Dr. Heidi Kao and associates

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Diagnostic Tests for Infertility

HSG Test (Hysterosalpingogram)

Make Sure You Check for Blocked Fallopian Tubes

The HSG Test is your most important functional fertility test. Functional tests assess the function of the major reproductive organs, including the uterus, cervix, ovaries and fallopian tubes. Before any invasive investigations are done, checking for blocked fallopian tubes is a priority. If the sperm can’t swim through the fallopian tubes to fertilize the egg, conception won’t occur. Alternately, the egg won’t be able to travel from the ovary to the uterus if there is a blockage. If fertilization occurs, the fallopian tube carefully monitors the progression of the fertilized egg through the fallopian tube. Cell division from two to four to eight to sixteen to 32 cells happens at specific points along the channel. Once the fertilized egg reaches the blastocyst stage, the fallopian tube makes the call for when to release the blastocyst into the uterus.

Infertility Can Be Caused by Fallopian Tube Blockages

In order for proper cell division to take place, the tubes must be open, patent and able to move freely. The hysterosalpingogram test is the best way to test that you don’t have blocked fallopian tubes. The HSG test is usually done in a hospital with your doctor or a radiologist. Contrast dye is injected into the uterus with a small catheter. X-ray images are taken as the uterus fills with the dye and the dye spills out from the fallopian tubes. If there is spillage on both sides, then the fallopian tubes are open. Sometimes the fallopian tubes can spasm and this can prevent spillage on one side. In these cases, it’s probably a good idea to have the test repeated at a later date to determine if there is a blocked tube or no. As mentioned earlier, the hystosalpingogram is the most important functional test that you can do to assess your fertility. This is often the first evaluation ordered by your Ob-Gyn..

Vaginal Ultrasound

What kind should you request from your doctor?

A vaginal ultrasound is a very important part of a full fertility work up. It’s an integral functional test that allows your doctor to evaluate the function of your uterus and ovaries. Generally, your doctor is ruling out fibroids and polyps in the uterus that can interfere with embryo implantation. Also, she can rule out an endometrioma on the ovaries that can interfere with ovulation. So, we’ve talked about the purpose of the vaginal ultrasound, now what kind of ultrasound (u/s) procedures are commonly offered? Within gynecology, you may encounter a uterine ultrasound or an ovarian ultrasound. Both of these evaluate the health and function of the uterus and ovaries. There is also a full pelvic ultrasound that looks at all of the organs of the pelvic cavity.
Trans Vaginal Ultrasound
When looking for reasons to explain infertility, most doctors do a standard trans vaginal ultrasound. This involves placing the ultrasound probe into the vagina and looking at the ovaries and the uterine lining. As you can see above, the probe is looking through the vaginal tissue and the uterine tissue. Also, it’s important to note that the uterus is compressed on itself with this test, so it can be hard to definitively diagnose fibroids or polyps.

A Sonohystogram May be Preferred

Instead of a general vaginal u/s, some doctors order a sonohystogram, which is basically a saline ultrasound. This is the test that I encourage my patients to request. As you can see below, the sonohystogram allows your doctor to have a better view of the interior of the uterus and therefore it’s more accurate at diagnosing fibroids or polyps. Also, this test is better at definitively ruling out growths on the uterine lining.
Sonohystogram
Any doctor’s office that has an ultrasound machine can perform a sonohystogram, as the only difference with the standard trans vaginal u/s is that saline is injected into the uterus. The saline inflates the uterus and makes the interior lining much more visible on the ultrasound machine.If you feel that you would like an even more thorough evaluation of your uterine lining, you may want to read about another important functional test that you can do to assess the health of your uterus. Please be sure to read about this hysteroscopy procedure if you are concerned about miscarriage or implantation issues.

Testing for Infertility in Males

Infertility in males has gone up significantly in the past 60 years. Just 10 years ago, doctors were saying that male factor infertility accounted for 25% of the infertility cases. Now, some doctors are saying that 50% of couples that have trouble conceiving may have some degree of male factor. With these dire statistics, why isn’t a sperm test the first test ordered when you tell your doctor that you’re trying to conceive?

The Sperm Test

A sperm test should be the first test ordered by your doctor, if you’ve been trying to conceive for at least 6 months. It’s a totally non-invasive test and it’s helpful to know what your partner’s sperm numbers look like. A sperm test looks at the various characteristics of the sperm to determine the likelihood that conception may take place. These characteristics include:
  • Count: How many million sperm there are per milliliter of semen?
  • Motility: What percentage of sperm are moving?
  • Forward Progression: What is the quality of this movement on a scale of 1 to 4?
  • Morphology: What percentage of sperm are normally shaped?
  • Volume: What is the volume of the ejaculate in milliliters?

Hormone Tests for Women

Your doctor should order a FSH and Estradiol test Day 3 of your cycle. FSH is secreted by your pituitary gland in response to the estrogen produced by your developing follicles. When there are a good number of follicles secreting adequate amounts of estrogen, FSH will push to create a dominant follicle. The distinction that needs to be made in terms of normal FSH levels is are we measuring a woman’s predictive response to fertility drugs or are we measuring her fertility? I meet too many women that were told that they had a 1 in 100 chance of getting pregnant, based on their high FSH levels. Many of these women went on to conceive naturally. When you listen to doctors explain what high follicle stimulating hormone test results mean, you will usually here two key points. First, they will often say that test results over 10 predict that the woman will respond poorly to IVF. Then they will say that high FSH “can indicate” low ovarian reserve. Short of dissecting the ovaries, there is no definitive way to know if a woman is running out of eggs. The truth is that ob-gyns now push for FSH testing and are using it as a benchmark for women’s fertility, when if fact it tests a woman’s responsiveness to IVF drugs. Women with high FSH won’t respond well to IVF drugs, but this doesn’t mean that she won’t conceive on her own. Fertility specialists also use AMH (anti- Mullerian Hormone) tests as another way to measure ovarian reserve. It can be measured at any time of the cycle and measures the general reserve a woman’s ovaries has.

What is a normal AMH level? Interpretation of anti-mullerian hormone levels and chances for conception

There are some problems involved with interpretation of AMH hormone levels. Because the test has not been in routine use for many years, the levels considered to be “normal” are not yet clarified and agreed on by the experts. Also, not all current commercial assays give equivalent results. The table below has AMH interpretation guidelines from the fertility literature and our own experience. Do not get carried away with the cutoff values shown here. For example, the difference between a 0.6 and a 0.7 ng/ml test result puts a woman in a “different box” in this table – but there is very little real difference in fertility potential. In reality, it is a continuum – and not something that categorizes well.
Interpretation AMH Blood Level
High (often PCOS) Over 3.0 ng/ml
Normal Over 1.0 ng/ml
Low Normal Range 0.7 – 0.9 ng/ml
Low 0.3 – 0.6 ng/ml
Very Low Less than 0.3 ng/ml
More will be learned regarding anti-mullerian hormone levels and outcomes as we continue to use the AMH fertility test and study the relationship between AMH hormone values and fertility, ovarian responsiveness, chances for IVF success, etc. Progesterone tests are ordered for day 18-21 of a woman’s cycle to determine whether she has ovulated that cycle. Your progesterone test results tell you how much progesterone is being produced by the corpus luteum in your ovaries. Low progesterone levels can result in premenstrual spotting or worse, miscarriage. Progesterone deficiency is very common and that’s why it’s important to test your progesterone levels when you are trying to conceive.

Fertility Preparation Tips

To help your body produce the healthiest eggs and sperm possible, there are several things we suggest. It takes approximately 100 days for a resting ovarian follicle to be initiated and grow toward a pre-antral, antral, and then finally a dominant follicle state which is ready for ovulation. Similarly, it takes about 60-90 days for the final stage of sperm maturation. It is during this time that diet & lifestyle can contribute to the health of the eggs and sperm either negatively or positively. For this reason, we recommend both male and female partners begin acupuncture and Chinese herbal therapy about three months prior to wanting to conceive. At your initial appointment, we will make herbal, nutritional/diet, and lifestyle recommendations to help positively affect the eggs and sperm during this time.

Avoid cigarette and marijuana smoke

According to a British Medical Association report, it was found that: male smokers have a lower sperm count and a higher percentage of malformed sperm; males who stopped smoking improved both sperm count and quality; women smokers take longer to conceive, but those who have quit smoking do not take longer to conceive; women smokers are twice as likely to be infertile as non-smokers; and both men and women smokers have a poorer response to fertility treatment. (British Medical Association, 2004, www.bma.org.uk)

Avoid Coffee

An American study of 1,900 women found a 55% higher risk of not conceiving for women drinking 1 cup of coffee per day. For those drinking 1½-3 cups of coffee, the risk was 100% higher, and 176% higher for 3+ cups a day. (Yale University School of Medicine, Epidemiological Reviews Vol 14, pg 83, 1992)

Avoid Chemicals/Pesticides – Eat Organically and non-GMO foods

A Yale study on rats found that the use of products with the contaminant bisphenol-A (BPA), which is found in food storage containers and dental sealants, may cause fertility defects. (Yale University (2007, February 15). Plastics In Common Household Items May Cause Fertility Defects. ScienceDaily. Retrieved June 7, 2010)

Avoid Alcohol Use

A 2001 study of couples undergoing IVF and GIFT found that alcohol consumption for women as associated with a decrease in the number of eggs aspirated, an increase in miscarriage by 2.21 times if consumed within a week of the procedure, and 2.86 times as likely of reduced success if consumed within a month of the procedure. For men, those who drank in the month before the procedure increased risk of miscarriage from 2.70 to 38.04 times, as well as reduced IVF success by 2.5 times as much with the ingestion of just one drink a day. (Fertility and Sterility 2003;79:330-339)

Avoid hot tubs, jacuzzis

A three year study analyzing data from infertile men showed that repeated exposure to hot tubs or Jacuzzis can lead to male infertility, although it was found to be reversible in half of the men who discontinued the practice. (University of California – San Francisco (2007, March 7). Hot Tubs Hurt Fertility, Study Shows. ScienceDaily.) A study found the heat generated by placing laptop computers on your lap can impact sperm production and development, leading to fertility problems. (Loyola University Health System (2009, June 13). Laptops Linked To Male Infertility. ScienceDaily.)

Basal Body Testing

Taking your Basal body temperature first thing in the morning is a great diagnostic tool to help us determine whether you are ovulating and when you are in your cycle. Many of our patients use this as well as Ovulation predictor kits to help understand their cycles better and to get a good idea of when ovulation is occurring. Take your oral temperature around the same time every morning before you get out of bed, speak or drink water. It is also more accurate if you can take your temperature after 4 consecutive hours of staying in bed. You can chart your temperatures on line with websites such as Fertility Friend, or Babyhopes. You can also download a blank chart here in PDF or Excel format.

Creighton Model for Cervical Mucus

The advantages of the CrMS are numerous. First of all, it is safe! There are no known medical side effects associated with its use. It is inexpensive! The cost of FertilityCare™ services is considerably less than that of contraceptives. It is highly reliable and it is natural. The CrMS cooperates with the couple’s own natural fertility process. Another important advantage to the system is that it is a shared method of fertility regulation. The responsibility for its use is placed equally upon both spouses. To use this system successfully, it is necessary to make accurate observations and to chart them correctly. In addition, one must follow the instructions of the system which depend upon the couple’s decision to either achieve or avoid pregnancy. Also, the couple should be mutually motivated in its use and enter into it with a loving and cooperative spirit. As the couple learns more about their natural phases of fertility and infertility, they will begin to realize how important and vital these gifts really are. Unlike contraceptives, the CrMS treats fertility as a normal and healthy process. It does not treat fertility as a disease! The challenge to live in harmony with one’s fertility it often one of the most exciting and meaningful aspects in the use of this system. Most couples find that the love and respect each holds for the other grows as their understanding and appreciation of their fertility increases. It is a system that it firmly based in a respect for human life, human dignity and the integrity of marriage. Indeed, it is the couples who use this system and their families that benefit from this experience. http://www.creightonmodel.com/background.htm