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Infertility Testing and Evaluation

This page includes information about the different tests and evaluations that may be performed.

Ovulation - establishing a regular menstrual pattern will often suffice as a means of establishing the presence of eggs. A Clomiphene Citrate Challenge Test (CCCT) will also yield information on the ovarian reserve, or potential to have a response to fertility medications. Women with an abnormal CCCT will be less likely to conceive. If the CCCT is very abnormal, pregnancy is not likely to occur no matter what treatment is used.

Semen analysis - this is the main test of the male fertility evaluation. A normal semen analysis does not guarantee a pregnancy but reduces the likelihood that fertilization problems are due to problems with the sperm. An abnormal semen analysis is usually repeated to confirm the result. 30-40% of infertility is due to male factors. When combined with female factors, male factor infertility may contribute to more than 50% of infertility. Click here for more information.

Pelvic ultrasound - Our clinic uses transvaginal ultrasound to evaluate the uterus, tubes, and ovaries. By using a vaginal probe instead of an abdominal probe we are able to obtain images that are very clear and show very small details. Things that can be detected on transvaginal ultrasound include uterine fibroids, hydrosalpinx, endometrial thickness, ovarian cysts including endometriomas, as well as other abnormalities which may require further evaluation and treatment. Transvaginal ultrasound is also very useful in viewing pregnancies as early as 6 1/2 weeks from last menses (4 1/2 weeks from conception). By this time a heartbeat is usually detectable by ultrasound.

Ovarian cysts are misunderstood and extremely common. Women who are ovulating regularly will form a follicle during her menstrual cycle. This follicle contains an egg, or oocyte. This follicle may become as large as 3 cm in diameter. This follicle and the structure that can form after ovulation known as the corpus luteum (secretes progesterone to support the uterine lining for a pregnancy) are cysts. Sometimes these cysts do not regress on their own and are called functional cysts. There are multiple other types of cysts, including ones that are malignant, but by far the most common type of cyst is the functional cyst. Observation is the most common form of treatment.

Saline Contrast sonography: This is a special ultrasound where fluid is put inside the uterine cavity to allow for better visualization of the inside of the uterus. This can detect small abnormalities inside the lining of the uterus which can decrease fertility and lead to a higher rate of miscarriages. [more information about saline contrast sonography, saline infustion hysterography, or saline contrast ultrasound]

Hysterosalpingogram (HSG): The HSG is a procedure done with contrast dye injected through the cervix into the uterus while observing with fluoroscopy (moving x-rays). This procedure is done in a radiology suite. The HSG's should be scheduled for the week immediately after your menses, ideally between cycle days 5-12. The HSG procedure will be performed by a physician who will also briefly review the results with you after the procedure. It is recommended that you have a small lunch and take 600-800mg of ibuprofen one hour before the procedure. If you cannot take ibuprofen, then 500mg of Tylenol may be helpful to reduce cramping during the procedure. [More Information]

Diagnostic hysteroscopy and diagnostic laparoscopy - these are surgical procedures that use instruments to look inside the abdomen (laparoscopy) and uterus (Hysteroscopy). These procedures will have to be scheduled. Hysteroscopy (H-scope) can often be performed in the office but, laparoscopy (L-scope) is usually performed under deeper sedation or general anesthesia in a hospital setting. [More Information]

Hormone Evaluations

The pituitary is located at the floor of the brain just above the mouth and nasal passages. It is responsible for secreting hormones to the rest of the body. These hormones regulate body functions such as thyroid hormone balance and ovulation.

Thyroid Stimulating Hormone (TSH): Like the thyroid exam, the TSH may uncover a thyroid abnormality that may have an impact on fertility. TSH is released from the pituitary gland and stimulates the thyroid gland to make thyroid hormone. An elevated level means the gland is not making enough hormone which is the case in hypothyroidism. Low levels indicate problems with TSH production or increased thyroid hormone production (hyperthyroidism). Additional tests may be necessary to determine the exact cause of the abnormality

Prolactin is another hormone of the endocrine system that is released from the pituitary gland. Prolactin is responsible for the production of milk. Prolactin levels can be elevated without causing galactorrhea (discharge of milk in a non-pregnant woman). Prolactin can hormonally interfere with the normal function of the hormones that govern follicular development and the menstrual cycle. Prolactin tumors may also cause the pituitary to stop producing other hormones, namely FSH and LH, which will also have an impact on normal reproductive function.

Androgens are a group of hormones usually thought of as male hormones; such as testosterone. These hormones are also present in females. There are several disorders in which the androgens are abnormally elevated in a female patient. Physical findings usually include abnormal hair growth, acne, and deepening of the voice. One of the most common scenarios in which increased effects of androgens are seen is in polycystic ovarian syndrome.

Infectious testing: Infectious disease testing is important to prevent the transmission of infectious agents to patients and newborns. Examples of infectious agents commonly assessed include:

HIV - Human Immunodeficiency Virus which is responsible for AIDS.
Hepatitis B & C
Syphilis
Cytomegalovirus (CMV)
HTLV - Human T-Cell Lymphocyte Virus types 1 & 2
Rubella Immunity
Gonorrhea & Chlamydia

There are state and federal regulations governing infectious disease testing, especially concerning donor tissues.

Pre-conceptual testing: In addition to infectious disease tests, other initial tests may include screens for genetic disorders. Examples of these tests include cystic fibrosis testing, sickle cell screening, and other blood disorders such as thalassemia.

 

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California IVF: Davis Fertility Center.  Providing infertility and IVF services to the Sacramento and Roseville area.  Services include IVF, inseminations - IUI, male and female infertility, PGD, ICSI, and much more.