The purpose of these tests is to diagnose the most common fertility problems.
In a Basic Fertility Study we need to know if ovulation is occurring, if the fallopian tubes are permeable and if there are an acceptable number of motile spermatozoids. Additionally, we must evaluate ovarian reserve if the female is over the age of 35, or in women under the age of 35 if we suspect poor ovarian response. For women who have irregular cycles we will also need to evaluate their basal gonadotropin levels (FSH and LH), as well as prolactin and progesterone during the second phase of their menstrual cycle (days 20-22).
Patients with infertility do not present a greater number of thyroid conditions than the general population, meaning a thyroid function study will only be performed if a thyroid disorder or abnormal menstrual cycles are suspected, or in women who do not ovulate.
To evaluate ovulation we must test the female’s level of progesterone between days 20-22 of her cycle, or a few days later in women who have longer cycles.
The hysterosalpingogram is the method of choice for determining whether the fallopian tubes are permeable, as this technique also allows us to evaluate the uterine cavity at the same time. This procedure involves introducing a radio opaque contrast (which doesn’t let X‑rays pass through) through the cervix and into the uterus and fallopian tubes. At the same time, X‑rays are taken to watch the contrast as it moves. As this procedure can be a bit uncomfortable, it’s not necessary to have it carried out in cases of severe male factor infertility if a previous transvaginal ultrasound has not shown signs of a condition in the fallopian tubes.
In order to evaluate the male factor the doctor will order a sperm study (semen analysis), as it is essential for us to know the number and motility of the spermatozoids, though morphology is not quite as important. A male’s results can differ greatly depending on several factors, making it important to undergo testing again after at least 3 months have gone by (as this is the amount of time it takes for spermatozoids to completely form), especially when the first analysis has yielded abnormal results.
At our clinics we also recommend undergoing the sperm DNA fragmentation study, as elevated levels of fragmented sperm DNA can negatively affect sperm functioning as well as the results of a cycle of assisted reproduction.
Finally, in order to assess the female’s ovarian reserve, there are several recommended analyses such as testing her levels of FSH (Follicle Stimulating Hormone) and estradiol, antral follicle count by means of a transvaginal ultrasound performed on both ovaries and a blood test to determine her Anti-Mullerian Hormone value.
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These tests provide information in terms of the female’s ovarian response as well as the number of oocytes that can be collected from ovaries undergoing ovarian stimulation. However, these tests cannot provide us with information regarding egg quality, nor her chances of successfully becoming pregnant. Thus, the purpose of these tests is to make it possible for the doctor to make a recommendation. Although these are clinical levels, we should not exclude patients from undergoing assisted reproduction treatment except in cases of extremely irregular results.
Clinical recommendation guidelines recommend that the local fertility team be in charge of deciding the order and preference of the ovarian reserve tests (Anti‑Mullerian Hormone, FSH and antral follicle count), depending on their diagnostic possibilities, the clinic’s laboratory and the sonographer’s capabilities.
Dr. José Martín Vallejo
Gynaecologist at Ginemed Valencia’s Assisted Reproduction Unit