To rule out the cause of Infertility - three factors have be ruled out
Female factor
Male  factor  


The female factor includes the problems concerning ovulation, egg transport, fertilization or implantation There are various tests that may be administered to rule out these problems they include:

Urinary luteinizing hormone (LH) test - detects the increase of luteinizing hormone that occurs before ovulation. Luteinizing hormone is secreted by the pituitary gland throughout the cycle, but increases mid-cycle to induce the release of the egg (oocyte).

Serum hormone testing - measures the levels of luteinizing hormone, follicle stimulating hormone (FSH), prolactin, progesterone and thyroid stimulating hormone (TSH). Follicle stimulating hormone is produced by the anterior pituitary gland and stimulates the ovary to develop a follice for ovulation. Progesterone hormone is produced after ovulation has occurred and prepares the uterus for pregnancy.

Luteinizing hormone and follicle stimulating hormone are checked for hypothalamic pituitary dysfunction. Prolactin (a hormone that stimulates breast milk production) levels are done to see if an excessive amount has caused hyperprolactinemia, a condition that interferes with ovulation. Progesterone levels are performed to determine if inadequate levels are interfering with the development of the endometrium, the lining of the uterus that prepares embryo implantation. TSH is checked as a measure for normal thyroid function.

Cervical mucus testing - performed at the time of ovulation to see if the quality and consistency of the cervical mucus is adequate for normal sperm function and survival. Cervical mucus permits passage of sperm to the uterus and fallopian tubes and changes in volume and quality at ovulation.

Postcoital testing - assesses the quality and quantity of cervical mucus and the number and motility of the sperm in the mucus at the time of ovulation and after sexual intercourse has occurred.

Hysterosalpingogram (HSG) - an x-ray of the uterine cavity and fallopian tubes using a radiographic dye to detect structural abnormalities of the uterine cavity fallopian tubes, as well as tubal patency.

Diagnostic laparoscopy - a minimally invasive surgical procedure typically performed in an outpatient day surgery setting. It permits direct visual assessment of the uterus, fallopian tubes, ovaries, and lower pelvis. It is particularly useful in diagnosing endometriosis, tubal disorders or pelvic adhesions and generally is performed at the end of a work-up, but may be performed earlier if deemed appropriate by the patient's history and referral diagnosis.

Hysteroscopy - often done in conjunction with a laparoscopy to examine visually the interior of the uterine cavity for scar tissue, adhesions, polyps, tumors, and other abnormalities and to eliminate endometriosis.

Ultrasound - performed seven to nine days after ovulation to reveal the thickness of the uterine lining (the endometrium) and its response to hormonal stimulation.

Endometrial biopsy - used to determine if the endometrium, the lining of the uterus, has responded appropriately for implantation of the embryo. This is obtained as a tiny tissue sample from the endometrium.

 

Male Factor :

Though the cause of male infertility is often unidentified, there are a few problems that have been indicated as potential causes.
Problems related to sperm production, the anatomy or structure of the man's reproductive organs and the man's immune system can all be factors in male infertility.

Genetic defects, infection, testicular trauma, hormonal imbalance or exposure to radiation and certain medications are all causes of sperm production disorders. Infertility can occur when there is a low sperm count, or problems with the motility (movement) or morphology (appearance or shape) of the sperm. Sperm that have poor motility often are not able to reach the egg and, therefore, fertilization does not occur. Abnormal sperm are sometimes unable to penetrate and fertilize the egg. Sperm DNA damage may interfere with conception as well as lead to a greater risk of miscarriage. 

Any structural or anatomical problems that block the path that sperm must travel to eventually reach the egg for fertilization can cause male infertility. Infertility related to structural and anatomical problems in the male anatomy may be caused by scar tissue, varicose veins or infection or, in some cases, the problems exist from birth.

In some cases, men have immune system disorders which cause their bodies to develop antibodies to their own sperm, which attack and weaken the sperm. The antibodies can also attach to the sperm surface and interfere with their movement or ability to fertilize the egg.

Diagnosis:-
When male factor infertility is suspected, the initial test performed is a semen analysis. A semen analysis allows the doctor to examine the count, motility and morphology of the sperm.

In order for a physician to evaluate the count, motility and morphology of sperm, a semen sample must be provided. The sample is most often collected by masturbation in a private, comfortable room in the fertility center. In some cases, the sample may be collected at home by masturbation or during intercourse with the use of a special condom provided by the physician. In some cases, the test results are not normal due to problems during sample collection and the test must be repeated.

Depending on the results of the semen analysis, more tests can be ordered to diagnose specific causes of infertility. If the semen analysis shows clumping or signs of infection, a semen culture, prostate fluid culture and urinalysis may be ordered. An antisperm antibody test may also be ordered to evaluate potential immune system disorders. A fructose test can be used to evaluate structural problem or a blockage of the seminal vesicles, or SCSA be done test to measure the level of DNA fragmentation in the sperm.