Fertility Testing for Women

Your fertility evaluation can include a questionnaire, blood tests, an x-ray, and an ultrasound. In some cases, your family doctor or Ob-Gyn may have already ordered some of these tests. However, if the results are generally older than one year, we will want to update them.

To make the most of your time with us, we suggest that you get as many of your tests done before your initial consultation. This information will help us decide with you what your best treatment options are. Some test results can take up to two weeks to be reported to us. 

Blood Tests

We do blood tests at specific times in your menstrual cycle to help determine if your ovaries are functioning as expected.

These tests include:

Follicle Stimulating Hormone (FSH) and Estradiol

FSH and estradiol blood tests are typically drawn within day 2-4 of your menstrual cycle, and are the traditional tests of "ovarian reserve," which refers to the relative amount of remaining eggs left in your ovaries.

What is the purpose of the test?

The tests will not tell us the exact number of eggs you have left, but can give us an idea if you are running out of eggs faster than expected. For patients with irregular periods, the specific timing of these tests do not apply, but your doctor will order a complete hormone panel to investigate the cause for menstrual irregularity.

Antimullerian Hormone (AMH)

AMH is a relatively newer blood test that provides a clearer picture of the ovarian reserve than the traditional test of FSH and estradiol.

What is the purpose of the test?

AMH is most useful to determine if the relative number of your remaining eggs is lower or higher compared to what is expected for other women of your age. This information can help us make some important decisions about your treatment plan. For example, if the AMH tells us that you are running out of eggs faster than we expect, we might advise that you consider more aggressive treatment. On the other hand, if the AMH is better than expected, we might suggest you consider more conservative treatment.

Thyroid Stimulating Hormone (TSH)

Your TSH levels will be tested since thyroid abnormalities are common in women of reproductive ages. In addition to problems with your general health, thyroid imbalances can cause menstrual disturbances, infertility, and miscarriage.

Prolactin Test

Prolactin is another hormone that will be tested. Prolactin is normally elevated when a mother is breastfeeding. However, some women may have abnormal elevations of prolactin levels even when they are not pregnant, which can contribute to ovulation problems and infertility.

General Pre-pregnancy Blood Tests

In addition, a standard panel of infectious disease testing is ordered for all patients to ensure a healthy pregnancy for mother and baby. A complete blood count and blood typing are also routine prenatal tests. Depending on ethnic background or other predisposing factors, some genetic testing may also be ordered to assess risks for possible inherited diseases.

 

Hysterosalpingogram X-Ray

A hysterosalpingogram (HSG) is an X-ray test that looks at the inside of your uterus and fallopian tubes and the pelvic area around them. Many patients feel anxious about this test. But there is nothing to worry about as this is a very safe, informative, and possibly therapeutic procedure (many women conceive shortly after having the HSG).

What happens during the procedure?

Unlike the other imaging tests, the HSG is not performed at Olive but at a radiology facility. After inserting a vaginal speculum, the physician will insert a small catheter into the cervix and instil about two tablespoons of water-soluble dye. Several X-ray films taken while the dye is instilled will show if your fallopian tubes are open, and if there are any obvious problems within the uterine cavity that could cause infertility or complications during pregnancy. The procedure is performed in the first half of your menstrual cycle, after your bleeding has resolved but before you ovulate.

While most women tolerate the procedure without significant discomfort, some women find the procedure quite uncomfortable. Much of the discomfort can be prevented by taking 400mg of ibuprofen an hour before the procedure. Patients allergic to ibuprofen can take two extra strength Tylenol instead. The procedure only takes a few minutes.

Safety

Many women are concerned about the X-ray exposure. However, the procedure has proven to be extremely safe. In fact, it is well documented that many women conceive shortly after having the HSG performed, as it seems that the procedure itself may help treat infertility by flushing out blockages in the fallopian tubes that maybe preventing a pregnancy. There is a small risk of infection. If you have ever had chlamydia or pelvic inflammatory disease (PID), please notify us prior to the test as we may recommend antibiotics be taken prior to the procedure.

Hysteroscopy

Depending on your HSG findings or other reasons determined by your physician, a hysteroscopy may also be required.

A hysteroscopy is a procedure that involves a physician inserting a very small camera through the cervix and into the uterus, in order to see if the environment within the uterus looks favourable for embryo implantation. This is the "gold standard" method of assessing the uterine cavity.

What happens during the procedure?

Sterile saline solution is instilled through the camera to inflate the uterus and separate the walls so that all the interior surfaces can be seen. Minor problems such as small polyps or mild scarring can be dealt with during this procedure, but more significant problems may require additional treatment.

The procedure itself takes about five minutes and may cause some minor discomfort or cramping that can be minimized by taking 400mg of ibuprofen (Motrin) an hour before the procedure. Patients allergic to ibuprofen can take two extra strength Tylenol.

Transvaginal Ultrasound

A transvaginal sonogram is an internal ultrasound. You can expect to get a transvaginal sonogram either at your initial or your follow-up visit.

What happens during the procedure?

This procedure is performed by inserting an ultrasound probe into the vagina, allowing your physician to see problems like cysts on the ovaries and fibroids on the uterus. In addition, your physician may perform an antral follicle count to assess your ovarian reserve, by counting the small follicles in the ovaries that contain the immature eggs. The AFC gives us information on your egg count, much like the FSH and AMH levels can.  

For some patients, this procedure may seem somewhat awkward and initially uncomfortable. However, it is not generally described as a painful procedure and is completely safe. It only takes a couple of minutes and does not require any medication or special preparation. 

 

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