Infertility
Tests for Infertility | Mayflower Women's
Hospital
Infertility
Tests for Infertility |
Tests for Infertility
Antibody TestingIn less than 5 percent of cases, the female produces antibodies to the
male's sperm. Her body may mistake the sperm for a hostile invader, such
as a cold or virus, and produce defensive antibodies. These antibodies
incapacitate the sperm before it can pass through the cervix and reach
the egg. Antibody testing may be done after a postcoital test indicates
a potential antibody problem. Treatment may consist of intrauterine insemination
or in vitro fertilization that bypass the cervical mucus. Basal Body Temperature Monitoring (BBT)Most infertility patients are familiar with the basal body temperature chart (BBT). BBT monitoring is recommended by many gynecologists as a first step in the infertility workup. The purpose of the BBT is to monitor the early morning resting (basal) body temperature. Women experience a rise in body temperature during ovulation. Daily monitoring can be used to document that ovulation has occurred and to time intercourse.
BBT ChartMost reproductive specialists no longer use the BBT method but instead
rely on the more accurate LH (luteinizing hormone) detection kit. Body
temperature can vary for a variety of reasons other than ovulation. The
LH kit allows the couple to predict ovulation 24 hours before it occurs
whereas BBT changes occur after ovulation. Endometrial BiopsyIn the endometrial biopsy, a small piece of uterine lining is removed
for microscopic examination. The biopsy is done in the office, takes less
than 10 minutes, and is sometimes accompanied by intermittent "cramping."
The lining of the uterus thickens in response to hormones produced during
ovulation by thickening. The degree of endometrial thickening (cellular
differentiation) yields information about ovulation and the ability of
the uterus to support a pregnancy. Estradiol (E2)Estradiol is one of many forms of estrogen released by the developing follicle. Estrogen has many physiologic effects and is primarily responsible for stimulating the development of the endometrium. In general, as more follicles develop, estradiol levels increase. Low levels of estradiol may indicate that the follicle does not contain a healthy egg.
Effects of Estrogen on the Endometrium (Lining of the Uterus)The use of ovulation-induction drugs necessitates several E2 measurements.
These measurements provide the physician with information needed to make
dosage adjustments. Low levels of estradiol may indicate a need to increase
dosage, and high levels may signal an increased risk of ovarian
hyperstimulation syndrome. Follicle Stimulating Hormone (FSH) AssayFSH is a hormone produced by the pituitary gland and is responsible for
the development of the egg in the female and sperm in the male. FSH is
measured in the female on day 3 of the menstrual cycle. An elevated FSH
level may indicate that the egg is not developing properly and may signal
menopause. A woman can have regular periods even if her eggs develop improperly.
Women with FSH levels on day 3 may be candidates for the Oocyte Donation program. FSH is the active ingredient
in the injectable drugs used to stimulate ovulation. HysterosalpingogramA hysterosalpingogram (HSG) is an X-ray examination used to outline the inside of the uterus and the Fallopian tubes. The HSG is recommended for various reasons, but is usually done to verify that the Fallopian tubes are open. The HSG is performed on days 5-12 of the menstrual cycle. A radiologist will take X-ray pictures of the abdomen as dye is slowly injected through a catheter. The patient may watch on a television monitor as dye fills the uterus and Fallopian tubes. Several X-rays are taken during the procedure but radiation exposure is minimal. Slight cramping or pinching may be felt as the catheter is introduced
and the dye is injected. Some women have an upset stomach or feel lightheaded
briefly after the HSG. You may wish to have someone drive you home after
the test. If you are scheduled for the HSG, you will receive complete
instructions. HysteroscopyA hysteroscope is an instrument used to visualize the inside of the uterus.
In hysteroscopy, a fiber optic tube is inserted through the cervix while
the uterus is expanded using a gas, usually CO2. This is an outpatient
test. Many surgical procedures are performed through the hysteroscope.
LaparoscopyLaparoscopy is a secondary test for infertility and is a final step in the infertility workup. It is an outpatient procedure done at the hospital.
Laparoscopic View of the Fallopian TubeTwo small incisions are made in the abdomen, one near the midline (belly button) and one at the top of the pubic hair line. These incisions usually heal with no visible scarring. The laparoscope is inserted through one of the openings, allowing the reproductive surgeon to visualize the internal organs, and small surgical instruments are inserted through the other. The laparoscope allows the reproductive surgeon to diagnose and treat diseases, such as endometriosis, at the time of laparoscopy. Laparoscopy often allows the surgeon to determine if the tubes are open, if adhesions are present, or if there are uterine abnormalities. Many patients have previously had one or more laparoscopies. Dependent
on the disease, another laparoscopy may be repeated by your Mayflower
physician. The reproductive surgeon is highly trained in infertility treatment
and advanced laparoscopic surgery. Ovulation Detection or LH KitsThe LH kit measures the level of luteinizing hormone (LH). The graph illustrates how three female hormones, LH, estradiol, and progesterone, vary during an ovulatory cycle.
Ovulatory Hormone ProfilesThe red (LH) line indicates the sharp increase in levels of LH that occurs
immediately prior to ovulation. LH is the hormone that triggers the release
of the egg from the follicle and is measured by the LH (OvuQuick™,
etc.) kit. The LH kit accurately documents that ovulation has occurred
and can be used to time intercourse. It has largely replaced BBT monitoring. Postcoital TestThe postcoital (after intercourse) test evaluates the sperm's ability
to survive in the cervical mucus and pass through the cervix. A sample
of the mucus is taken 2-3 hours after intercourse and examined for the
presence of healthy sperm. The cervical mucus normally serves as a nutrient
source and transport medium for the sperm. The presence of dead or incapacitated
sperm may indicate that the female has antibodies hostile to the male's
sperm. ProgesteroneProgesterone is a female hormone produced after ovulation. Levels of progesterone are measured to determine if ovulation has occurred. Blood is drawn 4-9 days after predicted ovulation (or 4-9 days after a positive LH surge). For women with a 28-day cycle this means blood progesterone should be drawn on day 20 or 21. Progesterone is usually administered for two weeks after an ART cycle
to help support the growth of the developing embryo. Semen AnalysisThe semen analysis will be one of the first tests ordered in the infertility evaluation. Male sperm abnormalities are implicated as a cause of infertility in more than 40 percent of couples and must be ruled out before extensive tests are done on the female. The male produces an ejaculate through masturbation. A minimum of 48 hours, and a maximum of 7 days abstinence from sexual activity is required for this test. Preferably, the specimen should be obtained at the laboratory; however, provisions can be made to obtain it at home. Care must be taken not to contaminate it with soap, lotion, or other agents, and it must be kept at body temperature. Detailed instructions are provided with the specimen-collection container. The lab examines the sperm and determines the concentration (millions
of sperm per milliliter of semen), the shape (head structure, tail, etc.),
and their ability to swim in straight lines. These characteristics impact
the sperm's ability to fertilize the egg. Other, more specific tests are
ordered if necessary. SonohysterographySonohysterography is a valuable, safe, easy and cost-effective new technique for examining the inside lining of the uterus. Sonohysterography can be used to evaluate abnormal bleeding, infertility and recurrent pregnancy loss. It also can define abnormalities such as possible polyps and fibroids that are detected on X-ray hysterosalpingography and pelvic ultrasound. Sonohysterography can distinguish between polyps and fibroids and clearly
identifies their location and size. In the case of a normal sonohysterogram
one might avoid unnecessary surgery. When an abnormality is found, it
allows for proper surgical planning and perhaps avoidance of a purely
diagnostic surgical procedure. UltrasoundThe graphic illustrates the use of a vaginal probe ultrasound to monitor follicle development in a stimulated cycle (cycle in which ovulation-simulation drugs were administered).
Vaginal Probe UltrasoundA probe is inserted into the vagina and sound waves are passed through the surrounding organ systems. These sound waves penetrate tissues of different density to different degrees, thus creating an impression similar to an X-ray. Unlike X-ray studies, ultrasound has no negative side effects. Vaginal probe ultrasonography is commonly used to monitor follicle development and visually confirm that the egg has been released from the follicle. Ultrasonography is also used to monitor the developing fetus and diagnose many other diseases. A needle is not used during diagnostic ultrasound. |
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