Female fertility testing at a glance
Special imaging tests
This procedure provides information about the fallopian tubes and uterine cavity. The doctor injects a special dye into the uterus and then performs an x-ray to visualize the path of the dye through the fallopian tubes. This test allows the doctor to determine if the fallopian tubes are open and the uterine cavity has a normal shape. The entire procedure takes approximately 45 minutes.
This test is generally done between day 6 and 12 of a woman’s menstrual cycle. The test cannot be done if a woman is pregnant or has an active pelvic infection. If the patient is allergic to shellfish or other seafoods, it is likely she will also be allergic to the iodine or x-ray dye used in an HSG, so the procedure cannot be performed.
The procedure involves the use of a speculum, the same instrument used for Pap smear exams. The speculum helps open the vagina so the cervix can be seen. Two instruments are then attached to the cervix to fill the uterine cavity and fallopian tubes with dye. Several pictures are taken and then the instruments are removed. The woman may need to change positions on the table in order for the doctor to get better views. Cramping occurs while the uterus is full of fluid and for about 15 minutes afterward.
Risks of the procedure, although rare, nonetheless include:
- Allergic reaction to the dye
- Developing an infection from the procedure
- Damage to the pelvic structures from instruments
A light discharge and some vaginal spotting or bleeding is normal, as is mild to moderate cramping for 24 to 72 hours. The physician will provide instructions on post-procedure care and activities.
Sonohysterogram (saline infusion ultrasound)
When the inside of the uterus cavity needs to be evaluated, a doctor may perform a saline infusion ultrasound. During this procedure, a small amount of sterile solution is placed into the uterus to provide a better ultrasound image of the cavity.
A pelvic sonogram, also called vaginal ultrasound, utilizes a probe that is placed inside the vagina. The probe transmits sound waves that allow visualization of the organs in and around the pelvic cavity. The use of vaginal ultrasound helps the doctor see the wall and lining of the uterus, which are soft tissue and cannot be seen on regular X-ray.
Antral follicle count
In addition, antral follicles (small follicles in the ovary that are 2 to 8 mm in diameter) can be seen, measured, and counted with ultrasound. Pelvic sonogram is the best way to accurately assess and count these small structures. Presumably, the number of antral follicles visible on ultrasound is indicative of the relative number of microscopic (and sound asleep) primordial follicles remaining in the ovary. Each primordial follicle contains an immature egg that can potentially develop in the future.
Uterine fibroid detection
Uterine fibroids, which can be difficult to detect during a physical exam, are also commonly detected via ultrasound or occasionally by magnetic resonance imaging.
Blood tests for ovarian reserve
The term “ovarian reserve” refers to the reserve of the woman’s ovaries (remaining egg supply). A woman’s fertility (with the absence of any other fertility problems) mainly depends on the number and quality of eggs in the ovaries and how well the ovarian follicles are responding to the hormonal signals from the brain.
Ovarian reserve can be tested by measuring follicle-stimulating hormone (FSH) levels and estradiol levels, as well as with clomiphene citrate challenge and Anti-Mullerian hormone tests. (A fifth test can be done through ultrasound to measure antral follicle count – see above.)
Follicle-stimulating hormone (FSH)
Follicle-stimulating hormone (FSH), which helps control a woman’s menstrual cycle and the production of eggs, is tested to determine a woman’s ovarian function and evaluate the quality of her eggs. The test is done on day 3 of the menstrual cycle.
Estradiol is an important form of estrogen, and is tested in conjunction with follicle stimulating hormone (FSH) to measure a woman’s ovarian function and to evaluate the quality of the eggs. Estradiol testing is also used to measure the maturity of follicles and the resulting egg. Like FSH, it is done on the third day of a woman’s menstrual cycle.
Clomiphene citrate challenge test (CCCT)
A CCCT provides an additional assessment of ovarian reserve. It is performed by measuring the day 3 FSH and estradiol levels. Then the patient takes Clomid on days 5 through 9, and her FSH is measured again on day 10.
Anti-Mullerian hormone (AMH) test
The number of antral follicles (which produce eggs – see Antral Follicle Count section above) can be measured through an Anti-Mullerian hormone (AMH) test. The small follicles in the ovaries produce AMH, so the level of hormone detected correlates with how many antral follicles are in the ovaries. The more existing antral follicles, the better the woman will respond to fertility treatments.
Other Fertility Tests
This procedure is performed with a small telescope attached to a camera (called a hysteroscope) that lets the doctor look inside the uterus. Because the doctor has a direct view of the uterus, this procedure may provide the most accurate information.
An endometrial biopsy is a sampling of the uterus lining (endometrium) to test if it is able to support a pregnancy. The sample is viewed under a microscope and analyzed for abnormal cells and tested for balanced hormone levels. The biopsy can also detect infection in the uterus, which can be a cause of miscarriage.
Endometrial biopsy can also be performed to determine the cause of abnormal uterine bleeding, and diagnose uterine cancer or endometrial hyperplasia (an overgrowth of the lining). This test can be done at the same time as a hysteroscopy.
Thyroid-stimulating hormone (TSH) test
The level of thyroid-stimulating hormone (TSH) can be tested to check for thyroid disease. If TSH levels are lower or higher than the normal range (0.35 ml) (low TSH indicates hyperthyroid issues; high TSH indicates hypothalamic pituitary disease), the hormonal imbalance can cause anovulation (lack of ovulation) and other menstrual cycle problems, which cause infertility.
Prolactin hormone test
The prolactin hormone is produced by the pituitary gland. Elevated prolactin hormone levels found in pregnant and breast-feeding women cause milk production. However, if a woman who is not pregnant or breast-feeding has an elevated level of prolactin, it can cause abnormal breast discharge and lack of periods, which results in infertility.
Elevated prolactin levels can also indicate a tumor in the pituitary gland.