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• Laparoscopy In laparoscopy, a doctor inserts a viewing instrument (laparoscope) into your abdomen to evaluate the condition of the ovaries, fallopian tubes, and uterus. With laparoscopy, a doctor can detect conditions such as endometriosis (see page 870), adhesions (scar tissue), and abnormalities of the ovaries.

• Endometrial biopsy Doctors do an endometrial biopsy (see page 849) to determine if the lining of the uterus is thickening enough in preparation for pregnancy. If the lining is too thin, you may not be producing enough of the hormone progesterone, which is needed to maintain a pregnancy. The doctor will take a small sample of tissue from the lining of your uterus shortly before your next period and send it to a laboratory for analysis.

Infertility Testing in Men

At your first appointment, the infertility specialist will ask you about your health history to find out if any past medical problems—hernia repair, groin injuries, STDs, or inflammation of the prostate—could be affecting your fertility. He or she will ask about your current health and lifestyle to determine if excessive smoking, drinking, or other drug use could be affecting your sperm. The doctor will then perform a thorough physical examination, including an examination of the hair growth in your genital area to determine if you are producing a sufficient amount of testosterone, and an examination of your penis, scrotum, and prostate (to look for abnormalities).

The semen analysis is the most important test for male fertility. The doctor will ask for at least one semen sample, obtained by masturbation. Before producing a sample, you will have to wait at least 48 hours (but not more than 5 days) after your last ejaculation. Among the factors the doctor will consider when evaluating your semen sample are the appearance and consistency of the semen, the total sperm count, the shape and structure of the sperm, and the motility (movement) and speed of the sperm. If any of these factors fall outside the normal range, the doctor will probably order a second sperm analysis for confirmation and a hormone evaluation to screen for more specific abnormalities.

In a small number of couples with otherwise unexplained infertility, doctors sometimes order specialized tests, such as a sperm penetration assay, which measures the sperm’s ability to penetrate an egg by pairing the sperm with the egg from a hamster using in vitro fertilization (see page 500). Infertile men who have very low or absent sperm counts may undergo genetic testing to determine if they have a chromosome abnormality (see page 955). The results of the initial tests determine what other tests you will need.

If the results of your semen analysis are abnormal, the infertility specialist will probably refer you to a urologist (a doctor who specializes in treating disorders of the male urinary and reproductive system) who is trained in male infertility for a more extensive evaluation.

How to Choose an Infertility Treatment Center

Selecting an infertility treatment center can be confusing because different centers provide different services and produce varying success rates. When you are searching for infertility treatment, ask whether the centers you have selected offer the following basic services:

• Seven-day availability The center’s staff and services should be available every day of the week, on weekends, and on holidays so you can call with information about your menstrual cycle and find out your test results quickly.

• Psychological support The center should have mental health professionals available to provide support during this difficult time.

• On-site laboratory The clinic should be able to perform semen analysis, postcoital tests, and blood and hormone tests on site to save critical time. The laboratory should be fully certified.

• Ultrasound equipment Transvaginal ultrasound monitoring, in which an ultrasound scan of your ovaries is performed through the vagina, helps to determine if the prescribed medication