The first step in investigating your fertility is a consultation with one of our Fertility Specialist's. During this appointment, your medical history and lifestyle may be comprehensively investigated. Birth control use, pregnancy history, frequency and regularity of menstrual cycles, medications used, surgical history, other health issues, your lifestyle, and your work/living environment may be discussed.
A thorough physical examination, including a pelvic examination may be performed and appropriate investigations / tests ordered.
After this initial consultation, your Fertility Specialist may proceed with further investigations.
Common investigations to evaluate fertility potential in women include:
1. Ovarian reserve – A blood test for Antimullerian Hormone ("AMH"). AMH is one test of ovarian reserve. There are other tests that are currently used to evaluate the remaining egg supply. None of the tests are perfect, and our Fertility Specialists will often use a combination of tests to try to get a better estimate of the size of the remaining egg supply. AMH is a hormone produced in ovarian follicles that advance from the primordial follicle stage. A primary follicle is defined be the presence of one or more cuboidal granulosa cells that are arranged in a single layer surrounding the oocytes. Primordial follicles are considered the fundamental reproductive units of the ovary because they give rise to all dominant follicles, and therefore to all menstrual cycles. At these stages follicles are microscopic and cannot be seen bu ultrasound. AMH production decreases and then stops as follicles grow. Since AMH is produced only in small ovarian follicles, blood levels of this substance have been used to attempt to measure the size of the pool of growing follicles in women, Research shows that the size of the pool of growing follicles is heavily influenced by the size of the pool of remaining primordial follicles. Therefore, AMH blood levels are thought to reflect the size of the remaining egg supply or "ovarian reserve".
2. Hormone levels – Follicle stimulating hormone ("FSH") and estradiol test. FSH is the hormone involved in producing mature eggs in the ovaries. When a woman goes into menopause she has high FSH hormone levels. By measuring a woman's FSH, we get an indication as to whether she has normal "ovarian reserve". Therefore, if the FSH is elevated the ovarian reserve (how many eggs are left) is reduced.
3. Antral follicle counts - Antral follicles are small follicles that can be seen, measured and counted using a vaginal ultrasound. Antral follicle counts is a tool used for estimating a woman's remaining fertility potential (or ovarian reserve). The number of antral follicles visible on ultrasound is indicative of the relative number of primordial follicles remaining in the ovary.
4. Ultrasound scans – To assess the thickness of the lining of the uterus (endometrium), to monitor follicle development and to check the condition of the uterus and ovaries, for example whether you have any fibroids or polyps, and ovarian cysts. It is essential to determine the presence of fibroids or polyps before any treatment is initiated. The presence of any of these structures could significantly compromise the likelihood of embryo implantation.
5. Hysterosalpingogram (HSG) – This is an x-ray of the uterus and fallopian tubes. A dye is injected through the cervix into the uterus and fallopian tubes. The dye enables the radiologist to see if there is blockage or some other problem.
6. Diagnostic Laparoscopy.
7. Hysteroscopy.
8. Endometrial biopsy – This is a procedure that involves scraping a small amount of tissue from the endometrium. This procedure is performed to assess the lining of the uterus.
The first step in testing your fertility with one of our Fertility Specialist's will be a general physical examination and medical history. This includes examining your genitals and questions about any inherited conditions, health problems, illnesses, injuries or surgeries that could affect fertility.
A semen analysis is a common test for determining if there is a male fertility issue. Semen is collected and examined in order to evaluate the presence of sperm, evaluate sperm count, shape, appearance, and mobility of the sperm. Your sperm may also be checked for signs of problems such as infections.
While determining the sperm count, the sperm will also be checked to determine if the concentration is above or below 15 million sperm cells per millilitre of ejaculation fluid. Over 15 million sperm per millilitre is considered normal, according to the World Health Organization reference values for human semen characteristics.
Your Fertility Specialist may also recommend additional tests. Common test can include:
Hormone testing – Hormones play a key role in sexual development and sperm production. A blood test to measure the level of testosterone and other hormones.
Testicular biopsy – This is where a small piece of tissue is removed from the tubules in the testes and examined to determine if sperm production is normal.
Genetic tests - A blood test can reveal whether there are changes in the Y chromosome — signs of a genetic abnormality. Genetic testing may also be ordered to diagnose various congenital or inherited syndromes.