Fertility testing for women may include blood work, hormone testing, ultrasounds and genetic testing
Several baseline tests to gauge your fertility will likely be conducted after your first consultation appointment at Fertility Answers. The tests are varied and may be conducted in several different ways, such as a blood test, ultrasound, x-ray, or even surgically. Some of these tests are also cycle-dependent, meaning they need to be conducted on specific days of your menstrual cycle.
Medical histories for both partners will be taken at your first consultation appointment. Try to keep track of the length of your menstrual cycles for several months beforehand. Charting your basal body temperatures (BBTs) during your cycle for several months will also give your doctor some insights, as will using home ovulation predictor kits and recording the results. For more information on the female hormonal cycle, please see Hormone Cycle.
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, we may conduct one or more of these infertility tests for the female patient:
Anti-Mullerian Testing, AMH
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.
Antral Follicle Count
Counting the number of antral follicles, or those small, unstimulated eggs, can give an indication of how many eggs a woman still has. This test is performed via transvaginal ultrasound on day three of a woman’s menstrual cycle.
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.
Follicle-Stimulating Hormone, FSH
As a woman ages and menopause approaches, ovarian function decreases and eventually ceases. As this occurs, FSH and LH levels rise. This is because as ovarian function decreases, the pituitary has to produce more FSH in an attempt to stimulate the ovaries to produce follicles. Follicle-stimulating hormone levels are generally checked on day 2, 3 or 4 of the patient’s menstrual cycle.
Genetic Testing of Parents
Couples who feel they may be carriers for a genetic disease can opt for pre-pregnancy genetic screening test.
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. These may include FSH (follicle stimulating hormone) and LH (luteinizing hormone), estradiol, prolactin, anti-Mullerian hormone and thyroid-stimulating hormone. All of these tests provide us with important information about your hormone levels and how they may be affecting your ability to conceive.
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.
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.
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 ovarian reserve, 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 be extremely low unless you use egg donation and in vitro fertilization (IVF).
The ultrasound is used during testing to determine several things. Our team will be looking for any structural or anatomical issues with your uterus that may be the cause of you not being able to conceive or carry a pregnancy to term. They may also use an ultrasound to conduct an antral follicle count to give us a better idea of the number of antral follicles – small, unstimulated eggs – as an estimate of the amount of eggs you still have in your ovaries. These ultrasounds are typically conducted transvaginally to obtain a better representation of your uterus and ovaries. During a transvaginal ultrasound a slim wand is inserted into the vagina.