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FEMALE INFERTILITY/PRECONCEPTUAL TESTING
Basic testing of both female and male partners allows for more information to be gained regarding potential cause(s) of infertility and how best to proceed with treatment.
Anatomical Evaluation
The uterus should ideally be free of tumors (fibroids) that are large and/or near the endometrium, which is the site of embryo attachment. Additionally, the tubes should be free of obstruction and freely mobile in order to capture an egg efficiently. A combination of tests may be necessary to fully evaluate all of these factors.
Pelvic (transvaginal) ultrasound is commonly performed at the first visit. The purpose of the ultrasound is to exclude the presence of uterine tumors, ovarian cysts, and estimate the number of eggs contained within the ovaries (preantral follicle count).
Hysterosalpingogram (HSG) is a radiological study that allows for contrast dye to be injected through a small catheter into uterus and fallopian tubes. This exam evaluates the uterine cavity for shape/structure of the uterine cavity (rules out congenital anomalies), assesses for the presence or absence of tumors and endometrial polyps, and demonstrates patency of the fallopian tubes.
Sonohystogram (SIS) is performed by way of pelvic ultrasound combined with some saline instilled into the uterine cavity through a small catheter. This allows for evaluation of the uterine cavity from several angles and views to observe for potential filling defects consistent uterine polyps or fibroids .
Labwork
Blood work can aid in the diagnosis of potential cause(s) of infertility as well as assess for optimal maternal health preconceptually. Generally, appropriateness of specific labwork is determined after careful consideration of patient factors and determined in consultation with a clinic provider.
Infertility Testing can include the following:
- Antimullerian Hormone (AMH): diminished levels can indicate some concern for egg quality/quantity; can be drawn at any time in the menstrual cycle
- Follicle Stimulating Hormone (FSH): elevations of this hormone generally indicate concern for egg quality/quantity; should be drawn early in cycle, typically on cycle day 3 and accompanied by an estradiol level to fully evaluate meaning of results
- Thyroid Stimulating Hormone (TSH): properly-functioning thyroid gland is essential for optimal pre-conceptual and early pregnancy health.
- Prolactin: elevations in this hormone can indicate abnormalities in the function of the pituitary gland, a key player in optimal egg growth and development
- Polycystic Ovarian Syndrome (PCOS) panel: tests androgens such as DHEA and Testosterone levels,gonadotropin levels of FSH and LH, liver and kidney function, and potential for glucose intolerance/insulin resistance; typically performed in women who report more infrequent or irregular menstrual cycle lengths
- Premature Ovarian Insufficiency (POI) panel: assesses for potential causes of menstrual irregularities or complete cessation of menses in women who are of typical pre-menopausal age; includes antibody testing for thyroid and adrenal glands, chromosome analysis, and genetic conditions such as Fragile X
- Pre-Conceptual Testing (Prenatal Profile) includes the following:
- Blood type and antibody testing: blood type, specifically the Rh factor (positive or negative) is necessary to know if further intervention is warranted around the time of delivery or with bleeding episodes throughout an ongoing pregnancy
- Blood count: assesses for presence or absence of anemia
- Infectious Disease testing for HIV, hepatitis B and C, and syphilis allow for treatment plans to accommodate for safest prenatal conditions in the presence of any of these conditions
- Immunity testing for rubella (measles) and varicella (chicken pox):
Hysteroscopy and Laparoscopy
Based on your individual history or findings on ultrasound or HSG, an outpatient procedure called a laparoscopy and/or hysteroscopy may be recommended. Documentation of a normal anatomical relationship between the tubes and ovaries can be accomplished by laparoscopy. Laparoscopy directly visualizes the structures via a fiberoptic telescope placed through the abdominal wall. This outpatient procedure investigates whether endometriosis or scar tissue (adhesions) is present preventing the egg from efficiently traveling from the ovary to the fallopian tube. If these abnormalities are present, they are typically efficiently treated at the same time with the assistance of a carbon dioxide laser in an effort to restore the anatomy to a more normal state. This is best scheduled after menses but before ovulation. Oftentimes, a hysteroscopy (visual examination of the interior of the uterine cavity via a fiberoptic telescope) is done at the same time. Laparoscopy and hysteroscopy are not always necessary with the initial evaluations unless your medical history strongly implies endometriosis or scar tissue as likely contributing factors to infertility.
