Navigating the world of fertility testing isn’t easy. Trying to remember all of the medical terminology can bring you back to high school science class (and no one wants to go that far back). As a fertility nurse with more than 15 years of experience, I find myself answering a few key questions more often than others.
Below, I’ll define and explain common fertility testing terms that you might encounter before moving forward with fertility treatment. While some of this fertility testing can be accomplished at home, in-office testing can offer a few more data points and advantages. In fact, we also wrote an article on exactly that, at-home fertility testing vs. in-office.
For many couples, initiating the first steps to see a reproductive endocrinologist and start testing can cause a great deal of stress and anxiety. A woman should consider fertility testing if she has been actively trying to get pregnant by having unprotected intercourse on a regular basis with her partner for more than one year.
If a woman is age 35 or older, she should consider fertility testing after six months of trying to get pregnant. Your fertility center will help guide you through this testing process, often referred to as a diagnostic cycle. At Illume Fertility, you will have your own multi-disciplinary team, consisting of a primary nurse, patient navigator, and an insurance and billing advocate.
The eggs in a woman’s ovaries declines in quantity and quality with age. The rate at which it progresses can vary but can decline more rapidly after the age of 35. This means as woman age, the eggs inside their ovaries may also have a higher percentage of having genetic abnormalities.
While testing the quality of a woman's eggs isn't as clear and is often discovered when doing preimplantation genetic testing on embryos made through in vitro fertilization, the following are ways are simple tests looking into egg quantity prior to beginning any fertility treatment, like Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF).
AMH (Anti-Mullerian Hormone) is secreted from the egg follicles within the ovary and can be measured at any point in a woman’s cycle, even if she’s on birth control pills. It will give you a good “snapshot” of your remaining egg pool, also referred to as your “ovarian reserve.”
Basal Antral Follicle Count or (BAFC) is a simple tool to assess egg quantity. It is a transvaginal ultrasound done around day 3 of your menstrual cycle and counts the number of “resting” follicles seen on both sides of your ovaries. The higher your BAFC is, the better your ovarian reserve should be.
Day 3 testing is blood work done on cycle days 2-4 of a woman’s menstrual cycle. This includes an Estradiol (E2), Follicle Stimulating Hormone (FSH), and Luteinizing Hormone (LH). All these hormones will help your doctor assess your ovarian reserve and will help guide them when they discuss your treatment options.
How do we calculate the "Days" of a cycle? Consider the average 28 cycle (even if you don't have a regular 28 cycle, we can adjust the "days" according to your body): Day 1 of the cycle is the first day of a full "flow," not spotting. Day 14 is ovulation, and Day 28 is the final day of your menstrual cycle, before your have your period.
“Day 21” testing is blood work that is typically done around day 21 of your menstrual cycle to confirm ovulation. The testing window may need to be altered depending on the length of your menstrual cycle.
An Estradiol (E2) and Progesterone (P4) level is measured and will confirm if you have ovulated, and if you have enough hormones detected to support a pregnancy if implantation was to occur.
A saline sonogram is a transvaginal ultrasound that is performed while instilling a small amount of saline (water) into the uterus. It helps to assess for any abnormalities, such as fibroids or polyps.
It takes about 15-20 minutes to perform but can be very helpful to determine if there are any obstacles preventing you from getting pregnant. You may feel some cramping as the saline is inserted. The recommendation is to take Advil or Tylenol an hour before the procedure.
An HSG is an X-ray to assess your fallopian tubes. Dye is inserted into the uterine cavity, which will then spill into your fallopian tubes to determine if they are open. This is important to ensure there is no obstruction or abnormalities seen that may prevent pregnancy form occurring.
This also takes about 15-20 minutes to perform and can be uncomfortable as the dye is inserted. The recommendation is to take Advil or Tylenol an hour before the procedure.
A semen analysis (SA) is a test that analyzes a mans sperm count, sperm motility (movement of the sperm), and morphology (a reflection of the “shape” of the sperm). Sperm counts can vary daily, so you may need to do more than one depending on the sample collected.
Since 30% of infertility cases are related to male factor issues, it is very important to obtain this during an initial fertility evaluation.
Carrier testing for genetic disorders is an important part of the family building process. Here at Illume Fertility, we offer an expanded genetic carrier screening panel that looks mostly at autosomal recessive disorders. Testing can identify if you are a “carrier” for a specific genetic disorder.
Some examples of this would be Cystic Fibrosis, Sickle Cell Anemia, or Spinal Muscular Atrophy. Even if you don’t have a family history of any of these disorders, it is still possible for you to be a carrier for one or more of these diseases. For most of the disorders on the panel, you are not expected to have any health concerns.
If you and your partner are found to be carriers for the same recessive disorder, you would increase your risk of having a child affected with this disorder. For this reason, it is recommended that both partners proceed with testing to maximize the chance of having a healthy baby.
Our genetic counselors are an excellent resource for cases when both partners are found to be carriers for a genetic disorder, and will help educate you and provide guidance so you can make the most informed decision possible.
I understand that this is a fair amount of information to take in. It’s important to note that while most experience a similar degree of fertility testing and diagnostics, there are many different pathways to treatment that can result.
At Illume Fertility, everyone receives a treatment plan that is tailored to them. We often start with simple, non-invasive techniques like timed-intercourse before moving on to treatment therapies like intrauterine insemination (IUI), or in-vitro fertilization (IVF). We combine proven techniques with our state-of-the-art laboratory to give you the best chance of success.
If you have more questions or if you’re wondering about next steps, I recommend that you schedule an appointment with one of our fertility specialists who can help guide you to the right pathway, or simply, give you answers.