Fertility Evaluation

The ultrasound is brief, non-invasive and painless. For a pelvic ultrasound, a slender instrument called a transducer is inserted into the vagina. The transducer sends out high frequency sound waves and then listens for returning echoes from tissues in the body. The resulting image, viewed in 'real time,' can indicate the health of the ovarian egg follicles as well as any problems such as ovarian cysts.

These are blood tests to measure hormones essential for establishing and maintaining healthy pregnancies:

• Thyroid Stimulating Hormone (TSH) test Thyroid hormones impact the reproductive system. Both high and low thyroid levels can interfere with hormonal functions essential to ovulation and establishing pregnancy.
• Prolactin test This hormone is responsible for producing breast milk and is important to pregnancy, however, a high level can inhibit ovulation.

Given on day 2 or 3 of the menstrual cycle, this test measures FSH, the primary hormone responsible for prompting egg production, and also estradiol, the most important estrogen hormone, responsible for ovarian health and the growth of the reproductive organs. As women age and egg production decreases, FSH and estradiol levels will increase. This increase signals that the body is having difficulty making eggs and is working harder to 'make up' for this shortfall. The ideal FSH level on cycle day 2 or 3 is between 4 and 8 mIU/mL. Lower levels are better than higher levels. Any level greater than 10 mIU/mL suggests a problem with ovarian reserve. The ideal Estradiol level is between 30 and 50 pg/mL and mostly helps to validate that the FSH was drawn at the correct time of the cycle.

Anti-Mullerian Hormone (AMH) A newer test is the Anti-Mullerian Hormone test. This hormone is directly produced by developing follicles in the ovary and is less dependent on where a woman is in her cycle. The ideal level is 1.0 or higher. Higher levels are better.

The delicate fallopian tubes are the pathway to fertility. At ejaculation, sperm are deposited in the vagina and then swim through the cervix and uterus and into the fallopian tube, where they meet and fertilize the egg. Contractions of the fallopian tube smooth muscle and movements of microscopic fimbriae lining the tubes moves the fertilized egg (embryo ) back down through the tube to the uterus. Because any blockage or damage to this fragile mechanism can interfere with conception, assessing tubal health is a primary step in evaluation. In many cases, tubal problems can be treated. The following tests are commonly used to determine tubal health:

This is an X-ray exam, during which a small amount of dye is injected into the uterus and fallopian tubes. The X-ray is viewed on a screen as the exam is conducted. As the dye disperses, it illuminates any blockages (such as scar tissue or fibroids) that could prevent eggs from traveling to the uterus. The procedure also enables the doctor to view the structure of the uterus itself to see that it is ready to accept a fertilized egg. HSG is performed in the 2nd week of the menstrual cycle (i.e. after menstrual bleeding has stopped but before ovulation). The entire exam takes about 10 minutes. Side effects, if any, include cramping and pelvic pain. Taking Ibuprofen prior to the procedure can help with these symptoms. Most women can resume daily activities right away.

Fallopian Tubal Disorders

Conditions in the fallopian tubes consist of blockages and adhesions or scar tissue, either of which can obstruct sperm or embryo movement.

This provides the only method of actually predicting when ovulation will occur. The test requires a woman to urinate on a stick. The stick then indicates whether there is a rise in the LH or luteinizing hormone responsible for triggering ovulation. For most kits, a positive result means that ovulation will occur within 24 hours. The kit is useful for timing intercourse or insemination. Because it measures the key hormone responsible for ovulation, it can also indicate whether ovulation is or is not actually occurring.

The other key ovarian function, egg production, can be evaluated through blood tests given at key times in the menstrual cycle. Such tests can indicate the quality of a woman's eggs, and also the status of the body's egg supply or ovarian reserve.

It is important for the patient's physician to know the status of egg production and quality, in order to make treatment decisions that make sense for them. Even when hormone levels indicate that there is diminished egg quality, a woman's body is often perfectly capable of supporting a pregnancy. In these cases, egg donation (in which a recipient mother uses the eggs of a younger woman) can be very successful.

FSH (follicle stimulating hormone) and Estradiol blood test. Given on day 2 or 3 of the menstrual cycle, this test measures FSH, the primary hormone responsible for prompting egg production, and also estradiol, the most important estrogen hormone, responsible for ovarian health and the growth of the reproductive organs. As women age and egg production decreases, FSH and estradiol levels will increase. This increase signals that the body is having difficulty making eggs and is working harder to 'make up' for this shortfall. The ideal FSH level on cycle day 2 or 3 is between 4 and 8 mIU/mL. Lower levels are better than higher levels. Any level greater than 10 mIU/mL suggests a problem with ovarian reserve. The ideal Estradiol level is between 30 and 50 pg/mL and mostly helps to validate that the FSH was drawn at the correct time of the cycle.

Anti-Mullerian Hormone (AMH). A newer test is the Anti-Mullerian Hormone test. This hormone is directly produced by developing follicles in the ovary and is less dependent on where a woman is in her cycle. The ideal level is 1.0 or higher. Higher levels are better.

A thorough infertility evaluation can alert a patient's doctor to conditions in the male or female reproductive system that may be leading to infertility.