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FERTILITY TESTING

During a patient’s first visit to RMA at Jefferson, patients will be evaluated to determine why pregnancy has not yet occurred. Each patient will meet with one of our doctors, who will review the patient’s medical history and perform a comprehensive physical exam. Hormonal evaluation and ultrasound may also be performed. All of this, as well as other information, will be used to develop the right treatment plan, personalized for each patient.

fertility testing ovarian reserveOvarian reserve testing is the process of evaluating several hormone levels between days 2, 3, and 4 of a woman’s menstrual cycle to determine the quantity of eggs that she has available.

A blood sample is taken to evaluate estrogen (E2), follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), and luteinizing hormone (LH) levels.

FSH is a hormone that stimulates ovarian follicles (each follicle has the potential to release an egg) and is highly predictive of fertility. While elevated FSH levels mostly affect women in their late thirties and early forties, a younger woman with an elevated FSH level also has a reduced likelihood of establishing a pregnancy without the use of donor eggs.

AMH is a protein made by the cells that surround each egg. The more eggs a woman has, the higher her AMH level. A simple blood test can determine AMH levels. AMH levels can be drawn at any point in the menstrual cycle and results generally do not vary cycle-to-cycle. Ideally, AMH levels should be greater than 1.2 ng/ml. Levels less than 1.2 ng/ml are concerning and might lead to earlier or more aggressive fertility treatment to maximize the likelihood of a successful pregnancy. Low AMH levels are associated with a low likelihood of success.

LH is a hormone produced by the pituitary glands in the brain. An increased amount of LH is released when ovulation is about to occur. This increase allows the egg to mature within a follicle and sets ovulation in motion.

Another method to assess ovarian reserve and the chance for pregnancy is by assessing the woman’s antral follicles, which are small follicles that can be measured with ultrasound. An antral follicle count is a good predictor of the number of follicles in the woman’s ovaries that may produce a mature egg.

fertility testing amh

An anti-Mullerian hormone (AMH) test is used to determine the quantity of a woman’s ovarian reserve. AMH is a protein made by the cells that surround each egg. The more eggs a woman has, the higher her AMH level. A simple blood test can determine AMH levels. AMH levels can be drawn at any point in the menstrual cycle and results generally do not vary cycle-to-cycle. For the best results, the patient should stop taking birth control pills one to two months before having an AMH test.

Ideally, AMH levels should be greater than 1.2 ng/ml. Levels less than 1.2 ng/ml are concerning and might lead to earlier or more aggressive fertility treatment to maximize the likelihood of a successful pregnancy. Low AMH levels are associated with a low likelihood of success.

fertility testing clomidThe Clomid Challenge Test (also known as the clomiphene citrate challenge test, or CCCT) is a blood test used to assess ovarian reserve. Ovarian reserve is indicative of the quality and quantity of a woman’s eggs.

During this test, the patient’s Follicle Stimulating Hormone (FSH) level is taken on day two, three, or four of her menstrual cycle. FSH is responsible for stimulating the eggs in the ovary to begin maturation. On days five through nine she takes the fertility medication Clomid (clomiphene citrate). On day 10 of the cycle, FSH levels are obtained to assess the patient’s ovarian reserve. Blood tests are analyzed in our state-of-the-art, Joint Commission accredited, endocrine laboratory adjacent to our King of Prussia office.

fertility testing antral follicleAn antral follicle count test uses a transvaginal ultrasound (internal) in order to measure a woman’s ovarian reserve (quantity of eggs). Antral follicles are small sacks that each contain one immature egg. These follicles can be seen, measured, and counted on days 2, 3, and 4 of her menstrual cycle via ultrasound. An antral follicle count is a good predictor of the number of follicles in the woman’s ovaries that may produce a mature egg. Antral follicle count, along with a woman’s age and cycle day 3 hormone levels are great indicators for estimating ovarian reserve and a woman’s chance of getting pregnant with in vitro fertilization (IVF).

fertility testing semen analysisA semen analysis evaluates the quality and quantity of sperm by looking at:

  • Sperm count
    • Normal values:  ≥ 15 million/ml
  • Volume
    • Normal values: 2-5 ml
  • Motility (ability of sperm to swim)
    • Normal values: ≥ 50%
  • Morphology (size and shape of sperm)
    • Normal values: ≥ 30% of cells should be of normal shape
  • Forward progression of sperm
    • Normal values: 2.5-4.0 (scale of 0-4)
  • Liquefaction time (ability to go from normal gel-like state post ejaculation to a liquid state)

For this test, a semen sample is collected. The semen must be analyzed within a few hours after production to achieve the most accurate results. Semen analyses are performed in our state-of-the-art, Joint Commission accredited, andrology laboratory adjacent to our King of Prussia office.

hysterosalpingogram HSGA hysterosalpingogram (HSG) is an x-ray used to examine the uterine cavity, fallopian tubes, and pelvis. A radio-opaque dye is placed into the uterine cavity using a small plastic-tipped instrument. Information is gained about the size and shape of the uterus, as well as the appearance of the interior lining of the fallopian tubes, and of course, whether the tubes are open.

It is normal for women to have a sensation of warmth and some cramping during the procedure. Most women report that the discomfort is quite tolerable and usually resolves within an hour or two. It is recommended to take a Nonsteroidal anti-inflammatory (NSAIDS) drug such as Motrin® or Advil® about an hour prior to the procedure to decrease any cramping that may occur.

The test usually takes less than 5 minutes to perform and is typically performed after the patient’s period, but before ovulation.

femvueA sono hysterosalpingogram (HSG) is an ultrasound procedure used to assess the uterus and fallopian tubes. FemVue is the brand name of the device used to perform the sono HSG. During this procedure the FemVue device is used to disseminate an alternating pattern of saline and air into the uterus and fallopian tubes in order for the doctor to determine whether the fallopian tubes are open. It is recommended to take a Nonsteroidal anti-inflammatory (NSAIDS) drug such as Motrin® or Advil® about an hour prior to the procedure to decrease any cramping that may occur.

The test usually takes less than 5 minutes to perform.

HysteroscopyHysteroscopy is the process of inserting a hysteroscope into the vagina and through the cervix in order to examine the uterine cavity. A hysteroscope is a thin, tube-like device equipped with a light and a camera used to produce real-time video of the uterus. It is recommended to take a Nonsteroidal anti-inflammatory (NSAIDS) drug such as Motrin® or Advil® about an hour prior to the procedure to decrease any cramping that may occur.

A hysteroscopy is performed to diagnose and/or treat problems of the uterus that may be the cause of infertility. A hysteroscopy can also be used to remove fibroids or polyps from the uterus.

ultrasound

A transvaginal (internal) ultrasound uses high-frequency sound waves to create images of the vagina, cervix, uterus, and ovaries in order to diagnose certain types of infertility.

Ultrasound is used to monitor the ovulation cycle during monitoring visits.

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