Diagnostic Testing
When you are visiting your RE (also
includes OB/GYN, family physician, etc.) a few things will happen
to give them an idea of what might be going on with your
reproductive system. They will ask you a series of questions,
some may be personal, but they are needed to help correctly
diagnose your problem and fix it. To give you an idea, here are a
few questions.
- Have you ever been pregnant
before?
- How long are your menstrual
cycles?
- How often do you engage in sexual
intercourse?
- Do you have any sexually
transmitted diseases?
These questions are very important to
your doctor and may clue him/her to where to begin treatment.
Diagnostic testing should ALWAYS begin
with semen analysis. Never let a physician perform any tests on
you if your partner has not had a semen analysis. It is simple to
perform and almost painless for the man....maybe just a little
embarrassing. But hey, after all the woman goes through, a little
masturbation isn't going to hurt anyone. Anyway, a semen analysis
should be performed on freshly ejaculated semen. They will look
for volume, motility, viscosity, total count, and morphology of
sperm in the semen. The normals for these will be discussed later
in the page under Male Factor.
If there is a normal amount of sperm in
the semen, they will move on to tests concerning the woman. The
first of these is hormone tests, which include baseline tests for
follicle stimulating hormone (FSH) and luteinizing hormone (LH).
These tests should be done on day 3 of your cycle. Prolactin,
Thyroid Stimulating Hormone (TSH), Free T3, Free Thyroxine (T4),
Total Testosterone, Free Testosterone, DHEAS and Androstenedione
can be done at any time during your cycle. The norm for these
hormones are as follows...
- Luteinizing Hormone (LH)
- Follicular Phase:(day two or
three): less than 7mIU/ml
- Day of LH Surge: greater
than 15mIU/ml
- Follicle Stimulating Hormone (FSH)
- Follicular Phase: less than
13mIU/ml
- Day of LH Surge: greater
than 15 mIU/ml
- Estradiol
- Day of LH Surge: greater
than 100 pg/ml
- Mid Luteal Phase: (seven
days after O): greater than 60 pg/ml
- Progesterone
- Day of LH Surge: less than
1.5 ng/ml
- Mid Luteal Phase: greater
than 15 ng/ml
- Prolactin: less than 25 ng/ml
- Free T3: 1.4 to 4.4 pg/ml
- Free Thyroxine (T4): 0.8 to 2.0
ng/dl
- Total Testosterone: 6.0 to 89
ng/dl
- Free Testosterone: 0.7 to 3.6
pg/ml
- DHEAS: 35 to 430 ug/dl
- Androstenedione: 0.7 to 3.1 ng/ml
Ask for your results if you want to
compare them to this list. This list is courtesy of Chapel Hill
Fertility Center laboratory, and have been excerpted from The
Couple's Guide to Fertility by Berger, Goldstein and Fuerst,
published by Doubleday.
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The next battery of tests should be
done before ovulation, but as close to ovulation as possible.
Most doctors will ask that you use ovulation prediction kits to
time your appointments accordingly. During this visit, you should
have a cervical mucous test done as well as an ultrasound exam.
- Cervical Mucus Tests---These
include a post-coital test (PCT) to see that the sperm
can penetrate and survive in the cervical mucous and a
bacterial screening. It is important to note that the
appropriate time to do PCTs is just before ovulation when
mucous is the most "fertile." PCTs at any other
time may give false results.
- Ultrasound Exams---on the day of
LH surge are used to assess the thickness of the
endometrium (lining of the uterus), monitor follicle
development and assess the condition of the uterus and
ovaries. If the lining is thin, it indicates a hormonal
problem. Fibroid tumors can often be detected via
ultrasound, as well as abnormalities of the shape of the
uterus and ovarian cysts. In some cases, endometriosis
can also be detected. Many doctors order a second
ultrasound two or three days after the first. This second
ultrasound confirms that the follicle actually did
release and can rule out lutenized unruptured follicle
(LUF) syndrome---a situation in which eggs ripen but do
not release from the follicle.
With these inital tests done, your
doctor should have some answers to your problem. However, if
nothing is found with these tests, there are a few more
diagnostic tests that can give your doctor a little more insight.
- HYSTEROSALPINOGRAM (HSG): This
test is used to examine a woman's uterus and fallopian
tubes. It is essentially an x-ray procedure in which a
radio-opaque dye is injected through the cervix into the
uterus and fallopian tubes. This "dye" appears
white on the x-ray, and allows the radiologist and your
doctor to see if there are any abnormalities, such as an
unusually shaped uterus, tumors, scar tissue or blockages
in the fallopian tubes. If you are trying to get pregnant
in the same cycle as an HSG, make sure to schedule the
test PRIOR to ovulation so that there is no danger of
"flushing out" a released egg or developing
embryo. Although most women report only minor cramping
and short-term discomfort during this procedure, some
women, especially those who DO have blockages, report
intense pain. Speak to your doctor about taking a pain
medication about 30 minutes prior to the actual
procedure. Strangely enough, it has been reported that a
percentage of women achieve pregnancy immediately
following a HSG. This may be due to the fact that forcing
the "dye" through the fallopian tubes may
actually open up previously clogged tubes. However, if
pregnancy is to happen, it will occur in the first three
months.
- HYSTEROSCOPY: If a uterine
abnormality is suspected after the HSG, your doctor may
opt for this procedure, performed with a thin telescope
mounted with a fiber optic light, called a hysteroscope.
The hysteroscope is inserted through the cervix into the
uterus and enables the doctor to see any uterine
abnormalities or growths. "Photos" are taken
for future reference. This procedure is usually performed
in the early half of a woman's cycle so that the build-up
of the endometrium does not obscure the doctor's view.
However, if the doctor is planning to do an endometrial
biopsy at the same time, it is done near the end of the
cycle.
- LAPAROSCOPY: A narrow fiber optic
telescope is inserted through a woman's abdomen to look
at the uterus, fallopian tubes, and ovaries and to
discern endometriosis or pelvic adhesions, and is the
best diagnostic tool for evaluating the ovaries. This
test is usually done two or three days before
menstruation is expected, and only after an HCG beta
blood test ensures the woman is not pregnant.
Occasionally, this diagnostic tool is turned into a
theraputic procedure. Laser surgery is often accompanied
with laparoscopy in order to free the uterus, fallopian
tubes, and ovaries of endometriosis or scar adhesions
that may be found.
- ENDOMETRIAL BIOPSY: This procedure
involves a scraping a small amount of tissue from the
endometrium shortly before menstruation is due---between
11 and 13 days from LH surge. It should ONLY be performed
after an HCG blood test shows the woman is not pregnant.
This test is used to determine if a woman has a luteal
phase defect, a hormonal imbalance which prevents a woman
from sustaining a pregnancy because not enough
progesterone is produced.
This information is courtesy of
InterNational Council on Infertility Information Dissemination
(INCIID).
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