Fertility Diagnostics & Testing for Women
Fertility testing for women is an essential tool for single and partnered women who want to take charge of their reproductive health and make informed decisions about fertility care. Whether you’re ready to become a parent now or are interested in fertility preservation, fertility testing provides the information you need to create your family-planning roadmap.
There are various types of fertility tests available, ranging from simple blood tests to more complex procedures, such as ultrasounds and hysterosalpingograms. The results of these tests can provide insight into a woman’s ovarian reserve, hormone levels, and reproductive anatomy.
Ovarian Reserve Testing
Loss of eggs or oocytes is one of the reasons the basis for lower fertility and higher miscarriage rates seen in women as they age. The decline in ovarian reserve begins in the early thirties, accelerates in the late thirties, and plays a significant role in the increased incidence of infertility in the forties. The rate of this natural decline in ovarian oocytes varies among women. Some women will experience a decline in egg health in their 20s while others remain fertile into their early 40s.
Tests to assess ovarian reserve are useful for both the physician and couple experiencing infertility as they provide a more complete understanding of the likelihood of a woman conceiving with her own eggs. However, there are limitations to all tests such that some women with poor or abnormal results may still conceive a healthy child with their own eggs while others with normal results could still have unhealthy embryos with continued infertility. Several tests are now available to assess egg reserve.
Measuring Follicle-Stimulating Hormone (FSH) Levels
Follicle-stimulating hormone (FSH) is a hormone produced by the pituitary gland in the brain that provides an indirect measure of ovarian functioning. Test results can vary from menstrual cycle to menstrual cycle making the results less reliable.
Measuring Anti-Mullerian Hormone (AMH) Levels
Anti-Mullerian hormone (AMH) is a hormone that is generated within the ovary and therefore is considered to be a more direct measure of egg health. Unlike FSH, blood work can be obtained at any time during the cycle and the level shows less cycle-to-cycle variability.
Antral Follicle Count (AFC)
Antral follicle count (AFC) is obtained using transvaginal ultrasound measurements, usually early in the menstrual cycle. The size of the ovaries and the number of visible immature follicles present early in the cycle have been demonstrated to reflect the number of eggs that have the potential to develop during a treatment cycle.
Hysterosalpingogram (HSG) is an X-ray procedure that is useful in determining if the fallopian tubes and uterus are normally structured, and if the tubes are open.
During the procedure, you will lay on the exam table in a position similar to when you are having a pelvic exam or pap smear done. Just as with the pap smear, a speculum will be inserted into the vaginal canal. An antiseptic solution is placed onto the outside of the cervix and then a small catheter is placed into the cervical opening. Clear dye that contains iodine is injected through the catheter into the uterus while a special X-ray called fluoroscopy is performed. This allows for visualization of the uterine cavity.
Within less than a minute, the dye will enter the fallopian tubes if they are open and then spill out of the ends of the tubes. A cramping sensation may be felt as the dye enters and passes through the tubes but this should be brief, especially if you take the prescribed medications before the examination. The hysterosalpingogram takes about 15 minutes to complete.
If there is an abnormality in the shape or distribution of the dye within the uterine cavity, you may be advised to schedule a special ultrasound examination of the uterine cavity (saline infusion sonogram/SIS/hysterosonogram).
You will be given a prescription for an antibiotic and pain medication when you schedule the procedure. You may have some mild bleeding or spotting afterward. Should you experience bleeding heavier than a period, or a temperature above 100.4 degrees, call the office at which you are seen. If you are allergic to shellfish or iodine, or have had a prior reaction to X-ray dye, you must inform the office when you schedule the procedure.
HSG exams are performed at our North Tampa office and should be done between the 6th and 12th days of your menstrual cycle. Call the office to schedule your HSG at the onset of your menses the month you will have the test performed.
Saline Infusion Sonogram (SIS)
A saline infusion sonogram (saline sonography) is routinely performed to make sure that the endometrial cavity (inside of the uterus) appears normal. Benign uterine growths, such as endometrial polyps or uterine fibroids, may develop in the cavity and create an environment that is hostile to embryo implantation. Scar tissue may also be identified with the saline infusion sonogram.
This procedure may be done as part of an evaluation for recurrent pregnancy loss or done before an in vitro fertilization (IVF) cycle. It may also be done to evaluate the causes of irregular or very heavy menstrual cycles as well as some types of chronic pelvic pain. The saline infusion sonogram is scheduled early in a menstrual cycle, just after your period stops but before ovulation – usually between days 5-12 of your cycle.
The procedure is simple and usually takes 10 to 15 minutes to complete.
- A speculum is inserted into the vagina and the cervix is cleansed with an antiseptic solution.
- A special catheter approximately 1mm in diameter (about the size of a single strand of spaghetti) is inserted and slides through the cervical canal.
- The ultrasound probe is placed in the vagina.
- A sterile salt-water solution (saline) flows through the catheter into the uterine cavity. This distends the endometrial cavity and allows the physician to see the entire cavity on the ultrasound monitor. You may experience mild cramping at this point.
- Several images of your uterus will be taken during the procedure. Pictures of your ovaries may also be taken.
- You will need to schedule an appointment with your physician to discuss any abnormalities that are seen during the procedure.
After the procedure, you may continue to have mild cramping for a few hours. You may also experience light spotting or watery discharge for as long as 24 hours after the procedure. You should refrain from intercourse for approximately 48 hours. If any symptoms other than those listed above are noticed, please call the office at which you are seen.
Female Fertility Testing FAQs
When should women consider getting their fertility tested?
The decision of whether or not it’s time to see a fertility specialist for female fertility testing largely depends on the circumstances. In general, fertility experts recommend that women under the age of 35 who have been actively trying to conceive see a fertility specialist for testing after one year of trying. For women who are over the age of 35, it’s recommended that you undergo female fertility testing after six months. However, if you are interested in fertility preservation, have a reproductive condition (e.g., endometriosis, PCOS, etc.), or have a family history of fertility issues, you should consider scheduling a fertility testing consultation as soon as possible.
Does fertility testing hurt?
In general, fertility testing should not be a painful experience, however, everyone’s level of discomfort is different. Hormone levels are measured through blood tests, which involve drawing blood from a vein using a needle. While this can cause discomfort for some patients, it’s typically considered to be a tolerable procedure. Tests that involve inserting a speculum into the vaginal canal such as HSG and transvaginal ultrasounds, can also cause discomfort for some, but most patients report these tests as being similar to a pelvic exam.
Can fertility testing predict my chances of getting pregnant?
Fertility testing captures the full picture of what’s going on in your reproductive system, including your hormones, reproductive anatomy, ovarian reserve, and more. All of this information can be used to garner a better understanding of how likely you are to achieve pregnancy with or without fertility treatments. That being said, fertility testing cannot predict with absolute certainty your chances of getting pregnant.
Is there anything I should do to prepare for fertility testing?
If you are planning on undergoing fertility testing, it’s recommended that you start tracking your menstrual cycle for at least a few months before the test. It’s also recommended that you avoid taking certain medications. Talk to your doctor about what medications you should avoid before undergoing fertility testing. Your doctor will also advise you on any other instructions you may need to adhere to before the test, such as fasting before a procedure. Last but not least, be sure to prepare yourself emotionally and mentally, as fertility testing can be a stressful or overwhelming experience for some.
Advanced Female Fertility Testing Services in Florida
The Reproductive Medicine Group has many years of experience diagnosing the full spectrum of female infertility issues in Florida. With locations in North Tampa, South Tampa, Brandon, Clearwater, and Wesley Chapel, our expert team of fertility specialists is ready to answer all your questions and provide personalized fertility care. Schedule a consultation with The Reproductive Medicine Group.