trimester a woman will also be given the option of having a pap smear done. Pap smears are recommended once every 12 months for women, but are not generally done after the first trimester, and then not again until about six weeks after your baby is born. A pap smear is done by a doctor taking a sample of the cells around the outer edge of the cervix to test for precancerous cells. If caught early enough cervical cancer can often be avoided.

Some women who have recently had a pap smear done or have a history of miscarriages or problems during pregnancy will turn down a pap smear, which can irritate the cervix. If you are unsure about whether or not you should have a pap smear, tell your doctor about your history and ask his or her opinion on the subject.