There are several paths to parenthood, determining the right one for you is largely dependent on the cause of your infertility. One of our first steps in creating a detailed, personalized treatment plan for you is a diagnosis of your infertility issues.
Ovarian Reserve Assessment
Women are born with all the eggs they will ever have. When a woman enters puberty—around age 12—she has approximately 200,000 eggs. No eggs remain by the time she reaches menopause, around age 50. If ovulation were not interrupted—with birth control pills or pregnancy—a woman could expect to ovulate about 500 eggs from puberty to menopause.
The eggs that are not ovulated (from the initial 200,000) all die naturally. Currently, there are no treatments to improve ovarian reserve or restore egg numbers. A woman’s ovarian reserve is primarily determined by genetics, however some external factors accelerate egg loss. These include prior ovarian surgery, some chemotherapy agents, radiation to the pelvis, and smoking cigarettes.
It generally consists of a blood draw to test antimullerian hormone levels (AMH), and an ultrasound to check your antral follicle count. Your provider may recommend additional testing, depending on your personal medical history.
An HSG is an X-ray test to assess the fallopian tubes and evaluate the uterine cavity. A small amount of sterile, iodine-containing fluid is injected through a small catheter placed into the cervix. Continuous X-rays are taken as the solution fills the uterus and flows through the fallopian tubes. You may experience mild to moderate discomfort and cramping during this procedure.
Saline Infusion Sonohysterogram (SIS)
A SIS is an ultrasound test to evaluate the uterus. A catheter is placed within the cervix or lower part of the uterus, through which a small amount of sterile fluid (saline) is injected. A vaginal ultrasound is done as the saline is injected. The shape of the uterus, and abnormalities such as uterine polyps and small fibroids are evaluated. This test cannot determine if the fallopian tubes are open.
Office Hysteroscopy (OH)
An OH involves inserting a small fiberoptic camera through the cervix into the uterine cavity. Occasionally, it is necessary to dilate the cervical opening slightly to allow insertion of the hysteroscope. In order to see clearly, the uterine cavity is expanded by infusing a small amount of sterile fluid (saline) through a small channel in the hysteroscope. This test provides information about the uterine cavity and lining, and can evaluate for polyps and fibroids inside the uterus. The OH cannot determine if the fallopian tubes are open.
Follicular Dynamic Ultrasounds
Follicular dynamic (FD) ultrasounds are vaginal ultrasounds performed mid-cycle to evaluate timing of ovulation. In a normal cycle, beginning about four to five days prior to ovulation, ultrasound can identify the dominant ovarian follicle. In some women this process may not occur in a normal fashion. We can follow the growth of the follicle and determine its size just prior to ovulation.
In 40% of couples experiencing infertility, there is some degree of male factor. A semen analysis is recommended, even when the woman has already received a diagnosis and/or when the male partner has previously had a child.
The semen analysis is a microscopic examination of the ejaculate to determine sperm number and function. A variety of parameters are assessed including concentration (number of sperm), motility, and morphology (shape). Values frequently fluctuate, and interpretation will require your doctor’s input. Persistent abnormalities may require additional testing or consultation with an urologist.