Diagnosis/Testing: Preparatory Tests
Diagnosis/Testing: Preparatory Tests
On the third day of a spontaneous or progesterone withdrawal menstruation, blood is drawn to measure Estradiol (E2), FSH, LH and Inhibin-B. The specimen of blood should be sent to Millenova Immunology Laboratories in Chicago by overnight mail for the performance of the Inhibin-B test.
Blood should also be drawn (any time) for the measurement of Prolactin, TSH and antisperm antibodies (ASA).
Commencing on the second day (2nd) of the menstrual cycle, a basal body temperature chart should be initiated. A thermometer is placed in the mouth for a period of two (2) minutes upon awakening (prior to the ingestion of food/liquid and brushing of your teeth). The temperature should be documented graphically on the basal body temperature chart provided.
For women younger than 35 who have no evidence or symptoms suggesting underlying organic pelvic disease (e.g., endometriosis, chronic inflammation, pelvic adhesions, fibroids, etc.), a hysterosalpingogram (HSG) should be performed within a week of the cessation of menstruation. This out-patient procedure involves injection of a radio-opaque dye that outlines the fallopian tubes allowing the diagnosis of tubal blockage. To a lesser degree, it permits the detection of surface lesions inside the uterine cavity.
OR
For all women over 35 years of age, and for younger women who have evidence or symptoms pointing to underlying organic pelvic disease (e.g., endometriosis, chronic inflammation, pelvic adhesions, fibroids, etc.), a laparoscopy/hysteroscopy should be performed within a week of the cessation of menstruation.
Laparoscopy is a procedure where a telescope-like instrument is introduced through the belly button into the abdominal/pelvic cavity allowing diagnosis and treatment of ovarian cysts/endometriomas/benign tumors, uterine fibroids, tubal blockage, ectopic pregnancy, appendicitis, pelvic adhesions, etc. Laparoscopy is usually performed as an out-patient procedure with the patient under general anesthesia. It is one of the only ways to diagnose early pelvic endometriosis accurately.
Hysteroscopy is a procedure where a telescope-like instrument is inserted, via the vagina through the cervical canal into the uterine cavity, for the evaluation of the interior of the uterus. It is an important procedure because it allows for diagnosis and treatment of small surface lesions inside the uterine cavity (e.g., polyps, scarring or adhesions) that adversely affect the ability of an embryo to attach to the uterine lining. Such lesions are often missed through the performance of an HSG.
Commencing at least 17 days before the expected next menstrual period (i.e., usually about 10 days following the initiation of menstruation), urine should be collected twice daily and tested for the onset of the spontaneous LH surge. The initiation of the LH surge usually precedes ovulation by 8 to 36 hours. In order to detect the onset of the LH surge as early as possible, it is important that urine be tested at least twice daily. This is done as follows:
The bladder is emptied first thing in the morning, upon awakening. One half-hour later urine is collected (only a very small amount is required) and tested using an over-the-counter LH kit (obtainable at a drug store). The earliest sign of any color change should be documented. It need not be a pronounced color change as suggested by the insert in the kit. Any alteration in coloration is significant. The same process of testing is then repeated at night before going to sleep.
At the earliest sign of a color change the couple should have intercourse and thereupon contact their physician’s office to arrange for the first office assessment which should be scheduled for 6- 18 hours following intercourse. In other words, if the color change is observed in the early morning, the woman should schedule the “first office assessment” to the doctor’s office for the afternoon of the same day. If it occurs at night, the doctor’s office should be contacted first thing the next morning and the “first office assessment” should take place within hours.
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