Explore Your Options for Female Infertility Diagnosis & Treatment
The infertility evaluation of the female focuses on the number and quality
of eggs, the uterus and fallopian tubes. The initial tests assess these
factors which play an integral role in successful conception.
Egg Quantity
Egg quantity is assessed by measuring certain hormones and counting the
number of follicles in the ovaries by ultrasound.
AMH (antimullerian hormone) – AMH is a protein secreted by small cells within a follicle (the
cyst that holds the egg). It is secreted most intensely by the small follicles
that can be seen in the ovary on a transvaginal ultrasound at the beginning
of a menstrual cycle. AMH is a measure of the ovarian reserve, i.e. how
many eggs remain in the ovary. The level declines as a woman approaches
menopause. The test can be performed at any time in the menstrual cycle.
The AMH level helps physicians make decisions on how aggressive to be
in a patient's treatment plan. It also allows physicians to understand
if IVF (in vitro fertilization) is a viable option for a patient. When
the AMH declines below a certain level, IVF is less successful in achieving
a pregnancy.
Day 3 Labs - The combination of FSH (follicle stimulating hormone), LH (luteinizing
hormone) and estradiol hormones represents the communication pathway from
the brain to the ovary, and from the ovary back to the brain. By analyzing
all 3 labs together, physicians can detect subtle changes in the ovarian
reserve or in the way the brain and ovaries communicate with one another.
The most important of these three labs is the FSH. FSH is the primary
hormone secreted by the brain to signal to the ovaries that it is time
for an egg and its surrounding follicle to grow.
Egg Quality - Egg quality is related to a woman’s age, declining gradually once
age 30 is reached and declining more rapidly beyond age 35. The effects
of lower egg quality are lower pregnancy rates and higher rates of miscarriage
and birth defects.
Uterus and Tubes
There are several ways to assess the uterus and tubes.
HSG (hysterosalpingogram) - The HSG is an x-ray that allows the physician to evaluate the shape
and size of the uterine cavity as well as the appearance of the fallopian
tubes. It is performed in our office or at a radiology office. The patient
is situated in stirrups on the exam table, similar to when a pap smear
is done at the gynecologist's office. A speculum is then placed in the
vagina so that the cervix can be seen. A small, soft, flexible catheter
(a tube approximately the diameter of a coffee stirrer) is then gently
introduced through the cervix into the lower part of the uterus. A small
balloon is inflated which keeps the catheter in place. Radiographic dye
is introduced into the uterine cavity through the catheter. As the dye
fills the uterus and fallopian tubes, x-rays are taken. The physician
can then study the x-ray images. These may reveal a fibroid or polyp filling
up part of the uterine cavity, or an abnormal shape to the uterine cavity.
The fallopian tubes may appear blocked or damaged on the x-ray. This information
will allow the physician to determine the best treatment plan.
SIS (saline infusion sonogram) – Sometimes a more detailed evaluation of the uterine cavity is required
to make sure there are no abnormalities. SIS checks for endometrial polyps
or fibroids that may be on the inside of the uterus or pushing against
the cavity. It can also be performed to rule out deformities of the uterine
cavity present since birth. The SIS is performed similarly to the HSG.
A speculum is placed in the vagina and a small, soft, flexible catheter
is introduced through the cervix into the lower part of the uterus. A
small amount of saline (salt water) is then placed in the uterine cavity
through the catheter. At the same time, a transvaginal ultrasound is performed.
This allows for the distended uterine cavity to be evaluated and the presence
of polyps or fibroids noted.
Hysteroscopy – Hysteroscopy is a procedure that allows for direct visualization
of the inside of the uterine cavity. This can be done in the office, while
a patient is awake, or in a procedure room using anesthesia. A small diameter,
long metal tube is inserted through the cervix into the uterus. It is
attached to a camera that projects a picture onto a TV monitor. Saline
is pushed into the uterine cavity so that the uterus can be observed and
evaluated for scar tissue, polyps, fibroids or inflammation.
