Infertility Tests for women

These include ovarian reserve testing, progesterone tests, post coital test, biopsies and laparoscopy.

Hormone tests: these can be useful for checking for abnormalities in the endocrine system. The endocrine system is responsible for a variety of functions which includes the reproductive system.

One such hormone test is a progesterone check. This is carried out 7 days before your monthly period is due in order to check that you are ovulating. This takes the form of a blood test which checks for this hormone and others responsible for pregnancy.

Ovarian reserve tests: these are undertaken to determine the condition and function of your ovaries. It does NOT test whether you are ovulating or not; rather it is designed to see if your ovaries are in good shape or not. As they act as a repository for your eggs it is vital they are in the best shape they can be.

There are two types of results from this:

• Normal
• Poor

A normal result is not a guarantee of pregnancy: what it does say is that your ovaries are healthy and working properly.

But a poor result is exactly what it says: it means that it will be almost impossible to conceive.

There is a wide range of tests available which are:

• Day 3 FSH test
• Day 3 Estradiol test
• Clomid challenge test
• Antral follicle count
• Ovarian volume assessment
• Post coital test
• A hysterosalpingogram
• Pelvic ultrasound scan
• Endometrial biopsy
• Laparoscopy
• Hysteroscopy
• Thyroid function tests

Day 3 FSH test is usually carried out on the 3rd day of your menstrual cycle as this gives the most accurate reading of your ovarian reserve (number of eggs within your ovaries). FSH levels fluctuate throughout your cycle and peak at ovulation.

Your FSH level is measured along with your LH (luteinising hormone) and estradiol. This test takes the form of a blood test.

Day 3 estradiol test is exactly the same as the Day 3 FSH test. Estradiol is the most important form of oestrogen in the body and is responsible for the growth of the uterus, fallopian tubes and vagina. It also aids with breast development, body fat distribution and the development of external genitalia.

This also takes the form of a blood test.

So how do these tests determine fertility (or lack of it)?

It is linked to ovarian reserve in that it dictates the number of eggs present in your ovaries, but, and here’s the strange aspect of this, it does it in an inverse way.

In other words, high levels of FSH/estradiol mean poor quality ovarian reserve. Low levels are better, say 3 mIU/ml to 10 mUI/ml. More than 12 mUI/ml indicates a problem and 25 mUI/ml means ovarian failure. Certain ovulation drugs such as Clomid also raise FSH levels.

Conversely, very low FSH levels are equally undesirable. A reading of less than 2 mUI/ml can be found in women using birth control pills or suffering from hypogonadotropic hypogonadism.

Confused? Here’s a better explanation. Your ovaries contain a number of eggs which are needed for fertilisation. If your ovaries have a large number of eggs then your body doesn’t need to produce as much FSH for ovulation. So your FSH level is low.

But if your ovaries contain a limited supply of eggs then what happens is that your body has to work much harder to initiate ovulation so it increases FSH levels to put pressure on the ovaries. And a high FSH level means a decrease in egg supply which can prevent pregnancy.

It’s best to interpret your FSH level along with your estradiol level. A high estradiol level can suppress your FSH level which then gives a false reading. Basically, you are aiming for normal levels of both hormones as these indicate a healthy ovarian reserve.

The Day 3 FSH and Day 3 Estradiol tests tend to give limited results and because of that are not used very often.

You will find that specialists prefer the more accurate clomid challenge test (CCT), antral follicle count and ovarian volume evaluation.

The clomid challenge test involves measuring follicle stimulating hormone (FSH) levels and is more detailed than the standard Day 3 FSH test. It is carried out twice in the monthly cycle and measures both FSH and estradiol levels.

An antral follicle count involves counting the number of egg follicles present at the beginning of your menstrual cycle. It is done using transvaginal ultrasound and is considered to be a very good way of assessing your chance of success with IVF.

The more egg follicles you have the greater your chances of conceiving (and success at IVF). A count of 12 to 30 is good and over 30 is the best. However, more than 30 egg follicles can also be a sign of polycystic ovarian syndrome or problems with the quality of your eggs in general.

Ovarian volume evaluation (or assessment) involves the use of transvaginal ultrasound to measure the length, width and depth of both of your ovaries.

The ovaries do shrink as you age so the smaller the ovary the older you are in ‘reproductive age’ terms. Smaller ovaries also mean a less successful result from IVF than larger ones.

The post coital test is something you can do at home. It takes place at ovulation as this is the time when you have fertile cervical mucus. This mucus is examined shortly after sexual intercourse to analyse the interactions between sperm and mucus.

A sample of cervical mucus is taken shortly after sex and sent to a laboratory for further investigation. But it rarely used in the UK as it is seen as inaccurate and a poor indicator of infertility.

A hysterosalpingogram is a type of x-ray which shows the internal workings of the womb, ovaries and fallopian tubes. It can also check for growths and blockages. It is an alternative option to a laparoscopy.

But it can be painful so you will be given painkillers to take before the procedure.

The test involves the injection of a dye whilst you undergo the x-ray. If this dye flows easily then there is no problem but if there is a blockage then it will not pass through the womb or fallopian tubes.

A variation on this is a pelvic ultrasound scan which uses a transvaginal probe to show images of the womb and fallopian tubes. This is often used to observe the growth of eggs within the ovaries.

It can also check for polycystic ovarian syndrome or fibroids.

An endometrial biopsy is more intricate than an ultrasound scan but is not quite as versatile. A biopsy is a procedure carried out under a local or general anaesthetic and involves the removal of a small sample of tissue for further investigation. This investigation is carried out by a laboratory.

With an endometrial biopsy the sample is taken from the lining of the womb to check for polyps, vaginal bleeding, endometriosis or a hormone imbalance. It is performed via dilatation & curettage (known as a ‘D & C’) or a hysteroscopy.

A laparoscopy is an example of keyhole surgery in which the doctor will insert a small camera, mounted on a tube, into your abdomen. This is then passed down into your pelvic region and enables him/her to have a close look at your ovaries, fallopian tubes and womb. He or she can check for fibroids, growths, and blocked tubes, cysts on the ovaries and endometriosis.

He or she can take a small sample from the womb for further analysis or repair any damage.

There is minimal post-operative pain, reduced healing time, less scarring and a reduced risk of infection.

A hysteroscopy is very similar in that it consists of a small, thin tube which is inserted into the womb to check for any abnormalities. It is passed through the vagina and cervix and enables the doctor to look for fibroids, uterine septum and a ‘double womb’.

This procedure enables the doctor to take a closer look than with a hysterosalpingogram.

Thyroid function tests can be performed if a woman has irregular periods or shows abnormally high levels of prolactin – a hormone released by the pituitary gland that helps with breast milk production.

Very high levels of prolactin can inhibit ovulation.

The doctor will perform a blood test to check your prolactin levels if you have infrequent periods or an abnormal discharge from your breast.

Test results

Once you receive the results of your tests then your specialist will be able to decide upon a course of treatment. You will both undergo a series of basic tests to start with, which are carried out on every couple. These include an ultrasound scan for women and a sperm analysis for men.

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