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TESTING FOR WOMEN
Female factor is the sole cause of infertility in approximately 40% of cases. There are several conditions that contribute to female factor infertility, including age, weight, smoking, uterine and pelvic abnormalities, ovulatory disorders, tubal disease, polycystic ovarian syndrome, and endometriosis. In addition to the causes listed above, a significant portion of female infertility remains unexplained in spite of the fertility evaluation.
The following testing is recommend as a part of the initial infertility evaluation.
- Infectious Screen (Chlamydia antibody, Gonorrhea, Hepatitis B, Hepatitis C, Syphilis serology, HIV): having one of these organisms or viruses could adversely affect your treatment outcome, pregnancy, and your general health if left undiscovered or untreated. All of these infections with the exception of gonorrhea may go undetected for an extended period of time without adequate testing.
- Pre-Pregnancy Screen (Complete Blood count, Blood type & Rh Factor, Rubella titer) These tests are performed in order to avoid serious complications to the fetus during pregnancy and screen for anemia and possible other heritable disorders. While most people have been immunized for Rubella, in some cases a booster will be required to provide adequate coverage.
- Pituitary/Thyroid Screening (Prolactin, TSH, Free thyroxin): hormonal tests which screen for abnormalities that can effect your treatment or pregnancy.
- Genetic (Tay Sach’s, Cystic fibrosis, Sickle Cell): if your history suggests that you may be at risk for certain genetic, autoimmune diseases, or medical diseases, other tests may be ordered prior to initiating the cycle.
- Pap Smear – should be up-to-date per American College of Obstetric & Gynecology standards (usually within the year).
- Breast Screening Mammogram – recommendations are determined by your age.
Documentation of ovulation
Approximately one third of women who are infertile have irregular or absent ovulation. For the most part however, when ovulation is absent menstrual cycles become irregular and unpredictable. A variety of tests is available to help determine whether or not you are ovulating. These include serum progesterone levels testing, ovulation prediction kits, serial ultrasounds, and rarely basal body temperature charting. Keep in mind however, that while these tests are helpful adjuncts in determining ovulation, a successful pregnancy is the only definitive evidence of ovulation.
Abnormalities of the reproductive organs particularly the fallopian tubes can also limit the ability of the sperm to reach the egg. Tubal damage is usually the result of a pelvic infection or previous surgery. A hysterosalpingogram, (HSG or dye study), is the test most often performed to determine if there is blockage or damage to the fallopian tubes.
Other tests including laparoscopy or hysteroscopy may be performed to detect other conditions that may affect the tubes or other reproductive organs and make conception difficult.
Ovarian Reserve Testing
Chronological age has a significant impact on a woman’s ability to conceive. This is largely because women are born with all the eggs they will ever produce during their reproductive life. With increasing age, there is a gradual decrease in fertility potential. Hormonal testing and ultrasound evaluations can help to quantify your reproductive age and fertility potential. Commonly performed tests include:
- Day 3 FSH and Estradiol level
- Day 3 ultrasound for antral follicle count
- Inhibin B
- Anti mullerian hormone
- Clomiphene citrate challenge test