The initial fertility evaluation begins with a complete medical history
of you and your partner. Your ages, weights, menstrual history, current
medications, past pregnancy history will be considered.
Initial fertility testing will evaluate the health of your eggs and whether
they are being released each cycle.
Ovarian reserve (the quality and quantity of eggs available) is determined by doing a
vaginal ultrasound on day 2, 3, or 4 of your menstrual cycle for basal
antral follicle count. The follicle is the tiny “cyst” that
forms around an egg. Since the egg is microscopic, we use the basal follicles
seen on ultrasound as a surrogate for the number of eggs available.
On the same day, you will have blood work done for
follicle stimulating hormone (FSH),
luteinizing hormone (LH) and
estradiol. FSH and LH are pituitary hormones that stimulate the ovary to produce
an egg. Early in the cycle, FSH levels should be low. If the ovary is
not responding well, FSH rises and is a sign of diminished ovarian reserve.
Anti-mullerian hormone (AMH) is produced by the ovary. An AMH level is another way to estimate ovarian
reserve. It is particularly handy because the blood can be drawn on any
day of the cycle, in irregular cycles and even while a woman is taking
birth control pills. Low AMH levels are an indication of decreasing ovarian
reserve, whereas high AMH levels may be indicative of other ovulatory
disorders such as polycystic ovarian syndrome.
semen analysis is the initial test for male fertility. The semen specimen is produced
by masturbation. A sample should be collected after abstaining from ejaculation
for at least 48 hours, but not more than 5 days. It is evaluated for volume,
sperm concentration, motility and morphology. Total motile sperm should
be greater than 20 million per ejaculate. Often more than one analysis
is recommended. Some men will be referred for evaluation by a urologist
with a special interest in infertility. The urologic evaluation may include
a physical exam or blood work for hormonal or genetic concerns.
HSG or hysterosalpingogram is the radiologic study most often used to evaluate the shape of the uterus
and to determine whether the fallopian tubes are open. The HSG is done
between days 6 and 11 of the cycle (after menstrual flow has ended, but
prior to ovulation). A patient lies on a table under a fluoroscope (real-time
X-ray imager). The gynecologist or radiologist performs a pelvic exam
using a vaginal speculum to visualize the cervix. A balloon catheter is
placed in the cervix and a small amount of radiology contrast solution
gently fills the uterus and is observed as it flows through the fallopian
tubes and into the abdomen. Any abnormalities of the uterine cavity or
findings with regard to the fallopian tubes are noted immediately and
can be discussed with your physician.
The initial fertility evaluation is quite simple and can be completed in
a few days. An effective evaluation leads to a successful approach to
treatment and your best opportunity to move along in your journey to build
For more information and to schedule an appointment, please call 678-841-1089 or