It goes without saying that in order to develop a successful treatment plan for our patients we must first do our best to identify possible causes for their infertility. In order to do this we utilize a series of tests which will help identify if any or all of the causes listed above might be the culprit.
Although it is important to individualize testing, it is typical that we follow our patients through a cycle with serial ultrasounds and blood tests. These help identify egg reserve issues, ovulatory problems and evaluate the general hormonal status of our patients. If not done in the past we often recommend a Hysterosalpingogram (HSG) to diagnose possible tubal blockage and to get a closer look at the uterine lining. We also typically perform a semen analysis. Below is a timeline of a typical testing cycle.
Baseline Labs and Ultrasound
Days 2-4A blood test will be done to test 3 hormones at the beginning of your menstrual cycle: Estradiol, LH, and FSH. These hormones must be tested no later than day 4 of your cycle: Estradiol (estrogen), AMH, and FSH. At the same visit an ultrasound will be done to evaluate your pelvic organs. The result of these blood tests and the follicle count will give us a great deal of information about your ovarian reserve-the ability of your ovaries to produce good quality eggs. At the same time, blood will be drawn to check various other hormones including thyroid and prolactin. We will also make sure that you are immune to Rubella. In selected patients, a male hormone panel will be performed. This will help to detect such conditions as polycystic ovarian disease.
Uterine and Tubal Testing
Days 5-12During this time of your cycle, we will do a test to carefully evaluate your uterine cavity. This is extremely important as a normal uterine cavity is essential for successful implantation of a fertilized egg. This test is called a sonohysterogram. If you have not had your fallopian tubes tested recently to see if they are open, Dr. Springer may want to do a different test, a hysterosalpingogram. This test looks at both the uterine cavity and your tubes. On some occasions, the doctor may feel that both tests would be helpful.
HSG or SonohysterogramWhereas both the sonohysterogram and the HSG evaluate the uterine cavity, only the HSG can determine if your fallopian tubes are open. The HSG is an x-ray and is performed in our Crest Hill office. The test is done by injecting dye through your cervix (via an exam much like a Pap smear). We then watch (via x-ray) as the dye flows through your uterus and out through your fallopian tubes. It is normal to experience mild cramping during this procedure. We advise that you take 2 or 3 Advil or Tylenol an hour prior to your treatment. A course of antibiotics will be prescribed prior to your test as well. The entire exam usually takes only 20 to 30 minutes. The Sonohysterogram test is done instead of the HSG when there is no reason to evaluate the status of your tubes. It may also be done in addition to the HSG. This test provides an excellent view of the uterine cavity but does not evaluate your tubes. The Sonohysterogram is performed in our office. Sterile water is injected into the uterus while an ultrasound is performed to study the uterine cavity. The test causes minimal cramping and takes about 20 minutes.
Pre-ovulatory Labs and Ultrasound
Days 12-14A blood test is done to check your hormone levels. This will help in determining if you have a normal hormonal response just prior to ovulation (release of your egg). We will also perform an ultrasound to measure the size of your follicle. This will tell us if you are developing a mature egg. When done at the correct time it also tells us the approximate day that you will ovulate. We also measure your uterine lining to confirm that it is maturing normally. It may occasionally be necessary to repeat the pre-ovulatory labs and ultrasound a few days later if the first tests are inconclusive.
Day 21For approximately 2 weeks after ovulation (day 14 until the onset of your next menstrual cycle) several significant changes take place. If the egg has been successfully released, the following should occur: 1. The predominant female hormone switches from estrogen to progesterone. 2. Your ovulatory follicle will first collapse and then disappear completely. 3. The lining of your uterus will undergo very specific changes. During this portion of your testing, we will be doing a blood test to check your progesterone level. On the day of this blood test we will also do an ultrasound to ensure that your follicle is gone.
This test may be done anytime during your cycle. For convenience, most women have their partners collect the specimen at home and bring it to the office during one of their routine testing visits. This test gives us information about the count, the motility and the shape of your partner’s sperm. There are very specific directions that must be followed if the semen analysis is to give us accurate results. You will be given a specimen cup along with those instructions.