When women present to an infertility clinic, the first consultation is an
opportunity to know about their medical history and carry out a fertility
assessment. The result of this assessment helps with the preparation of a
personalized fertility treatment plan that addresses your wishes and
aspirations of having a healthy baby.
1. ASSESSMENT OF OVARIAN RESERVE
This test is done to assess the quality and quantity of eggs in your ovaries.
A woman needs a good amount of high-quality eggs to get pregnant. Both
the quality and quantity of eggs reduce rapidly after age 35.
Different Tests to assess the ovarian reserve include:
Anti-Mullerian Hormone [AMH]
This is a hormone present in women of reproductive age that gives us an
idea of the number of follicles in your ovaries and the chances of a
pregnancy occurring. The test can be carried out at any time of the
woman’s cycle and involves a blood sample.
Normal value: 1.0 – 4.0 ng/ml
Reduced value: Less than 1.0 ng/ml
Elevated value: More than 4.0 ng/ml [risk of polycystic ovary]
Hormonal Profile
A blood sample is taken on the 3 rd day of menses to assess for Follicle
Stimulating Hormone [FSH] and Estradiol. An elevated FSH level indicates
a reduction in the number of eggs. An elevation In prolactin levels indicates
hyperprolactinemia which needs to be treated.
Antral Follicle Count [AFC]
The doctor will perform a transvaginal ultrasound scan on day 3 of the
cycle. This procedure checks for the number of follicles available just after
the menses. It gives an idea of the fertility potential of the woman. 6 – 10
follicles per ovary are considered normal. If the follicles are less than 6, the ovarian reserve is considered low. These follicles usually vary in size from
2-10 mm.
2. ASSESSMENT OF FALLOPIAN TUBES
These tests are done to determine the patency of the fallopian tube and the
status of the uterine cavity to ensure the fertilized egg can implant in it and
thrive. A woman must have one or both tubes patent for the sperm to reach
the eggs after intercourse. If the tubes are blocked pregnancy will not occur
naturally.
Tests to assess this include:
Hysterosalpingogram [HSG]
This is an X-ray test in which a radio-opaque dye is injected into the uterus
to outline the endometrial cavity and the fallopian tube. The test is carried
out within the first 5 days after menses.
Saline Sonohysterogram
This is an imaging study of the uterus using a transvaginal scan to view the
uterine cavity and the fallopian tube while inserting fluid into the uterus via
the cervix. It picks up conditions like endometrial polyps and endometrial
fibroids.
Laparoscopy and Dye Test
A laparoscopy and dye test is an operative procedure to look at your
internal organs usually the fallopian tube using a telescope and a monitor.
A blue dye is pushed through the vaginal and the fallopian tube to check if
the fluid flowing out through the other end of the tube. It is usually the gold
standard test for checking if the fallopian tubes are open.
