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Infertility Workup

Prior to commencing any treatment, it is important that a number of investigations are carried out to gain a clearer understanding of the patient’s current situation so that we can devise a tailored treatment plan that is most appropriate. Some of the commonly performed tests also known as Pre IVF investigations are described below:

Female Partner Tests

Ovarian Function Tests : The most important aspect of an IVF cycle is to understand the ability to recruit and retrieve multiple follicles. Certain Hormone levels are checked before deciding to go ahead with any treatment:

Serum AMH Level : An Anti-Mullerian Hormone (AMH) test is a routine blood test in assisted conception that gives some insight into the remaining quantity of eggs and number of fertile years a woman has. It is useful for those women who have been trying to conceive for over six months, and want to check her ovarian reserve is suitable for the age. Serum AMH Level can be measured at any point of the menstrual cycle. A woman can also have her AMH tested while still on birth control pills.

TSH Level : A thyroid-stimulating hormone (TSH) test is a common blood test used to determine if the thyroid is functioning normally. The TSH screening test is also used to help evaluate pituitary gland function. TSH is produced by pituitary gland that regulates thyroid functions and the hormone is essential for a baby to develop normally during pregnancy. To get the best results, TSH is conducted for patients four hours after the last meal on an empty stomach.

LH Level : The LH blood test measures the amount of luteinizing hormone (LH) in blood or urine. The test is used to determine if a woman is ovulating, or have trouble getting pregnant or irregular periods.  LH blood tests can be measured on the 2, 3, and 5 day of menstrual cycle.  Fasting is not required for this test. A patient can take all medications as prescribed by the doctor.

Transvaginal (pelvic) Ultrasound ExamA transvaginal  ultrasound is a test that is used to see woman’s reproductive organs like the uterus, ovaries, cervix, and vagina. It is also used to diagnose pelvic pain, menstrual and gynecological problems, abnormal bleeding and certain types of infertility. A transvaginal ultrasound is done with your bladder empty or partly filled.

Antral Follicle Count Test : Antral follicle count (AFC) or basal antral follicle count is a transvaginal ultrasound study that measures a woman’s ovarian reserve or her remaining egg supply. The ovarian reserve reflects her fertility potential. The basal antral follicle can be measured and counted on Day 3 of the menstrual cycle by using ultrasound. The cycle Day 3 hormone levels are used as indicators to determine ovarian reserve and the woman’s chances for pregnancy with in vitro fertilization.

Evaluation of the Uterine Cavity : The embryos that develop in the lab during an IVF cycle will eventually be placed into the uterine cavity. Therefore, it is critical that the cavity is normal. The most common procedure used to investigate the shape of the uterine cavity is Hysterosalongogram (HSG) and hysteroscopy. These tests are scheduled between the end of menses and the onset of ovulation.

HSG : is an X-Ray test that looks at the inside of the uterus and the shape of the fallopian tubes. These tests are usually carried out in the Radiology Department in the hospital.

Hysteroscopy : viewing of the uterine cavity through a lighted scope in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to study the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.

Male Partner Tests

Male fertility testing can include surgical procedures such as a testicular biopsy and vasography. These tests are designed to identify blockages, as well as problems with sperm production.

Semen Analysis : A semen analysis is the most common test and is used to determine the quality and quantity of the sperm, motility-the sperm’s swimming ability, morphology- the shape of the sperm, count- the number of individual sperm and vitality- the capacity of the sperm to live and last. Semen analysis is to be done with abstinence of 24-72 hours.