Background, Genetic and Infectious screening
The most important
part of the infertility work-up is obtaining screening history and blood work so
we can evaluate any potential problems before you get pregnant. This blood test is designed to assess your general health
and tests also for
infectious problems that may interfere with a healthy pregnancy.
Screening blood tests include: complete blood count including differential, blood group and type and Rh. Blood tests also screen for HIV antibodies, Hepatitis B and C surface antigens, immunity against Rubella and German measles, syphilis serology, and Chlamydia antibody, as well as hormonal testing for Thyroid Stimulating Hormone (TSH) and prolactin (PRL). A PAP smear should have been done within the last year. Approximately 30 ml (2 tablespoons) of blood will be taken from your arm while you lie down. It is best to have this blood test drawn after fasting since midnight because your cholesterol and triglyceride levels will be checked. Therefore, you should not eat breakfast on the day of your blood test.
We may order appropriate genetic screening based on your background and family
history. Examples of genetic screening tests include evaluations for sickle cell
anemia and/or cystic fibrosis.
Ovarian function/ovulation screening
Disorders
in the ovary account for about 30% of female related infertility. Our main
questions are: 1. Are you ovulating? 2. How well do you ovulate (or what is the
quality of eggs you produce)? Many women have premenstrual symptoms
(bloating,
breast tenderness) a few days before their menses. This is a good sign that you
ovulate. Some women may have regular bleeding, but not actually ovulate. We may
evaluate this question by ordering levels of Follicle Stimulating
Hormone
(FSH), or Luteinizing Hormone
(LH), which are made by the brain (pituitary gland) in order to stimulate egg
development in the ovary. We also may order a
progesterone level, a hormone
made by the ovary only after ovulation, or have you check your urine with an
ovulation predictor kit (LH surge kit), which you can buy in the drug store.
While the question of whether you ovulate is an important one, it is equally
important to
know how well you ovulate. Some women may have regular, monthly, ovulatory periods, but the "quality" of their eggs may be reduced. This happens
naturally as women age. By testing the FSH
on the third day of the cycle, we can predict how well the ovary is making the
eggs. These tests of "ovarian reserve" allows us to better predict how well your
ovaries will respond to stimulation with
fertility drugs, and help us to predict your potential pregnancy rate with
infertility treatment.
This test, a
day 3 FSH,
is drawn on day 3 of your cycle, and is required by all women undergoing
advanced infertility treatment. We will inform you if you are a
candidate for
testing. Sometimes we may need to stimulate the ovary a little to get even more
information about how well the eggs are doing. In this case, we perform a
clomiphene citrate challenge test (CCCT),
where we draw an FSH on day 3 and day 10 of your cycle after you have taken 100
mg of clomiphene on day 5-9 of your cycle. We perform this test in all women
over the age of 35, and in women with unexplained infertility. We can perform an
intrauterine insemination (IUI) during the same cycle as your CCCT,
potentially turning a diagnostic test into a therapeutic one.
Uterine evaluation
The uterus, or womb, is lined on the inside by a layer called the
endometrium. This is where the developing pregnancy will implant. It is
important to evaluate the uterine cavity, looking for potential problems such as
uterine scar tissue,
polyps, fibroids, or other structural defects in the
uterus. These problems may interfere with a developing pregnancy, leading to
miscarriage and/or infertility. The uterine evaluation will consist either of an
X-ray study of the uterine cavity, a hysterosalpingogram (HSG) or a
sonohysterogram, a special ultrasound test. If there are abnormalities on these
tests, we may perform a hysteroscopy, a surgical procedure used to correct
problems inside the uterus.
Tubal evaluation
Problems with the fallopian tubes, such as tubal blockage,
account for about 30% of
female infertility problems. This is especially true in
women who may have had a pelvic
infection in the past. Blocked tubes and scar
tissue can also be caused by abdominal infections such as appendicitis, prior
surgeries, or endometriosis. We screen for problems on the fallopian tubes by
performing a hysterosalpingogram (HSG). This test evaluates problems in both the
uterus and the fallopian tubes (see above). If we find tubal blockage, we may
perform a laparoscopy, a surgical procedure done to better diagnose and
potentially correct tubal problems.
Endometrial biopsy
An endometrial biopsy, or biopsy of the lining of the uterus, may
be done to look for a potential problem in the development of the endometrium
called luteal phase defect. It may also be done to look for infectious
problems.
