Diagnostic Procedures in Infertility
During a fertility evaluation, a vaginal ultrasound exam is part of an initial consultation with our clinic. Our doctor will use the results of the ultrasound to assess the overall condition of your uterus and ovaries, the thickness of the lining of your uterus (the endometrium), and follicle development on the ovaries. An early ultrasound has proven invaluable not only for ovarian reserve testing but also for evaluation of other abnormalities of the ovary (ovarian cysts or masses), uterus (polyps, fibroids) or other structures found in the uterus. Early identification and treatment of any abnormalities may often facilitate pregnancy.
Although the semen analysis is obtained from the male partner, it is an essential part of the infertility evaluation. Semen is generally obtained by masturbating and ejaculating your semen into a clean container. Our laboratory analyzes the semen specimen for the health of sperm and the semen fluid. A semen analysis provides information about the number, movement, and shape of the sperm. A semen analysis is necessary even if the male partner has fathered a child before.
Hormone Levels & Fertility Blood Work
Depending on the each couple’s situation, various blood tests on either the female or the male may be needed. Common blood tests that might be needed include:
- Follicle-stimulating hormomes (FSH) test measures the level of FSH in blood. FSH is a hormone released by the pituitary gland, located on the brain. FSH is one of the most important hormones involved in the natural menstrual cycle as well as in drug-induced stimulation of the ovaries. It is the main hormone involved in producing mature eggs in the ovaries. FSH is the same hormone that is contained in the injectable gonadotropins which are used to produce multiple eggs for infertility treatment. In women, a FSH test is done on the third day of the menstrual cycle and is used to evaluate egg supply FSH helps manage a women’s cycle and stimulates the ovaries to produce eggs. The test is used to help diagnose or evaluate: menopause, women who have polycystic ovary syndrome, ovarian cysts abnormal vaginal or menstrual bleeding and problems becoming pregnant, or infertility. In men, the test is used to determine sperm count. FSH stimulates production of sperm. The test is used to help diagnose or evaluate men who do not have testicles or whose testicles are under-developed and infertility.
- Lutenizing hormone (LH) is a hormone that is vital for reproduction. It is produced by your pituitary gland. LH helps regulate your menstrual cycle and ovulation. A rise in LH, called the LH surge, triggers ovulation. It gives information about your ovarian reserve. If you are not ovulating, your LH levels can help determine if it is a primary failure (failure of the ovaries themselves) or secondary failure (failure of the ovaries related to problems with the pituitary gland or hypothalamus). It can also be used to monitor your response to ovarian stimulation. In women, luteinizing hormone (LH) is linked to ovarian hormone production and egg maturation. In men, it stimulates the hormone testosterone which affects sperm production.
- Estradiol (E2) is an important form of estrogen, the major sex hormone in women. It is secreted by the ovarian follicles. A blood test to check estradiol levels is one of the most common fertility tests. One reason to have your estradiol levels checked is to determine your ovaries’ ability to produce eggs which is known as ovarian reserve. As the follicles grow and develop each month, they produce estradiol. This sets the rest of the reproductive cycle in motion. An estradiol test is used to measure a woman’s ovarian function and to evaluate the quality of the eggs. It is done on the third day of a woman’s menstrual cycle.
- Serum Progesteron test is used to determine if ovulation is occurring. Since progesterone levels increase towards the end of a woman’s cycle, the test is done during the luteal phase of the menstrual cycle which is just before her period starts. Progesterone is a female hormone produced by the ovaries during ovulation. It causes the endometrial lining of the uterus to get thicker, making it receptive for a fertilized egg. Both men and women produce progesterone. However, it is produced mainly in the ovaries, which means that women have more than men. In women, this hormone helps prepare the uterus for a fertilized egg. Once a woman is pregnant, progesterone helps her remain pregnant. Progesterone inhibits milk production during pregnancy and the drop in progesterone at the time of labor helps to trigger milk production. In men, progesterone’s role is sperm creation among other roles.
- Prolactin (also called PRL or lactogenic hormone) the hormone prolactin is made by the pituitary gland and causes milk production. Prolactin plays an important role in the reproductive health of both women and men. In women, a prolactin test is done to find out why they are not menstruating, or why they are having infertility problems or abnormal nipple discharge. In men, the test is done when there is a lack of sexual desire, difficulty getting an erection, or if there might be a problem with the pituitary gland.
- Androgens are typically thought of as male hormones, but they also play an important role in women. Testosterone is probably the most well-known androgen and it affects the sexual functioning of both men and women. Testosterone is a hormone that is produced primarily in a man’s testicles. When the testosterone level is low it may cause symptoms such as lower sex drive, a lack of energy or increased fatigue, reduced muscle strength or endurance, less strong erections, and a lower sense of well-being or happiness. It is normal for testosterone levels to gradually decrease as you get older. However, if you have a low T and have the symptoms associated with low T you may want to consider your options for treatment. But before you start treatment it is important to have a discussion about your future fertility plans because taking testosterone supplements will dramatically reduce the amount of sperm your testes produce. Both male and female libido is in large part driven by testosterone. In women, women produce androgens in their ovaries and adrenal cortex. Almost all of the androgens a woman makes are immediately converted into estrogen. Estrogen promotes the development of female secondary sex characteristics. It is also involved in thickening the endometrium and regulating the menstrual cycle. It is used to determine the cause of irregular periods or a low sex drive. In men, androgens support sperm production and the development of male secondary sex characteristic and an androgen test is used to find the cause of a low sex drive, the inability to get an erection, or infertility.
- Thyroid stimulating hormone (TSH), also known as thyrotropin, thyrotropic hormone, or hTSH for human TSH, is a pituitary hormone that stimulates the thyroid gland to produce thyroxine. TSH also plays a significant role in reproduction and pregnancy health: there may be a higher risk of miscarriage and other pregnancy problems when levels of the hormone are off-the-scale. Women planning IVF treatment should be tested for TSH and as should women struggling to conceive naturally.
- Anti-Mullerian Hormone (AMH) is produced by the ovaries. This test is egg (ovarian) reserve test. Since women are born with their lifetime supply of eggs, and these gradually decrease in both quality and quantity with age. The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve. The blood sample can be taken at any time of the month since it does not change during the menstrual cycle. To interpret your AMH level, you should compare your own level with other women of the same age. Studies indicate that women with high AMH level were about 2.5 times more likely to have a successful IVF cycle than women of a similar age with low levels of AMH.
- Testosterone Testosterone is a hormone that is produced primarily in a man’s testicles. When the testosterone level is low it may cause symptoms such as lower sex drive, a lack of energy or increased fatigue, reduced muscle strength or endurance, less strong erections, and a lower sense of well-being or happiness. It is normal for testosterone levels to gradually decrease as you get older. However, if you have a low T and have the symptoms associated with low T you may want to consider your options for treatment. But before you start treatment it is important to have a discussion about your future fertility plans because taking testosterone supplements will dramatically reduce the amount of sperm your testes produce. Both male and female libido is in large part driven by testosterone. In man, hypotestosteronism causes impotence and a lack of sex drive. In female, the production and the local release of testosterone by the ovaries also profoundly influences female libido.
is an X-ray procedure to see if the fallopian tubes are open and to if the shape of the uterine cavity is normal. A catheter is inserted into the opening of the cervix through the vagina. Liquid containing iodine (contrast) is injected through the catheter. The contrast fills the uterus and enters the tubes, outlining the length of the tubes, and spills out of the fallopian tube ends if they are open. Blockage or other problems often can be located.
Hysteroscopy is a procedure used to examine the inside or the lining of the uterus using a thin viewing tool called a hysteroscope. The tip of the hysteroscope is put into the vagina and gently moved through the cervix into the uterus. The hysteroscope has a light and camera hooked to it so the doctor can see the lining, endometrium, on a video screen. Hysteroscopy may be done to see if a problem in your uterus is preventing you from becoming pregnant. Also, it can be used to remove growths in the uterus, such as fibroids or polyps. Another surgical procedure called a laparoscopy, may also be done at the same time as a hysteroscopy if infertility is a problem.
This minimally invasive surgery involves making a small incision beneath your navel and a lighted telescope-like instrument, laparoscope, is inserted through the wall of the abdomen into the pelvic cavity. With this thin viewing device (laparoscope), the fallopian tubes, ovaries and uterus are examined. Laparoscopy may identify endometriosis, scarring and adhesions, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus. Laparoscopy is not a first line option in the evaluation of a female patient. It may be recommended depending on the results of other testing and a woman’s history, such as pelvic pain and previous surgeries.