Fertility testing for women may include blood work, hormone testing, ultrasounds and genetic testing
Several baseline tests to gauge your fertility include FSH (follicle stimulating hormone) and LH (luteinizing 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. Read through our Appointments page to get more information of what to expect at your first visit to our office.
After learning more about your medical history, your doctor may conduct one or more of these infertility tests for the female patient:
Hormone evaluation tests are frequently performed to help determine the cause of your infertility. They help in determining ovulation, diagnosing polycystic ovary syndrome (PCOS), decreased ovarian reserve, inadequate production of hormones, thyroid abnormalities, diabetes or insulin resistance. For more information on the female hormonal cycle, please see Hormone Evaluation in Women.
Hysterosalpingogram or HSG
A Hysterosalpingogram 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.
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).
AMH testing is a simple blood test that can give your physicians an indication of your remaining egg supply. AMH is produced in the very immature egg follicles found in a woman’s ovaries. The levels of AMH in the blood indicate the approximate number of follicles in a woman’s ovaries. AMH testing is a unique form of ovarian reserve testing because it can be performed at any time during your menstrual cycle. This is because AMH levels do not fluctuate throughout the month.
If a uterine abnormality is suspected after the HSG, your doctor may opt to do a hysteroscopy. This procedure is 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.
One of the best diagnostic tools for evaluating a woman’s ovaries is a laparoscopy. With this procedure 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.
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.
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.
Couples who feel they may be carriers for a genetic disease can opt for pre-pregnancy genetic screening test.