fertility tests will be conducted with both partners. Fertility
tests document the physiologic processes that must take place in
order for successful pregnancy to occur. First, the male must produce
an adequate quantity and quality of sperm that can reach and fertilize
the egg. These sperm must be deposited into his partner's vagina,
and then, must be able to swim through the cervix (mouth of the
uterus). Once inside the uterus, the sperm must then travel through
the fallopian tubes to their ends where fertilization occurs.
female must produce healthy eggs that can be fertilized. Once developed,
the eggs are released from the ovary into a sticky substance on
the surface of the ovary. The fallopian tubes then must pick up
the egg (s) so they might be fertilized in the end of the fallopian
tubes. The resultant embryos must then travel to the endometrial
lining of the uterus where they implant and develop.
corpus luteum is the structure formed by the follicle after ovulation.
The cells within the corpus luteum produce progesterone to help
stimulate the lining of the uterus (endometrium) to help support
embryonic development. After approximately 9 weeks of gestation,
progesterone is produced by the placenta. The uterus must be able
to support the fetus as it develops to term and delivery.
is one of the most important fertility tests because approximately
50% of infertile couples have a male infertility component. The
semen analysis documents the quantity and quality of sperm. Please
read our "semen analysis" Web page for a complete discussion.
Analysis with Strict Morphology
male, after 48-60 hours of abstinence from sexual relations, produces
a semen sample by masturbation into a clean labeled specimen cup
for analysis of volume, absolute number of sperm, percentage that
are motile, sperm morphology, and presence of white blood cells.
is important to note that sperm within the uterus or fallopian tubes
survives for a maximum of 72 hours while the female's egg survives
a maximum of 24 hours once released at the time of ovulation. The
Strict Morphology assay takes a critical look at the individual
spermatozoa according to a strict set of criteria. A relatively
low number of sperm are rated as "normal" or essentially
near perfect during a typical Strict Morphology test, as compared
to the estimated morphology done during a Complete Semen Analysis.
result is an assay that can distinguish very fine differences in
morphology from one specimen to the next, and yields a quantifiable
result that is indicative and predictive of the entire sperm population's
potential fertility function.
pregnancy requires the recruitment, development and ovulation of
eggs that can be fertilized. If a woman is not ovulating, she is
said to be anovulatory. See our Web
page on amenorrhea for more information.
and Documenting Ovulation
first fertility tests seek to document that successful ovulation
is occurring. The patient may be asked to use a basal body temperature
thermometer or an ovulation predictor kit (OPK) to chart her temperature
throughout her cycle. The body temperature is measured each morning
before getting out of bed and noted on the BBT chart.
to ovulation, there is a small temperature increase indicating imminent
ovulation and intercourse is timed around this period. The BBT is
charted for several months making it possible to predict the time
of ovulation in subsequent cycles. Because BBT charting is less
than 50% accurate in documenting adequate ovulation, Dr. Mac prefers
his patients no longer use this technique.
specialists prefer to use the urinary ovulation predictor kits to
document ovulation because they are more accurate. The urine is
tested daily around the time that ovulation is expected. A sharp
rise in luteinizing hormone (LH) indicates that ovulation is imminent
within 36 hours.
of Fertility Tests
Profile (CD=cycle days 3 - 5) (Checks brain - thyroid - adrenal
- ovary axis). When grouped together these tests (FSH, LH, E2 (estradiol),
Prl (prolactin), DHEA-S, Testosterone, TSH) are called an endocrine
profile. They are all normally occurring hormones.
the levels are out of the normal ranges, interference with ovulation
can occur. Follicle stimulating hormone (FSH) is produced by the
pituitary gland and stimulates the ovary to produce estrogen (E2).
Luteinizing hormone (LH) is also produced by the pituitary gland
and induces the ovary to ovulate.
(Prl) is also produced by the pituitary gland and may interfere
with the mid cycle LH surge if prolactin levels are higher than
normal. Dehydroepiandrosterone sulfate (DHEA-S) is a hormone produced
by the adrenal gland. Its level allows us to determine whether or
not the adrenal gland may be acting to suppress the ovulatory process.
is an androgen (male-like hormone) that is produced by both the
ovaries and the adrenals. Its production, along with DHEA-S, allows
us to better identify if the ovaries or adrenal glands are in a
resistant (suppressive) state. Thyroid stimulating hormone (TSH),
yet another hormone produced by the pituitary gland, may increase
prolactin production to higher than normal levels that act to interfere
B serum concentration provides a new measure of ovarian reserve.
Ovarian reserve describes the ovaries' capacity to respond to gonadotropin
(FSH & LH) stimulation by producing a sufficient number of good
quality eggs capable of generating normal embryos.
Inhibin B concentrations drawn on cycle days 3 to 5 have been shown
to predict response of the ovaries to ovulation induction medications.
In addition, these levels have been used to predict the chance of
miscarriage after becoming pregnant. These levels are recommended
in any woman where ovarian reserve may be suspected to be low, i.e.
age > 35, previous ovarian surgery, when premature ovarian failure
is considered, etc.
challenge fertility test (CCT)
clomiphene challenge test is a sensitive way to measure a woman's
"ovarian reserve," or relatively speaking, whether she
has fertilizable eggs left in her ovaries. It appears to be more
sensitive than an endocrine profile since some women with normal
profiles on day 2 or 3 may have an abnormal clomiphene challenge
fertility test. It is most often used in women over the age of 35
to assure the patient that ovulation induction is worthwhile. Results
of this test will help you and your physician evaluate your ovarian
reserve and how aggressive you may need to be with regard to treatment.
is an x-ray of the uterus and tubes. It is an outpatient procedure
that takes less than 30 minutes performed in the radiology department.
A catheter is threaded through the cervix into the uterus and dye
is injected to determine whether the fallopian tubes are open and
to see if the shape of the uterine cavity is normal. This procedure
causes moderate menstrual cramps and ibuprofen is recommended 1
hour prior to the procedure. Antibiotics are also recommended to
decrease any risks of developing a uterine infection.
LH "Ovulation Predictor" Kits
pituitary hormone that triggers ovulation suddenly rises about 36
hours before ovulation and is easily measured in the urine. One
can predict ovulation and plan intercourse, insemination, or post
coital test based on this test.
develop in a characteristic fashion prior to ovulation. After ovulation,
the ruptured (ovulated) follicle becomes the corpus luteum that
produces progesterone. The endometrial lining also develops gradually
throughout the cycle. Watching the development and changes via ultrasound
is a safe and simple method of determining ovulation and appropriate
growth of the endometrial lining.
pelvic ultrasound has many uses including assessing follicular development,
measuring endometrial thickness, and diagnosing other abnormalities
such as large uterine fibroids. Please see our Web page on "Ultrasound"
for more information.
cervical mucus changes from scant, thick, sticky, and cloudy early
in the cycle to plentiful, thin, clear, and stretchable just before
and during ovulation. As estrogen levels increase mid cycle, the
mucus changes. This allows for sperm to be easily transported to
the fallopian tubes where fertilization takes place.
coital Test (PCT)
PCT or "post-intercourse test" is done from 2 to 12 hours
after intercourse within 2 days of predicted ovulation. Evaluation
is made of both the mucus and the number of sperm that show progressive
forward movement, thus examining simultaneously both female and
post coital test (PCT) is a test performed on the cervical mucus
after intercourse looking for sperm. In the post coital test, the
couple has intercourse and the female then comes to the office within
2 to 12 hours. At the office, a speculum exam is performed where
a sample of her vaginal and cervical fluid is examined.
fluid will be analyzed and the quantity and quality of sperm will
be determined. If numerous dead or nonmoving sperm are seen, it
may be indicative of the presence of antisperm antibodies. The cervical
mucus may also be too thick or there may not be enough mucus to
transport sperm into the uterus.
type of infertility is known as "cervical factor infertility"
and is often treated using intrauterine insemination (IUI), which
places sperm directly into the uterus.
is an ovarian hormone secreted by the cells that surround the egg.
This hormone helps develop the uterine lining during the first half
of the cycle. It is also used to monitor the development and health
of the developing egg (s).
is an ovarian hormone secreted by the corpus luteum after ovulation.
This hormone helps maintain the endometrial lining which is crucial
for implantation of the embryo. Furthermore, it is vital in sustaining
the early pregnancy for the first 7-9 weeks of gestation.
endometrial lining changes throughout the cycle from "proliferative"
before ovulation to "secretory" after ovulation. This
is necessary to allow implantation by the embryo. A biopsy allows
one to assess if the proper amount of hormone (E2 and P4) was received
by the lining by a certain day of the cycle. The physician may want
to document that the endometrium is properly prepared to accept
the developing embryo by ordering an endometrial biopsy. In this
procedure, a small sample of the endometrium is taken and examined
under a microscope. The depth of the endometrium can also be determined
using transvaginal ultrasound. Progesterone levels are often measured
before an endometrial biopsy to insure that successful ovulation
function test (EFT)
family of cell-surface protein receptors appears on the endometrial
lining of the uterus during "the window of implantation."
This window often exists 8-10 days after a woman's urinary LH peak.
The absence of certain proteins leads to poor implantation or lack
of implantation in many cases. It is now been proven that implantation
markers are necessary for proper development of the endometrial
lining during a woman's menstrual cycle and for implantation.
Recently, many women with "unexplained infertility," "luteal
phase defect," "endometriosis," or "hydrosalpinx
(swollen tubes)" have been shown to have alterations in their
endometrial lining function at the time of implantation. The lack
of these implantation markers has been associated with each of these
disease states. Biopsies of the uterine lining at appropriate times
in the cycle can identify this type of abnormality. These biopsies
collectively are termed the endometrial function tests.
laparoscopy is a cornerstone infertility test where the physician
can visually examine the internal "pelvic" organs. It
is an outpatient surgical procedure performed to inspect the female
for such infertility factors as endometriosis or pelvic scarring.
Please see our page on "Laparoscopy"
for an extensive discussion of this procedure.
is a procedure in which a small camera is inserted through the vagina
into the uterus. The structures such as fibroids can be seen. Please
see our discussion on the
hysteroscopy for more information.
Many other tests that may be ordered based upon each couples individual