What tests should I do if I am not pregnant?

Modern young people are under great pressure from work and life, and their daily routines are irregular, which leads to more and more cases of infertility after many years of marriage. There are many reasons for female infertility. In addition to some external factors, one's own physical health is also very important. If you are unable to become pregnant normally within three years after marriage, you need to do some detailed examinations to find out the cause of infertility and provide symptomatic treatment. Let’s take a look at the tests that need to be done regarding infertility.

What tests should I do if I am not pregnant?

1. Physical examination

When a woman undergoes a pregnancy test for the first time, the doctor will first understand her basic condition. In addition to her health status, medical history and family history, the doctor will also ask about the time of her menarche, menstrual cycle, date of her last menstrual period, whether her menstruation is abnormal, whether she has had any miscarriage experience, her history of treatment for pregnancy problems, and whether her current sexual life is regular.

The second step is to further understand the woman's physical condition through visual inspection and general physical examination, such as body shape, obesity level, breast and reproductive organ development, and whether there is current inflammation and trauma.

Finally, the doctor also needs to perform a colposcopy and internal examination to understand the general condition of the female vagina, cervix, uterus, ovaries and pelvic cavity, such as whether the size and position of the uterus are normal, whether there are lumps or tenderness in the uterus, fallopian tubes, and ovaries, whether there is pain when the uterus is lifted, and the mobility of the appendages.

2. Check for patency of fallopian tubes

The patency of the fallopian tube is an essential condition for conception. The lumen of the fallopian tube is relatively narrow. When salpingitis or pelvic inflammatory disease occurs, the narrowest part and fimbria of the fallopian tube are prone to adhesion or complete atresia, so that the sperm and egg cannot meet in the lumen, resulting in inability to get pregnant.

Therefore, fallopian tube examination is one of the key routine examinations for infertility. It can help doctors understand whether the development of female fallopian tubes is normal, whether there are any deformities or blockages, and can also provide certain treatments for those with poorly patent fallopian tubes. The examination methods include X-ray hysterosalpingography and fluid permeability test, which are usually required for women to undergo within 3 to 7 days after the end of menstruation.

Among them, the perfusion test is mainly judged based on pressure and the patient's feeling, and its accuracy rate is low. X-ray angiography can accurately determine whether the fallopian tubes are unobstructed and the location of obstruction, and can also check whether there are polyps, adhesions and myomas in the uterine cavity. Since salpingography and hydrosalpingography are both invasive procedures, women often need to take anti-inflammatory drugs to prevent infection after the examination, and refrain from sexual intercourse and bathing in a tub within half a month after the operation.

3. Ovulation function test

Next, women need to undergo a series of pregnancy tests in conjunction with their menstrual period. The first step is to determine whether ovulation has occurred and predict the ovulation period by measuring basal body temperature and checking cervical mucus or ultrasound.

Basal body temperature usually rises with ovulation, fluctuating between 36.6℃ and 37℃ and lasting for about two weeks. Women need to measure their basal body temperature 1 to 2 times a cycle and draw a basal body temperature curve. The doctor will judge the woman's ovulation status based on the trend of the curve.

Cervical mucus undergoes periodic changes under the influence of estrogen. Combined with basal body temperature, it can determine whether a woman's ovulation is normal and infer the ovulation period.

Determining whether ovulation has occurred through basal body temperature measurement and cervical mucus examination will be affected by some objective factors, while ultrasound examination of follicular development has unique advantages. It can directly observe the development of follicles and whether ovulation has occurred, and is currently the most widely used detection method.

4. Endocrine function test

Estrogen and progesterone are mainly synthesized and secreted by the ovaries, and change with the ovarian cycle, playing a dominant role in the development of female reproductive organs, ovulation and pregnancy. Blood tests at different times of the menstrual cycle can detect the concentration of hormones in the blood, including progesterone, estrogen, follicle-stimulating hormone, prolactin, etc. Doctors can use the test results to determine whether a woman is ovulating and whether her ovaries are functioning well.

5. Ultrasound examination

Ultrasound can help doctors further understand the condition of a woman's reproductive system, such as checking the shape, position and size of the uterus, measuring the length, width and thickness of the uterus, observing the degree of development of the uterus, and determining whether there are uterine malformations such as a bicornuate uterus, a unicornuate uterus, or a rudimentary horn uterus. It can also identify various causes of inability to get pregnant, such as uterine fibroids, ovarian tumors, polycystic ovaries, fallopian tube lesions, etc., and through continuous testing, it can well observe the development of follicles.

6. Uterine and abdominal examination

If abnormalities are found after internal examination or ultrasound examination, further hysteroscopy or laparoscopy may be required in some cases, but not every woman who cannot conceive will take this step.

Hysteroscopy can check whether there are abnormalities or lesions in the uterine cavity, such as uterine cavity malformation, submucosal uterine fibroids, and endometrial polyps, adhesions and other conditions that are easily missed by ultrasound, all of which can affect fertilization or implantation. Laparoscopy can diagnose and treat pelvic adhesions, endometriosis, and structural abnormalities, adhesions, or lesions of the uterus, ovaries, and fallopian tubes.

Hysteroscopy and laparoscopy can be performed by making only a few small holes in the patient's abdomen, replacing most laparotomies and avoiding blind laparotomies. The operation is performed in a closed pelvic and abdominal cavity, with far less trauma than abdominal surgery and less postoperative pain. The patient can get out of bed and move around after the anesthetic wears off, and can be discharged from the hospital after 2 to 3 days.

7. Immunological examination

Some couples do not find any major problems after each other's examinations. It may be that the female body has an immune response and produces anti-sperm antibodies, making the vaginal environment unsuitable for sperm activity and survival, thus affecting conception. The presence of anti-sperm antibodies can be checked by a sex test, which is a test used to detect the interaction between sperm and cervical mucus and needs to be performed during the woman's ovulation period.

Women need to take a sample of cervical mucus for examination within a few hours after sexual intercourse. Under normal circumstances, the number of active sperm in cervical mucus per high-power field of view under a microscope should be greater than 10. If the semen and cervical mucus are not compatible, the results will show that the sperm died in the vagina or were very weak, which means that the sperm was unable to penetrate the cervical mucus and swim from the vagina to the uterus.