DIAGNOSIS/TESTING: In-Office Assessments
DIAGNOSIS/TESTING: In-Office Assessments
The First In-Office Assessment
1. A Post-Coital Test (PCT) or Huhner test is performed on the cervical mucus. The purpose of the PCT is to assess sperm survival within the mucus. Since sperm can only survive for six hours in the vagina, a positive PCT is indicative of:
Good quality sperm.
Good sperm/cervical mucus interaction suggesting that there will be safe passage of sperm to the uterine cavity.
Absence of ASA antibodies in the sperm or mucus.
That the production of estrogen is adequate.
That the endometrial lining is well primed by estrogen, which is essential for adequate preparation of the uterine lining for implantation.
2. Cervical mucus is cultured for:
UreaplasmaUrealyticum (this requires a specialized medium to transport the specimen to the laboratory)
Chlamydia and Gonococcus (these also require a specialized transport medium).
Aerobic and anaerobic pathogens.
3. A cervical mucus evaluation: A sample of the cervical mucus is allowed to dry on a glass slide and is examined under the microscope for specific features such as “ferning,” which is indicative of an adequate estrogen effect.
4. A vaginal ultrasound examination is performed to detect the presence of at least one dominant follicle that measures 18 mm in mean diameter, thus helping confirm that ovulation is imminent. It also allows for the assessment of the thickness and appearance of the endometrial lining. A normal endometrium should measure at least 9 millimeters in sagittal diameter at this time.
The Second In-Office Assessment
This visit is scheduled three (3) days after the first office assessment. At this visit, a vaginal ultrasound exam is performed to check whether ovulation has occurred (i.e., whether the egg has been released). The presence of small amount of fluid collecting in the lower most region of the pelvis or a change in the shape of the follicle is suggestive of ovulation.
The Third In-Office Assessment
The third visit takes place five (5) days after the second visit. At this visit, blood is drawn for the measurement of progesterone and estradiol.
The Fourth In-Office Assessment
The fourth and final visit is scheduled for five (5) days after the third office assessment. At this visit, an endometrial biopsy is performed. This is a simple in-office procedure, whereby a sliver of uterine lining (endometrium) is removed and sent to the laboratory to evaluate histologic changes in the endometrium.
IntercurrentTesting (any time in the cycle)
1. An immunologic work-up may be required in certain cases of female infertility or where there is a past history of recurrent pregnancy loss. This usually requires measurement for antinuclear antibodies (ANA), antiphospholipid antibodies (APA), antithyroid antibodies (ATA) and a Natural Killer Cell activity test (NKa). Blood should be sent Millenova Immunology Laboratories in Chicago as such tests can usually not be performed in a regular reference laboratory because the methods they employ are neither sensitive nor specific enough to be of value in cases of reproductive failure.
2. For those who anticipate going into an IVF cycle sometime in the near future, blood should be drawn for the measurement of HIV, Hepatitis B surface antigen, Hepatitis C antibody and RPR (a Syphilis test). Blood grouping and RH testing as well as a Rubella antibody test should also be performed. Such tests will usually not be required in the course of a routine basic infertility work-up. Their performance should be confined to cases where it is anticipated that assisted reproductive technology (ART) procedures such as IVF or GIFT, will be the primary approach.
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