An initial evaluation can be performed by a primary care physician. The doctor will check for obvious hormonal or reproductive tract disorders that could explain infertility, such as an excess or deficiency of thyroid hormone, an excess of prolactin (a hormone involved in regulating menses), or an excess of androgens (hormones that stimulate male sexual characteristics). The physician will look for excessive facial or body hair and other symptoms of hyperandrogenism, such as obesity, acne and menstrual irregularities. A pelvic exam will check for signs of endometriosis, uterine fibroids, inflammation of the mucus membrane or other cervical abnormalities, cysts or other growths, and congenital abnormalities.

After an initial evaluation, the couple will be referred to a reproductive endocrinologist,­ an infertility specialist. Both partners will be evaluated by a specialized medical team that includes the physician, scientists, nurses, technicians and other staff members.

Specialists use a variety of tests to diagnose the cause of infertility.

Since hormonal imbalances can lead to inadequate sperm production or function and problems in ovulation, both male and female hormones are tested in the UC Davis hormone reference laboratory. The laboratory meets the highest standards for quality assurance and is registered through the State of California Department of Health and Human Services (CLIA ID# 05D0644121).

UC Davis investigators are among the world's experts in semen analysis.

Semen analysis is one of the first tests performed because any problem would preclude additional and more invasive tests on the woman. A low sperm count, unusual shape and structure, and slow movement can inhibit fertilization.

The UC Davis Andrology Laboratory meets the highest quality assurance standards, and it is registered through the State of California Department of Health and Human Services (CLIA ID# 05D0692854). Most of the tests offered in the laboratory are not routinely available outside the university.

Tests include:

Computer Aided Sperm Analysis (CASA)
Highly specialized methods of computerized analysis of sperm motion and shape were largely pioneered at UC Davis. CASA has dramatically improved the accuracy and precision of sperm analysis.

Antisperm Antibody Testing
Antibodies are normally made by the body's immune system to destroy or neutralize foreign organisms such as bacteria and viruses. Some types of infertility may be caused by antibodies against sperm. The immunobead test at UC Davis can detect three different types of antisperm antibodies in a variety of biological samples, including blood, cervical mucus and on sperm cells. Most commercial laboratories can only measure these antibodies in blood.

The Postcoital Test
For pregnancy to occur, sperm must swim from the vagina through the cervix (mouth of the womb), and up through the uterus and into the fallopian tubes to meet the eggs. The postcoital test analyzes the amount and quality of cervical fluid (called mucus) and tests the ability of sperm to swim into cervical mucus after coitus (intercourse). Fertile cervical mucus is made just before ovulation. Since only a few days of each menstrual cycle are suitable for performing this test, our offices are open seven days a week to ensure optimal timing.

Cervical Mucus Penetration Test
A poor postcoital test can be caused by abnormalities of cervical mucus, sperm cells, or both. The cervical mucus penetration test pairs samples of cervical mucus and sperm from patients and compares both with control samples on a microscope slide. The cervical mucus penetration test can determine whether there is a mucus abnormality, a sperm abnormality, or both.

Irregular or abnormal ovulation accounts for approximately 25 percent of all cases of infertility. Physicians use a variety of tests to evaluate ovulation:

Basal Body Temperature
A simple, inexpensive way to see if a woman ovulates is by charting the body's temperature for a month. This daily chart of a woman's morning temperatures, called basal body temperature, reveals a 0.5 to 1.0 degree Fahrenheit rise when the hormone progesterone is released after ovulation. If ovulation doesn't occur, body temperature remains relatively unchanged.

Progesterone Hormone
Progesterone is an ovarian hormone that thickens the uterine lining (endometrium) to prepare for implantation. It can be measured in a carefully timed blood sample. The basal body temperature pattern helps plan the progesterone test.

Endometrial Biopsy
The endometrium forms the protective environment where the embryo "nests." When the embryo attaches to the endometrium, the process is termed implantation. Since an abnormal uterine lining may prevent implantation, a sample of the endometrium is collected for microscopic analysis during an office procedure known as an endometrial biopsy.

The hysterosalpingogram (HSG) is a test that can reveal if the fallopian tubes are open. During this special X-ray procedure, the specialist uses a catheter to pass a radio-opaque contrast agent through the cervix. As the contrast fluid flows up into the uterus and fallopian tubes, any obstruction or other abnormality becomes apparent.

A blockage in the fallopian tubes is a common cause of infertility. Benign tumors (fibroids, polyps) or uterine scarring can distort the uterine cavity and interfere with reproduction.

Laparoscopy is an outpatient surgical procedure that enables the physician to see the female pelvic organs. A small telescope is inserted through a one-half inch incision below the navel while the patient rests under general anesthesia. Laparoscopy can diagnose and treat problems such as endometriosis or scar tissue, which might not be detected with X-rays or blood tests.

Hysteroscopy is an outpatient procedure that enables the physician to look directly into the uterus. A small telescope is inserted through the cervical opening, avoiding surgical incision. Abnormalities of the inside of the uterus (fibroids, polyps, scar tissue) can be confirmed and treated by hysteroscopy.