Infertility Diagnosis
Diagnostic Studies
Although the sequence of these studies may vary, it may include some or all of the following:
Female Partner Diagnostic Tests
Cycle Day 1,2, or 3 Blood Tests
We need follicle stimulating hormones (FSH), luteinizing hormone (LH), prolactin, and estradiol levels (E2) on either Day 1, 2, or 3 of your cycle. Generally, Cycle Day 1 is defined as the first day of flow (i.e. not spotting). These are baseline hormones that give us an idea of how sensitive the ovaries are to fertility drugs. We can determine the dosage you may need in order to ensure adequate ovulation. A thyroid panel is also done since an abnormal thyroid level may interfere with normal ovulation.
Contagious Disease Panel
You may be screened for HIV, Hepatitis B and C, RPR, and sexually transmitted diseases (STD’s). The female partner may need a blood type and Rubella Titer (to make sure she is immune to German Measles).
Hysterosalpingogram (HSG)
This test is done on an outpatient basis. It involves injecting dye into your uterus that shows up on an X-ray. The dye outlines the inside of the uterus and tubes. If the fallopian tubes are open, the dye passes into the surrounding pelvic cavity and is re-absorbed by your body. It may be associated with cramping. This test is done after you have stopped menstruation but before ovulation, generally between days 6 and 12 of your cycle. You must be on antibiotics for four days, beginning the day before the procedure. Please be sure to have your prescription on hand.
LH Surge/Ovulation Predictor Kits
Usually on Cycle Day 10 (10 days from the first day of your menses) you will be asked to check your urine every morning with a special test stick provided in an ovulation predictor kit. When you have a positive result, you will ovulate within 24-36 hours. This test predicts whether you are releasing the egg at the correct time of your cycle, and helps us to schedule your post ovulation diagnostic testing.
Post Coital Test
This tests for the sperm’s ability to penetrate the cervical mucus. It is performed like a pap test on the female partner the day before ovulation. We will request that you have normal sexual relations (without the use of lubricants) the night of your LH surge (using an ovulation predictor kit). Your appointment should be between 6 to 12 hours after intercourse. While it is okay to shower, please do not take a bath or douche prior to the appointment. The doctor or nurse will take a small amount of mucus from your cervix and check it under the microscope for moving sperm. You will know the results immediately.
Progesterone Level
Progesterone is a hormone made by the corpus luteum (the follicle that released the egg). It is responsible for maintaining a healthy endometrial lining to support a pregnancy. It is a blood test drawn seven (7) days after ovulation. A level of above 10 ng/ml indicates a healthy ovulation.
Sonohysterogram (water ultrasound)
This is a test to examine the uterine cavity for abnormalities, such as polyps or fibroids. It is performed between cycle day 6-12. It takes approximately 10 minutes in the office and is associated with minimal discomfort.
Other Possible Tests
On certain individuals, other hormones called androgens (DHEA-S, testosterone) may be drawn.
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Male Partner Diagnostic Tests
Semen Analyis
This is a test for sperm count and characteristics. It is obtained after three days of sexual abstinence. We will provide instructions and a container to collect the specimen. The sample needs to be kept at room to body temperature and transported to the laboratory within one (1) hour. The results will be discussed with you at the next appointment.
Contagious Disease Profile
You may be screened for HIV, Hepatitis A, B and C and syphilis.
Other Possible Tests
If a sperm count or motility is low, some blood tests, such as FSH, LH, Prolactin and a testosterone level may be drawn.
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