Fertility Diagnosis and Testing: Preparatory Fertility Tests for Women

Blood 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).

Follicle Stimulating Hormone (FSH)

A gonadotropin that is released by the pituitary gland to stimulate the ovaries or testicles. FSH, when marketed in the United States, is also known as Follistim, Gonal-F or Bravelle follicular phase insufficiency or defect. An abnormal pattern of estrogen production during the first half of the menstrual cycle, which could result in infertility or recurrent miscarriages.

Lutenizing Hormone (LH)

A gonadotropin released by the pituitary gland to stimulate the ovaries and testicles. LH serial blood tests. When this test is performed several times daily around the presumed time of ovulation, the detection of a rapidly rising blood LH (luteinizing hormone) concentration can accurately determine the time of probable ovulation. This test, which requires blood to be drawn several times and is therefore painful, time consuming, and expensive, has been virtually supplanted by serial urine LH testing.

BBT Charting

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.

Postcoital Test (PCT)

Assessment of the cervical mucus after intercourse to evaluate the quality of the mucus and mucus sperm interaction; also known as the Huhner Test.

Transvaginal (Pelvic) Ultrasound Exam

Transvaginal Egg Retrieval – An ultrasound guided egg retrieval procedure in which the needle is passed through the back or side of the woman’s vagina into her ovaries. It is the most commonly performed egg retrieval procedure today.

Hysterosalpingogram (HSG)

A procedure used to assess the interior of the fallopian tubes and uterus; it involves injecting a dye into the uterus via the vagina and cervix, and tracking the dye’s pathway by a series of X-rays.

For women younger than 35 who have no evidence or symptoms suggesting underlying organic pelvic disease (e.g., endometriosis, chronic inflammation, pelvic adhesions, uterine 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.

Hysteroscopy

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.

Laparoscopy

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.

Endometrial Biopsy

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.

Sclerotherapy for Ovarian Cysts (Endometriomas)

Sclerotherapy is a safe and effective alternative to surgery for definitive treatment of recurrent ovarian endometriomas in a select group of patients planning to undergo IVF. Sclerotherapy for ovarian endometriomas involves: needle aspiration of the liquid content of the endometriotic cyst, followed by the injection of 4-5% tetracycline into the cyst cavity. Treatment results in disappearance of the lesion within 6-8 weeks in more than 75% of cases so treated. Ovarian sclerotherapy can be performed under local anesthesia or under general anesthesia.  It has the advantage of being an ambulatory office-based procedure, at low cost, with a low incidence of significant post-procedural pain or complications and the avoidance of the need for laparoscopy or laparotomy.

Semen Analysis on Male Partner

Semen analysis: for accurate measurement of sperm motility and count. Sperm morphology is assessed employing “Kruger criteria.” Semen should also be cultured for UreaplasmaUrealyticum, Chlamydia, Gonococcus and for aerobic/anaerobic pathogens.