When embarking on a family building journey, understanding your fertility and reproductive health is crucial. When you start treatment at a fertility clinic, the process begins with a series of diagnostic tests to provide comprehensive insight into your fertility profile. We spoke with Sara Arian, MD, MSc, FACOG, double board-certified REI at Boston IVF, a part of the RMA Fertility Network and Progyny provider, to learn about how this allows your team to craft a personalized treatment plan tailored to your unique circumstances, setting you up for success.
Analyzing the Eggs and Ovaries
To understand the fertility health of an individual with ovaries, several tests are conducted to better understand their ovarian reserve and overall health. Ovarian reserve is a measure of how many eggs the individual has remaining and is an important predictor in how an individual might respond to fertility treatments. It is not indicative of whether a person will be able to get pregnant or not. The most standard tests to assess the ovarian reserve include bloodwork and a transvaginal ultrasound.
Bloodwork
Blood tests are conducted between days 2 and 4 of the menstrual cycle to measure hormone levels that regulate egg supply and ovulation. Key hormones analyzed include:
- Anti-Müllerian Hormone (AMH): Predicts the quantity of remaining egg supply.
- Estradiol (E2): A form of estrogen.
- Follicle Stimulating Hormone (FSH): A brain hormone that stimulates growth of a follicle.
- Luteinizing Hormone (LH): Signals egg release from the ovaries.
- Thyroid Hormones: Affect overall fertility health and ovulation.
The levels of these hormones, both individually and in relation to each other, provide critical information about ovarian function and egg supply.
Ultrasound
A transvaginal ultrasound is used to count the small follicles within the ovaries, known as the Antral Follicle Count (AFC). The AFC correlates with the egg supply, indicating the number of viable eggs available. A follicle is a fluid-filled sac that contains an egg. These types of ultrasounds may also be used to check the quality and thickness of the uterine lining.
Assessing the Uterus and Fallopian Tubes
In addition to understanding an individual’s ovarian reserve, it’s essential to assess whether any abnormalities in the uterus or fallopian tubes are hindering conception or maintaining a pregnancy. There are common tests to assess the health of the uterus and fallopian tubes, some of which may be recommended depending on the individual’s family building goals and medical history.
Hysterosalpingogram (HSG): An x-ray test using contrast dye to visualize the inside of the uterus and check for blockages in the fallopian tubes as well as signs of uterine fibroids, polyps, adhesions, and structural abnormalities.
Sonohysterogram (SIS): An ultrasound procedure with saline introduced through the cervix to image the inside of the uterus.
Hysteroscopy: A visual examination of the uterus and inside of the uterine cavity using a small, telescopic instrument inserted through the vagina.
Measuring Sperm Quality
If an individual with ovaries has not conceived and has a partner with sperm, it’s essential to rule out any sperm-related issues. The initial step is a semen analysis, which evaluates the number, movement, and shape of the sperm. This test helps determine the quality of the sperm, a vital factor in the conception process. For additional testing, the sperm-producer may be referred to a reproductive urologist, who specializes in male fertility.
Completing Genetic Testing
In addition to basic testing, identifying whether you or your partner (if applicable) carry any genetic disorders or mutations is a standard part of the initial fertility workup. Current technologies can test for more than 400 hereditary diseases, ensuring that potential genetic issues are identified early.
Common Causes of Infertility
The results of your initial evaluation are instrumental in allowing your reproductive endocrinologist and care team learn about what factors maybe be impacting your ability to conceive and what types of treatment will be most advantageous based on your unique situation. That being said, there are several common factors that can affect female fertility, of which your team will be especially cognizant:
- Age-related infertility
- Endometriosis
- Diminished Ovarian Reserve (DOR)
The Importance of Fertility Tests
Fertility tests are a fundamental part of understanding and addressing fertility challenges. These tests provide a comprehensive insight into an individual’s/both partners’ reproductive health, identifying potential obstacles and informing personalized treatment plans. From assessing ovarian reserve and uterine health to evaluating sperm quality and genetic factors, each test plays a crucial role in creating a clear fertility profile. This personalized approach ensures that individuals and couples receive the most effective treatments tailored to their unique needs, significantly increasing the chances of achieving their family-building goals. By demystifying the process and highlighting the importance of these initial evaluations, individuals are better equipped to navigate their fertility journey with confidence and hope.