Infertility laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Sanjana Nethagani, M.B.B.S.[3]


Many laboratory tests such as hormone levels, checking basal body temperature and imaging are employed in the diagnosis of infertility.

Laboratory findings

Basal body temperature

  • Basal body temperature is measured just on waking up in the morning. Usually there is a biphasic pattern in temperature in ovulatory cycles. There is no rise in temperature in anovuluatory cycles. [1][2]
  • This is measured as a 0.2-0.5 degrees Celsius rise in temperature after ovulation which is sustained till the beginning of the next cycle.
  • There is a drop pf 0.2 degrees Celsius right before the rise in temperature. This coincides with the Luteinizing hormone surge.
  • Basal body temperature recording is a tedious process and involves recording of temperature at the same time everyday.
  • Temperature changes can also be attributed to other causes such as fever, cold or hot temperatures and usage of air conditioners.

Hormone estimation

  1. Serum progesterone is measured on day 8 and 21 in the cycle.
    • Increase in serum level from >1 ng/ml-6 ng/ml suggests ovulation
    • In anovulatory cycles and irregular menstrual cycles, this increase might not be appreciated.
  2. Serum Luteinizing hormone is measured daily to look for a mid-cycle surge.[3]
    • Ovulation occurs around 36 hours after LH surge.
  3. Serum estradiol is measured around the same time as the LH surge
    • Estradiol peaks around 24 hours before the LH attains its peak
    • Therefore an increase in estradiol right before the LH surge indicates the presence of an ovulatory cycle.


  • Hysterosalpingography is done to detect the continuity between cervical canal and fallopian tubes. [4]
  • This test can detect the side on which obstruction is present, if any.
  • It can also detect congenital abnormalities, synechiae and presence of fibroids etc.

Pelvic ultrasound

  • Pelvic ultrasound can predict ovulation with higher accuracy than basal body temperature.
  • It can also detect the cyclical changes in uterine endometrium. These changes are absent in anovulatory cycles.
  • The position of uterus, presence of fibroids, cystic changes in ovaries, congenital anomalies in the genital tract can be detected via pelvic ultrasound.


  • Laparoscopy is the best method to detect any abnormalities in the fallopian tubes.[5]
  • Tubal potency, motility, adhesions, etc can be visualised directly.
  • Changes in the ovary such as cysts, endometriosis are also seen.
  • If any adhesions or synechiae are present, adhesiolysis can be attempted during the diagnostic procedure itself.



  1. Royston JP, Abrams RM (1980). "An objective method for detecting the shift in basal body temperature in women". Biometrics. 36 (2): 217–24. PMID 7407311.
  2. Dishuck CF, Perchik JD, Porter KK, Gunn DD (2019). "Advanced Imaging in Female Infertility". Curr Urol Rep. 20 (11): 77. doi:10.1007/s11934-019-0942-0. PMID 31734736.
  3. Mihm M, Gangooly S, Muttukrishna S (2011). "The normal menstrual cycle in women". Anim Reprod Sci. 124 (3–4): 229–36. doi:10.1016/j.anireprosci.2010.08.030. PMID 20869180.
  4. Baramki TA (2005). "Hysterosalpingography". Fertil Steril. 83 (6): 1595–606. doi:10.1016/j.fertnstert.2004.12.050. PMID 15950625.
  5. Hassa H, Aydin Y (2014). "The role of laparoscopy in the management of infertility". J Obstet Gynaecol. 34 (1): 1–7. doi:10.3109/01443615.2013.817981. PMID 24359039.

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