Infertility Tests for Females
- FSH (follicle-stimulating hormone) – FSH is the hormone that triggers your ovaries to prepare an egg to be released each month. High FSH levels indicate low ovarian reserve, or a diminishing egg supply, which typically means a lower chance of getting pregnant. An FSH level is typically checked around Cycle Day 3.
- AMH (Anti-Mullerian Hormone) – AMH is a protein hormone produced by cells within the ovary. You AMH level helps to assess your ovarian egg reserve. AMH levels on average, are lower in older women, and higher in those women with PCO or PCOS (Polycystic Ovarian Syndrome).
It’s important to rule out general physical problems, as well as evaluating the uterus and ovaries through a combined physical examination and an internal ultrasound. Depending on your situation, you may be asked to schedule this test for a certain time during your menstrual cycle (ex: ~CD#3 – or – between CD#6 to CD#15).
- Physical examination – This commonly involves listening to your heart and lungs, along with a brief pelvic examination.
- Pelvic Anatomy Ultrasound with BAFC – an ultrasound probe (or “wand”) is placed into the vagina to view the patient’s pelvic organs. The ultrasonic sound waves allow for 2D and/or 3D imaging of the ovaries and uterus, allowing us to identify certain abnormalities, such as polyps, fibroids, or a septum. The BAFC (Basal Antral Follicle Count), provides information on the number of basal follicles a patient has on their ovaries at that time.
Hysterosalpingogram or an “HSG”
This is an X-ray of the fallopian tubes. The X-ray is performed immediately following the injection of a liquid dye, through the vagina and into the tubes. An HSG allows us to view the patient’s fallopian tubes, looking for defects or blocked areas. It also allows the physician to determine if the patient has any abnormalities of the uterine cavity (see below pic). The test is typically performed between days 6 to 15 of a patients’ cycle (i.e. ~6 days after starting your menstrual cycle/period through the 15th day).
Hysteroscopy or HSC
The physician uses a thin, flexible tube, with a camera on the end, and inserts it through the cervix and up into the uterine cavity. Tissue samples can be taken, and photographs of the inside of the uterine cavity allow us to view any defects present, such as: Endometrial Polyps, Adhesions, or Fibroids. Small defects, can typically be removed at the time of the procedure. Larger defects, such as fibroids, may require a more extensive surgical procedure to remove (at a later time).
This procedure involves scraping and examining a small sample of tissue from the lining of the uterus (endometrium). It allows the physician to determine if ovulation has occurred, and whether the lining of the uterus has undergone the changes necessary for the implantation of a fertilized egg and the support of an early pregnancy. An endometrial biopsy can also detect an infection or inflammation of the endometrium (endometriosis).
*ERA, or Endometrial Receptivity Analysis
This is a test used to determine the receptivity of the endometrium.
ERA may increase the chance of pregnancy by predicting the ideal time for the implantation of the embryo during an IVF cycle.
A biopsy of endometrial tissue is taken and analyzed. Results will indicate whether the endometrium was receptive or non-receptive at the time the biopsy was taken.
A receptive result indicates the endometrium is likely to be receptive and the embryo is likely capable of implanting into the uterus relative to the day the biopsy was taken.
A non-receptive result indicates that the endometrium is either pre- or post-receptive relative to the day that the biopsy was taken. The embryo transfer would not be recommended.
A non-receptive result means the endometrium is either pre-receptive or post-receptive.
In this case, a new window of implantation will be suggested and a second biopsy and test are recommended to confirm the new personalized window of implantation.
ERA links to a major improvement of the global pregnancy rate, up to 85%* in those personalized transfers made according to the test results.
* SREI Prize Paper. O-115 Simón et al. on behalf of the ERA RCT Consortium. Prospective, randomized study of the Endometrial Receptivity Analysis (ERA) test in the infertility work-up to guide personalized embryo transfer versus fresh transfer or deferred embryo transfer.
Infertility Tests for Males
Since sperm issues affect around 40% of couples with infertility, it is important to do a semen analysis to identify any issues that may be present. The male partner should have between 2 to 5 days of abstinence, prior to collecting a semen sample for testing.
Semen Analysis or S.A.
A semen sample is collected through masturbation into a sterile cup. This “collection” can be done at home – only if – the couple lives within 30 minutes of the clinic. Otherwise, it should be collected at the clinic, using one of our available collection rooms.
The test will measure the amount and quality of the sperm present in the semen sample.
This analysis provides the following information:
- Viscosity (resistance to flow)
- Motility (movement of the sperm)
- Count (number of sperm)
- Morphology (Structure or shape of the sperm)
- Volume of semen
It’s extremely important to have this particular information, because certain fertility treatments are less likely to be successful with low numbers of moving sperm and/or an increased percentage of sperm that are “abnormal” in shape.
In some cases, a physical examination may be performed (or ordered), to evaluate the pelvic organs — the penis, testes, prostate and scrotum.
Hormone tests evaluate levels of testosterone and FSH (follicle-stimulating hormone) to determine the overall balance of the hormonal system and specific state of sperm production. Serum LH and prolactin are other hormonal tests that may be done if initial testing indicates the need for them.
*Episona Test – Sperm DNA Test
Sperm DNA fragmentation testing measures the amount of damaged DNA in a sperm sample. All men have some amount of damage to their sperm DNA, but high percentages of damage may indicate greater difficulty achieving pregnancy with IUI and IVF.
The Episona sperm test looks specifically for epigenetic abnormalities in the particular genes with a known role in fertility and embryo development. Abnormalities in these genes correlate with male infertility, and knowing which genes are affected may offer new insight into why problems are occurring.
Information included in this test is a list of which genes had abnormalities (if any), so your physician can better approach your treatment.