Diagnostic fertility testing is essential for the partner who wishes to become pregnant utilizing her own eggs. At LGBT Fertility, our doctors realize that the expense of using donor sperm with IUI can rapidly increase if multiple cycles are required. With this in mind, we focus on identifying any factors early on that could have an adverse effect on fertility.
Diagnostic testing is scheduled after the initial new patient appointment with one of our physicians. The testing performed is separated into three categories:
- Ovarian function
- Evaluation of the uterine cavity
- Blood work to screen for infectious and genetic diseases
Ovarian function is determined by evaluating several hormone levels on day 3 of the menstrual cycle:
- Follicle Stimulating Hormone (FSH): Assessing the FSH on day 3 of the patient’s menstrual cycle helps establish egg quality. FSH is required for the maturation of an egg each month. Elevated levels of FSH may indicate a diminished ovarian reserve.
- LH (luteinizing hormone): LH, which regulates the menstrual cycle and ovulation, varies throughout the month. This test helps determine ovarian reserve.
- Estradiol: On day 3 of a woman’s cycle, estradiol should be greater than 10 but below 68. An elevated estradiol may suggest the presence of an ovarian cyst. Very low levels may reveal that the ovaries are suppressed and may not respond to stimulation.
- Anti-mullerian Hormone (AMH): AMH is produced in the ovarian follicles. AMH blood levels are thought to be a marker of the size of the remaining egg supply or ovarian reserve.
Evaluation of the Uterine Cavity
Because embryos implant in the uterus, LGBT Fertility performs tests to determine if the uterine cavity is normal. We can do this with either a hysterosalpingogram (HSG) or a hysteroscopy.
HSG: An HSG is an X-ray that reveals the interior contour of the uterus and fallopian tubes. This test can detect irregularities inside the uterus that could interfere with fertility. It also allows us see if the tubes are open or blocked. The fallopian tubes need to be open so that the sperm and egg can meet. The HSG is performed by injecting a special dye through the cervix and observing the flow of the dye through the uterus and tubes on X-ray. HSGs can be performed in any of our three offices by one of our physicians. These tests are scheduled between menstrual day 6 and 10.
Ultrasound: A pelvic ultrasound is very useful when performed at the appropriate time in a woman’s cycle. It should be performed a few days prior to ovulation and is usually an office procedure. This procedure can assess approaching ovulation and evaluate the thickness and pattern of the endometrial lining, where the embryo would implant. Fibroids, polyps and ovarian cysts can also be detected by ultrasound.
Saline Infusion Sonohysterogram (SIS or SHG): This test may also be performed in the office and allows the physician to visualize any irregularities that might interfere with fertility in the uterine cavity. The test requires injecting a saline solution through the cervix into the uterus while imaging the uterus with a sonogram. It does not evaluate the fallopian tubes and does not take the place of an HSG.
Testing Your Ovarian Reserve
Your age is very important to your fertility. The major factor that links age and infertility is called ovarian reserve and it’s the quantity and quality of eggs you have available when you are trying to conceive.
We utilize information from an ovarian reserve test to help determine the best treatment options and medication protocols for each patient. Women are born with their full amount of eggs (oocytes). A woman’s ovaries are programmed to lose many oocytes by atresia throughout her reproductive years. Starting in pre-puberty and continuing until her body’s natural progression to eventual ovarian failure and infertility.
As a woman ages, not only does her egg count diminish more rapidly, but the chromosomes within the oocytes become more likely to have abnormalities. This leads to increasing embryo aneuploidy (abnormal number of chromosomes) from the aging oocytes, and is the reason prenatal genetic testing in recommended in pregnant women 35 years and older.
The degree and rate of ovarian aging is specific to each patient and is partly genetically predetermined. Although several environmental factors, including smoking, chemotherapy and drug use can increase ooctye atresia and aneuploidy, there is nothing that can be done to delay it. Our therapeutic medications are meant to increase the maturation of more eggs in a cycle thereby rescuing them from atresia. This can help the patient to maximize the use of a larger quantity of eggs/embryos from the remaining oocytes.