Fertility Testing and Evaluation (Women)
When it comes to evaluating and treating infertility, the first step is to obtain a thorough understanding of your medical and reproductive history and that of your partner and immediate family members, if appropriate. Once we’ve reviewed your medical history, we may recommend additional testing in an effort to determine why you are having difficulty conceiving. We will evaluate the relationships between many important factors and your reproductive system. These factors may strongly impact the ability to conceive and carry a pregnancy. As we investigate, it allows us to build a more comprehensive treatment plan that is best suited for you and your needs.
To learn more about the various factors that we will be evaluating through this process, please see below.
Perhaps the easiest fertility indicator to start with is age. Unfortunately, when it comes to fertility, age is not just a number. As women get older, egg quality declines. For this reason, it is not only more difficult to conceive but the chance of miscarriage or having a baby affected by a chromosomal abnormality increases. For some women in their 40s, achieving a pregnancy through the use of donor oocytes (eggs) may be recommended.
Ovulation occurs when a woman’s body matures and releases an egg from a follicle within the ovary. Without consistent ovulation each menstrual cycle, it is very difficult for conception to occur. There are many reasons why a woman may not ovulate, such as reproductive medical conditions (e.g. PCOS), hormonal imbalances (e.g. thyroid dysfunction), and significant changes in body weight or activity level. The good news is that women who do not ovulate regularly can often be induced to ovulate with the assistance of fertility medications.
Every woman is born with a lifetime supply of immature eggs. These eggs are stored within the ovaries and are rapidly lost as a woman ages. Approximately 300,000 eggs remain at the time of puberty, of which 300 to 400 may be ovulated during a woman’s reproductive lifetime. Ovarian reserve testing is designed to help determine the number of eggs still available, as well as whether or not the ovaries are responding to hormonal signals sent from the brain.
You may be wondering how we’re able to obtain this information. We start with blood tests that measure various hormone levels. We may also perform a pelvic ultrasound at the beginning of your menstrual cycle, which allows us to examine your ovaries and count the number of small follicles that are present. This is called an Antral Follicle Count (AFC). Together, these tests provide us with valuable insight on egg supply.
Having clear and open fallopian tubes is critical when attempting to conceive. After all, the fallopian tube is where the sperm and egg meet and fertilization occurs. If there is a blockage for some reason (scarring, endometriosis, a prior pelvic infection, etc.), the egg and sperm are unable to meet. One of the first tests we often recommend is a hysterosalpingogram (HSG). A HSG is a procedure that uses a special dye and an x-ray to highlight any potential tubal blockages. This “tubal dye test” is a non-surgical method to ensure that the fallopian tubes are open.
Please note that we do not perform HSGs at any of our office locations. They are typically performed by a TFC physician at a nearby hospital. Should you need to schedule a HSG, please call our scheduling department. If it is more convenient, your OB/GYN may perform the HSG for you.
A pelvic ultrasound is an imaging study that will provide information on the anatomy of your reproductive tract (uterus, ovaries and the surrounding areas in your pelvis). A pelvic ultrasound can be performed transabdominally or transvaginally and in 2D or 3D. Fibroids, polyps and ovarian cysts can be detected, ovarian reserve can be assessed and follicle development can be evaluated.
Oftentimes we will recommend a more comprehensive imaging study to examine the inner contour of the uterus called a saline infusion sonohysterogram (SHG). A SHG is an ultrasound that is performed while a small amount of sterile fluid is injected into your uterus. This fluid allows the doctor to evaluate your uterine cavity more clearly and determine if polyps, fibroids or intrauterine scarring are present. The good news – most of the issues detected can be corrected with a simple outpatient procedure.
Unlike the HSG, the SHG is performed by a TFC physician in the office – you do not need to go to a hospital for this procedure.
We conceived our daughter when we were newly married, no problems at all, actually were not even trying. When she turned about 20 months old, we started to try and conceive again. After months of trying with no luck, we sought our general...