THE EVALUATION PROCESS
An infertility evaluation will answer four basic questions:
- Do we have eggs?
- Do we have sperm?
- Can the sperm and egg meet?
- Does the uterine cavity look normal?
To answer these questions, specific tests are order
Ovarian Reserve – Do we have eggs?
Ovarian reserve is a term used to determine the capacity of the ovary to provide eggs capable of fertilization. Evaluation of certain hormones (AMH, FSH, and Estradiol) and an ultrasound evaluation (AFC) of the ovary are utilized to determine a woman’s ovarian reserve.
AMH (Anti-Mullerian hormone) is a substance produced by the remaining follicles in the ovaries and provides insight into the size of the woman’s remaining supply of eggs. Ovarian reserve is a term used to determine the capacity of the ovary to provide eggs capable of fertilization. Evaluation of certain hormones (AMH, FSH, and Estradiol) and an ultrasound evaluation (AFC) of the ovary are utilized to determine a woman’s ovarian reserve. AMH (Anti-Mullerian hormone) is a substance produced by the remaining follicles in the ovaries and provides insight into the size of the woman’s remaining supply of eggs. Measurement of FSH (Follicle Stimulating Hormone) and Estradiol (estrogen) levels early in the menstrual cycle help us estimate a woman’s ability to produce multiple eggs in response to fertility medications. The Antral Follicle Count (AFC) is the number of follicles starting to develop on each ovary early in the menstrual cycle as seen via ultrasound. Combining the information of the hormone levels (AMH level, FSH and Estradiol) and AFC number helps indicate the ovarian reserve.
Semen Analysis – Do we have sperm?
A complete semen analysis is a quick and simple way to determine if sperm are present. The semen analysis evaluates the concentration or number of sperm, how many are moving (motility), their forward motility (swimming ability), and morphology (amount of normally shaped sperm). If a previous test from another lab shows an abnormal result, our Andrology Lab will repeat the semen analysis using Kruger strict criteria to determine if the sperm’s ability to fertilize an egg is compromised or normal.
HSG (Hysterosalpingogram) – Can the sperm and the egg meet?
For fertilization to occur an egg and sperm must be able to meet in the fallopian tubes. Damage or obstruction of the fallopian tubes can prevent fertilization from occurring. A hysterosalpingogram (HSG) can reveal an obstruction and its location, as well as document the shape of the uterus to rule out an abnormality that might interfere with an embryo implanting.
This brief, in-office test involves Dr. Troché injecting contrast media or dye through the cervix into the uterus and seeing if it can flow into the fallopian tubes. X-rays are taken periodically to document the flow of the dye through the tubes.
A normal test shows free flow of the dye through the fallopian tubes.
HSG Test Results
Normal HSG Result
Abnormal HSG Result
For your convenience, the HSG is performed at TFC.
SIS (SALINE INFUSION SONOGRAM) – Does the uterine cavity look normal?
Abnormalities of the uterine cavity (inside of uterus) can interfere with implantation of a fertilized egg by changing the shape of the uterus. These abnormalities are commonly caused by growths, such as fibroids or polyps, or scar tissue from a previous procedure or infection. The SIS is performed when only information about the uterine cavity is needed (as for IVF) since it provides no information about the patency of the fallopian tubes. It does not involve x-rays.
During the SIS, normal saline is injected via a small tube (catheter) through the cervix and into the uterus. Using ultrasound, Dr. Troché evaluates the inside of the gently distended uterus for any abnormality. The examination takes only a few minutes.
SIS Test Results
Normal SIS Result
Abnormal SIS Result
For your convenience, the SIS is performed at TFC.
Additional Tests in the Evaluation Process
In addition to the tests listed above, which help answer the four crucial questions of fertility, other factors are evaluated that play a critical role in conception.
In addition to the hormones tested for ovarian reserve, (FSH, Estradiol and AMH), Thyroid Stimulating Hormone (thyroid function) and Prolactin hormone levels are routinely checked as these affect ovulation also.
Progesterone is a hormone produced after ovulation and is essential for preparing the lining of the uterus to accept an embryo and for maintaining an early pregnancy. Measuring the progesterone level after ovulation (mid luteal phase) confirms ovulation occurred and indicates normal endometrial development.
With the recent advances in genetics, affordable genetic testing is now available and we offer it to all people. Genetic carrier screening provides information if an adult may be at increased risk to pass along a genetic disorder to their child. Usually the tests ordered are based upon a person’s ethnic background and family history. This is different from PGS/PGD which tests the embryo for a chromosomal abnormality or genetic condition.
Other testing to Maximize a Healthy Pregnancy
Immunity to Rubella (German measles) and Varicella (chicken pox) is determined as either infection can cause serious birth defects if acquired during pregnancy.
Recent studies indicate adequate levels of Vitamin D may improve a woman’s ability to become pregnant. A Vitamin D level is measured and supplements are added if the level is low.
Testing for infectious diseases such as HIV, hepatitis, CMV (cytomegalovirus) syphilis, gonorrhea, chlamydia, West Nile Virus and HTLV I/II are performed if certain medical procedures are recommended (such as IVF, donor insemination, etc.).
Testing for vaginal organisms, Mycoplasma/Ureaplasma, is performed if certain medical procedures are recommended (such as IVF, donor insemination, etc.). These vaginal organisms are associated with poor reproductive outcome and poor growth of the embryos in the laboratory. Antibiotics are used if the test results are positive.