Fertility Evaluation for Women
We recommend a basic fertility evaluation of all couples. This evaluation may occur before or after seeing one of our Genesis physicians.
Your fertility evaluation will include blood tests to measure your hormone levels. As well, we recommend an examination of your Fallopian tubes and uterus with a special a special x-ray called a Hysterosalpingogram (HSG).
The following is a list of typical tests used to assess your fertility and to prepare for pregnancy:
- Ovarian reserve testing – there are several different ways to assess your ovarian reserve. Common tests include: day 3 FSH (follicle-stimulating hormone), antral follicle count, and clomiphene citrate challenge. A recent review of ovarian reserve testing can be found here.
- Hysterosalpingogram (HSG)—this is a diagnostic x-ray that allows a study of your uterus and fallopian tubes
- Hysteroscopy
- Prolactin
- Thyroid stimulating hormone (TSH)
- VZV IgG (to test chicken pox exposure)
- Rubella titre
- Complete blood count
- Blood type
- HIV, hepatitis B, hepatitis C, syphilis testing
Day 3 FSH
What is a day 3 FSH?
One of the best ways to evaluate your fertility potential is to measure the concentration of the follicle stimulating hormone (FSH) on the 3rd day of your menstrual cycle. As a woman ages the number of eggs in her ovaries declines. As egg number or reserve declines the FSH level increases.
What is a day 3 FSH test used for?
The results of the day 3 FSH gives us a rough idea of the number of eggs in your ovaries at a given time. It helps us predict how well you might respond to the fertility medications used in assisted reproductive technologies (ART) like superovulation, IVF, and ICSI.
Although day 3 FSH levels may vary from cycle to cycle, it is the highest level of FSH on day 3 that is associated with the potential outcome of treatment. As a result, we may advise a woman not to proceed with ART treatment if her day 3 FSH level is elevated.
The methods used to measure the FSH level vary from clinic to clinic, and thus the level above which the FSH is considered to be elevated will vary among clinics. At the Genesis, we consider the upper limit of normal to be 12 U/L.
Your physician may use other estimates of ovarian or egg reserve such as a clomiphene challenge test or an antral follicle count.
Antral Follicle Count
What is an antral follicle count?
An antral follicle count is a vaginal ultrasound examination of the ovaries used to determine the number of antral follicles in each ovary. An antral follicle is a tiny (2-10mm) fluid-filled structure that contains an immature egg. As a woman ages the number of eggs or follicles in each ovary declines.
What is an antral follicle count used for?
Much like day 3 FSH testing, the antral follicle count (AFC) gives us an estimate of the number of eggs in your ovaries at a given time. An AFC is done prior to IVF or ICSI to help us predict how well you might respond to the fertility medications.
A woman’s day 3 FSH level can vary from month to month while the AFC varies less so. There is no single number of antral follicles that is considered low or high – a woman’s age and medical and fertility history are considered, along with her AFC to estimate her ovarian reserve. Typically, an AFC > 10 is reassuring, while an AFC < 5 is worrisome.
The Clomiphene Citrate Challenge Test
What is a clomiphene citrate challenge test?
This test, called “a provocative test,” is used to assess your fertility potential or ovarian reserve function.
Who is a clomiphene citrate challenge for?
This test gives us more information about your ovarian reserve if you have:
- Borderline high day 3 FSH level
- History of poor response to the stimulation of egg growth in a previous cycle of an ART
- Increasing female age
What does the test involve?
The test involves first measuring the cycle day 3 FSH and estradiol blood level. Then, after you take 2 tablets per day of clomiphene citrate (Clomid, Serophene) each morning from day five to day nine of the cycle, we do a repeat measure of your FSH and estradiol blood levels on cycle day 10 (the day after completing the clomiphene tablets).
If either the day 3 FSH or day 10 FSH level is greater than 12 U/L, the prognosis for a successful outcome with one of the assisted reproductive technologies like superovulation, IVF, or ICSI is very poor. If this is the case, we will discuss other options with you.
Hysterosalpingogram
What is a hysterosalpingogram?
A hysterosalpingogram (HSG) is an X-ray test that looks at the inside of your uterus and fallopian tubes.
What is a hysterosalpingogram used for?
A hysterosalpingogram shows:
- Abnormalities in the uterus or fallopian tubes
- Blockages preventing the egg from moving through a fallopian tube to the uterus
- Blockages preventing the sperm from moving into a fallopian tube and fertilizing the egg
- Problems on the inside of the uterus preventing a fertilized egg from attaching to the uterine wall
What does a hysterosalpingogram involve?
During a hysterosalpingogram, a radiologist injects a dye through a thin tube that is inserted through the vagina and into the cervix. The radiologist takes pictures using x-ray (fluoroscopy) as the dye flows through the uterus and into the fallopian tubes. If there is any blockage or problems with your uterus, this will show up on the x-ray.
Some women find this test to be quite “crampy,” so we suggest that you take 2 tablets of Ibuprofen (e.g. Advil or Motrin) about one hour prior to the procedure.
Hysteroscopy
What is a hysteroscopy?
A hysteroscopy is a procedure where the doctor passes a hysteroscope—a narrow, telescope-like instrument with a camera on the end—through your vagina and cervix and into the uterus to directly examine the interior of your uterus.
What is a hysteroscopy used for?
This procedure is used to determine if you have any fibroid tumours, polyps, scar tissue, or other obstructions that could be affecting your fertility.
What happens during the procedure?
During the procedure, the doctor inserts the hysteroscope into your uterus and may inflate the uterus with gas or saline liquid to get a better view of the uterine interior.
If the doctor finds anything abnormal, he or she may remove a small sample for further examination. You don’t need to have an incision with a hysteroscopy, and most women recover within an hour or two.
Because many women find this test to be quite “crampy,” we suggest that you take 2 tablets of Ibuprofen (e.g Advil or Motrin) about one hour prior to the procedure.
For more information on fertility testing, see: