Female Fertility Tests
Anti-Mullerian Hormone (AMH) Test
A woman’s AMH level provides us with crucial information for both diagnosis and treatment of subfertility. The level of this hormone in the blood reflects the extent of the remaining egg supply or ‘ovarian reserve’.
The AMH reading is not static and the levels are known to decrease with age, in the same way that a woman’s fertility decreases as she gets older. We are not only looking for unusually low levels of AMH because equally, excessively high levels of AMH may also adversely affect a woman’s ability to conceive.
The AMH level is an important piece of information to have for doctors of patients who are undergoing IVF. Its tells them how you are likely to react to the different types of hormones that we prescribe during your treatment as our aim is for you to have a moderate and controlled response to the medications. The AMH result allows us to modify the medications we use and tailor our approach to your individual case.
It is rare that we use this test in isolation and generally we will perform an ultrasound scan or other hormone blood tests like prolactin and thyroid stimulating hormone (TSH) as part of our assessment.
Uterine & Tubal Assessment
There are several ways that specialists can assess the condition of a woman’s uterus and fallopian tubes and it is important as part of a fertility assessment that these are considered. A transvaginal ultrasound scan will allow us to look at the uterus and ovaries to assess if they appear normal.
Most women who attend ReproMed will have at least an ultrasound scan as part of their assessment. It is usually carried out early in your cycle, is not considered to be painful and is quite quick. In some cases, our doctors may recommend an SIS (Saline Infusion Sonogram).
This test allows us to assess the appearance of the lining of the uterine cavity and to determine whether the fallopian tubes are open. If we find any polyps, fibroids or irregularities, or in fact if we ascertain that one or neither of the fallopian tubes are open it may be the reason that you have not been able to conceive and we use this information to treat you appropriately.
Female Hormone Blood Tests
The Anti-Mullerian Hormone is not the only hormone we are interested in when assessing fertility. There are several other hormones that when not at the optimum levels can negatively affect a woman’s (and indeed a man’s) fertility.
For this reason we routinely assess a number of hormones both before and during treatment cycles to make sure that we have established a full clinical picture in order to diagnose and treat fertility issues appropriately. Some of the blood tests you may see requested by the doctor are: Follicle Stimulating Hormone (FSH); Luteinising Hormone (LH); Progesterone; Oestradiol; Thyroid Stimulating Hormone; Prolactin to name a few. We may be looking for signs that a patient has an under or active thyroid, or may have signs of PCO, both of which can affect the ability to conceive.
Antral Follicle Count Scan
A follicle is fluid filled sac of specialised cells in your ovary which surround an oocyte or ‘egg cell’. When stimulated they multiply and expand creating a fluid filled cavity around the egg. Directed by hormones these cells encourage the development of the egg and once mature it can be successfully fertilised. In order to achieve a pregnancy a mature follicle must release an egg. Normally this occurs once a month around the mid part of the menstrual cycle and is called ovulation.
A trans-vaginal ultrasound scan will indicate the number of follicles present and their size. Follicles over 18mm are considered mature. The scan will also measure the thickness of the lining of the womb called the endometrium.
This scan can be used for diagnostic purposes or as part of most of our fertility treatment options.
Male Fertility Tests
A semen analysis is the primary tool used to assess semen quality and plays an essential role in the diagnosis of male factor infertility. The results offer an excellent overview of the health and fertilising potential of sperm.
We are able to ascertain three important pieces of information from a semen analysis: count, motility, and morphology.
A normal semen sample provided should contain sperm cells of more than 15 million cells per ml. 40% of the sperm should be motile, and 32% of these should be of good progressive swimming motion to help meet the egg in the fallopian tubes.
The shape and appearance of the sperm (morphology) is also important in the ability of the sperm to reach the egg and we expect that 4% of the sperm cells would be of normal morphology.
We also test to see if there are any immunological factors (your own antibodies) working against your own sperm.
By ascertaining if any or all of these three factors are outside the normal ranges we can make both diagnosis and recommendations for treatment.
Semen analyses are the most commonly performed tests in our clinic! Not because there are more men than women attending the clinic, but because we perform a semen analysis prior to every treatment, just to make sure that the sperm we are using on the day of treatment is approximately the same or better than it was when the doctor made recommendations for your treatment.
Sperm DNA Fragmentation Analysis
DNA holds each individual’s genetic code and every cell in our body contains DNA.
Sperm DNA is tightly packed during the final stages of sperm maturation and unlike other cells in our body, sperm DNA possesses very poor repair mechanisms. If a sperm cell with damaged DNA fertilises an egg, important genetic information may be missing resulting in poor fertilisation rates, poor embryo development and higher rates of miscarriage.
For this reason your doctor at ReproMed may recommend a DNA Fragmentation Analysis, the result of which will tell us what steps we need to make to either treat the problem in itself; and what fertility treatment is best for you and your partner to help you achieve a healthy pregnancy regardless of this problem.
Sometimes measures as minor as dietary and lifestyle changes can alter the results to well within the ideal parameters. We encourage our patients to opt for this test early in your fertility journey, but also to keep yourself as healthy as possible by reducing alcohol intake, reducing your BMI, giving up smoking and maintaining an appropriate temperature for your scrotum, all of which will greatly reduce the degree of DNA fragmentation and improve your chances of conceiving without intervention.