Female Fertility Evaluation

Evaluation of female partner

Ovarian function

The menstrual cycle is controlled by the ovary through the cyclic development of eggs or oocytes. Testing ovarian function examines the hormones, estradiol and follicle stimulating hormone (FSH) early in the menstrual cycle. These hormones, along with thyroid-stimulating hormone (TSH) and prolactin, can help identify problems that might interfere with oocyte development or release.

Testing for ovulation

Urinary luteinizing hormone (LH) detection. Using a kit that comes with multiple detection strips, a woman can test daily around the middle of the month to try and detect the luteinizing hormone (LH) surge. This usually occurs the day prior to egg release and therefore might also be used to time intercourse or schedule IUI.

• Basal body temperature (BBT) charting. BBT charting requires the woman to measure her morning body temperature first thing in the morning and record the value to a 1/10th of a degree on a chart. In ovulatory women, the temperature usually rises after ovulation. This might be helpful in some cases, but cannot be reliably used to time intercourse.
• Ultrasound. Ultrasounds can be used effectively to check for follicle development and determine endometrial thickness. Vaginal probe ultrasounds give the best images and don’t require the patient to have a full bladder. In ovulation induction cycles, the ultrasound is used to count the number and size of follicles to determine when to release the eggs and to make sure it is safe to do so.
• Hormone testing. Progesterone is a hormone produced by the follicle after ovulation and is a sensitive measure of ovulation. It is usually measured around day 21 of a 28-day cycle, near the time of peak secretion from the corpus luteum. Low progesterone levels may require further treatment.
• Endometrial biopsy. After ovulation, the lining to the womb or endometrium, prepares for implantation of the fertilized egg or embryo. Once the embryo reaches a certain size it is ready to attach to the uterine lining. The endometrial biopsy is a method to evaluate the development of the endometrium or histology. We also recommend the evaluation of markers of uterine receptivity. Certain proteins are required for successful pregnancy to occur and might be missing in certain conditions, such as endometriosis, tubal disease or in polycystic ovary syndrome (PCOS). The biopsy requires proper timing and should be performed 8 or 9 days after the LH surge has occurred.

Evaluating fallopian tubes

Hysterosalpingogram (HSG) is a test performed with a radiologist and can detect whether the fallopian tubes are blocked or open. This test also can be used for evaluation of the uterine cavity. Patients getting an HSG are instructed to take an antibiotic for a day or two prior to the test. The evaluation only takes a few minutes to perform and you will usually be given the results the same day.

Evaluation of the uterine cavity

The uterine lining is where the newly fertilized egg will implant. Disruptions in the lining can occur. Problems with the uterus may include fibroids, endometrial polyps, adenomyosis, scarring or a uterine septum. While HSG traditionally has been used to evaluate the uterine lining, ultrasound has largely replaced it as a more sensitive and less painful approach. Any abnormalities observed can usually be treated. Hysteroscopy is a procedure in which the inside of the uterus is visualized. The procedure can be done in the office or the operating room and is a valuable way to evaluate and treat problems with the uterine lining.

Blood testing

In most women, we check the following with blood tests:

• Anti-mullerian hormone (ASH)
• Testosterone
• Dehydroepiandrosterone sulfate (DHEA-S)
• Follicle stimulating hormone (FSH)
• Estradiol
• Thyroid stimulating hormone (TSH)
• Prolactin