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Infertility Testing for the Female Patient

Your First Appointment

Try to schedule your first appointment during the first week of your cycle. This will enable us to take baseline levels of FSH (follicle stimulating hormone) and LH (lutenizing hormone). We also offer routine screening of both partners---AIDS, hepatitis, etc. Medical histories for both partners will be taken. Try to keep track of the length of your menstrual cycles for several months beforehand. Charting Basal Body Temps (BBTs) for several months will also give your doctor some insights---as will using home ovulation predictor kits and recording the results.

Hormone Tests

Hormones are frequently evaluated to help determine the cause of your infertility. They help in diagnosing polycystic ovary syndrome (PCOS), decreased ovarian reserve, inadequate production of hormones, thyroid abnormalities, diabetes or insulin resistance.

Specific hormones that are tested include:

FSH (Follicle Stimulating Hormone)
Clomid Challenge Test (FSH on day 3 and 10, clomid on days 5 - 9)
LH (Luteinizing Hormone)
Estrogen (Estradiol or E2)
Progesterone
Androgens
Prolactin
TSH (Thyroid Stimulating Hormone)
Insulin
Glucose

Some of the conditions that are evaluated with these hormone tests:

Polycystic ovary syndrome (PCOS) (LH to FSH ratio of greater than 2)
Decreased ovarian reserve: FSH > 12 mIU/ml
Premature menopause: FSH > 40 mIU/ ml
Hyperprolactin disorders: Prolactin > 25
Hypothyroid: TSH > 3.0
Hyperthyroid: TSH < 0.5 and High free thyroid hormone
Insulin resistance: Glucose to Insulin ratio of less than 4.5

The normal hormone levels for each of these during specific parts of your cycle are as follows:

	Follicular Phase (Day 2 or 3)	Day of LH Surge	Mid Luteal Phase (7 days after ovulation)
Lutenizing Hormone (LH)	<7 mIU/ml	>15 mIU/ml	NA
Follicle Stimulating Hormone (FSH)	<13 mIU/ml	>15 mIU/ml	NA
Estradiol (E-2 Levels)	NA	>100 pg/ml	>60 pg/ml
Progesterone	NA	<1.5 ng/ml	>15 ng/ml

<= less than;>= greater than; mIU=milli International Units; ml=milliliter; pg=picograms; ng=nanograms; uIU=micro International Units; dl=deciliter; ug=micrograms
NOTE: These levels are those used at Fertility and Women's Health Center of La.

Other tests ordered may include:

Prolactin: <25 ng/ml
Thyroid Function tests:
Thyroid Stimulating Hormone (TSH): 0.4 to 3.0 uIU/ml
Free T3: 1.4 to 4.4 pg/ml
Free Thyroxine (T4): 0.8 to 2.0 ng/dl
Androgens:
Total Testosterone: 6.0 to 80 ng/dl
Free Testosterone: 0.7 to 3.6 pg/ml
DHEAS: 35 TO 400 mcg/dl
Androstenedione: 0.7 to 3.1 ng/ml

Hysterosalpinogram (HSG)

A Hysterosalpinogram (HSG) test is used to examine a woman's uterus and fallopian tubes. It is essentially an x-ray procedure in which a radio-opaque dye is injected through the cervix into the uterus and fallopian tubes. This "dye" appears white on the x-ray, and allows the radiologist and your doctor to see if there are any abnormalities, such as an unusually shaped uterus, tumors, scar tissue or blockages in the fallopian tubes. If you are trying to get pregnant in the same cycle as an HSG, make sure to schedule the test PRIOR to ovulation so that there is no danger of "flushing out" a released egg or developing embryo.

Although most women report only minor cramping and short-term discomfort during this procedure, some women, especially those who DO have blockages, report intense pain. It is generally accepted to take 3 - 4 ibuprofen tablets 30 minutes prior to the procedure if your doctor approves.

Hysteroscopy

If a uterine abnormality is suspected after the HSG, your doctor may opt for this procedure, performed with a thin telescope mounted with a fiber optic light, called a hysteroscope. The hysteroscope is inserted through the cervix into the uterus and enables the doctor to see any uterine abnormalities or growths. "Photos" are taken for future reference. This procedure is usually performed in the early half of a woman's cycle so that the build-up of the endometrium does not obscure the doctor's view. However, if the doctor is planning to do an endometrial biopsy at the same time, it is done near the end of the cycle.

Laparoscopy

A narrow fiber optic telescope is inserted through a woman's abdomen to look at the uterus, fallopian tubes, and ovaries and to discern endometriosis or pelvic adhesions, and is the best diagnostic tool for evaluating the ovaries.

Cervical Mucus Tests

Mucus tests include a post-coital test (PCT) to see that sperm can penetrate and survive in the cervical mucus, and a bacterial screening. It is important to note that the appropriate time to do PCTs is just before ovulation when mucus is the most "fertile." PCTs at other times may give false results.

Endometrial Biopsy

This procedure involves scraping a small amount of tissue from the endometrium shortly before menstruation is due--- between 11 and 13 days from LH surge. It should ONLY be performed after an HCG blood test shows the woman is not pregnant. This test is used to determine if a woman has a luteal phase defect, a hormonal imbalance which prevents a woman from sustaining a pregnancy because not enough progesterone is produced. This test is not performed regularly because it is not very reliable to determine if there is indeed a luteal phase defect. Most of the time, the medication used to correct ovulation abnormalities will correct the luteal phase defects.

Decreased Ovarian Reserve Testing

As a woman ages, her fertility decreases. This decrease usually occurs slowly up until about 35 years of age, when fertility falls even faster. This drop in fertility is seen even in women who have perfectly normal, regular menstrual cycles. In fact for some women, fertility may no longer be possible five to 10 years before menopause. Diminished fertility, also called diminished ovarian reserve, is thought to reflect both a decreased number of eggs and a decrease in egg quality. There are several tests for decreased ovarian reserve (DOR), but one of the most common test is the clomiphene challenge test (CCT). This involves measuring your levels of the hormones FSH and estradiol on the third day of your cycle. Then, from day 5 through day 9, you take 100mg clomiphene (two tablets) each day. A day or two later, FSH level is measured again. If the FSH value is high, that indicates your fertility potential is diminished due to age. Values of FSH above 10 indicate that you may have difficulty conceiving or carrying a pregnancy. Values over 14-15 indicate that your chance of success would probably extremely low unless you use egg donation and in vitro fertilization (IVF).

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