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Infertility Evaluation
The initial evaluation can be performed by an obstetrician/gynecologist; however, a Board-Certified Reproductive Endocrinologist will also offer these tests, as well as advanced therapy.
The most common forms of testing include:
> A hysterosalpingogram (an x-ray of the uterus and fallopian tubes) is usually performed after a women’s menstrual cycle and before day 12.
> Tests of blood hormone levels: Antimullarian Hormone (AMH), Thyroid Stimulating Hormone (TSH), Prolactin, and other hormones specific for the patient.
> Semen analysis (a test to check the male’s sperm) is usually performed after two to four days without intercourse.
> Ovulation test (using an ovulation predictor kit, ultrasound, or blood test)
Blood Work
Blood tests are intended to measure hormone levels and identify any underlying causes of infertility.
The most common tests that will be ordered are Estradiol (E2), Follicular Stimulating Hormone (FSH), Anti-mullerian Hormone (AMH), Thyroid Hormone (TSH) Prolactin, Vitamin D, carrier screening for genetic diseases, along with prenatal labs such as blood type Rubella, Varicella HIV,1,2 Hepatitis B, C, and RPR. Abnormally high levels of tyroid hormone (hyperthyroidism) can lead to irregular ovulation, premature labor, and fetal abnormalities. Abnormally low levels (hypothyroidism) can lead to irregular or no ovulation and early pregnancy loss.
Prolactin is the “breast milk” hormone responsible for stimulating milk production in pregnant women. An abnormally elevated level in non-pregnant women is termed “hyperprolactinemia,” and can lead to lower estrogen levels, which result in irregular or failed ovulation.
In women with suspected Polycystic Ovarian Syndrome (PCOS) we will check the levels of androgens (male hormones), including testosterone and adrenal DHEAS. We also recommend checking for insulin resistance with the two hour glucose tolerance tests as well as determining metabolic abnormalities with testing of lipids
These blood tests will be provided for your continued prenatal care. Other blood tests may be ordered as needed.
Regular lab work results may take up to 2 weeks and will be viewable to you in your portal. Genetic testing may take up to 3- 4 weeks.
> SONOHYSTEROGRAM
For this procedure, the uterus is filled with saline solution (causing it to expand) and a vaginal probe ultrasound is inserted. The ultrasound outlines abnormalities, such as fibroids and polyps, which appear as shadows on the ultrasound monitor.
The physical exam includes cultures to rule out infections as well as a pap smear if needed. The trial transfer uses an empty catheter, which is introduced through the cervix and into the uterus.
> HYSTEROSALPINGOGRAM (HSG)
During this procedure, a radio-opaque dye is injected into the uterus, and X-rays are taken as the dye travels through the uterus and fallopian tubes.
If there is a blockage of the fallopian tubes, it shows as a collection of the dye at the point of the obstruction. The dye also shows the size and shape of the uterus.
> HYSTEROSCOPY
In this procedure, intravenous sedation is provided while a camera is introduced through the cervix and into the uterine cavity.
Complete assessment of the cavity allows us to correct any intrauterine pathology, like polyps (benign growths), fibroids, chronic inflammation, and opening the tubal ostium if they are blocked. This process is a completely painless and lasts about twenty minutes.
Please go to your portal to let us know your first day of your cycle, so we can schedule this procedure between days 5 and 11 of your menstrual cycle.
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