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Fertility Tests
Dr. Deaton will order several fertility tests to assess the reproductive processes in both partners. Fertility tests evaluate the organ systems responsible for successful conception and pregnancy. A brief description of common fertility tests is included here and there are links to more detailed discussions.
In the female, the following biologic processes must occur to result in a pregnancy:
- The ovarian follicles, each of which contains an egg, are “recruited” from the ovaries under the influence of follicle stimulating hormone, FSH. FSH also supports the development of the ovarian follicles. The ovaries contain the lifetime supply of eggs at birth. The fertility specialist will order fertility tests to evaluate ovarian reserve which might include the Clomid Challenge fertility test.
- Several fertility tests are used to monitor follicular development. Ultrasound is used to visualize the follicles as they develop in the ovaries. The day 3 FSH level is an indicator of “ovarian reserve” and an abnormally high level may signal, “diminished ovarian reserve”.
- As healthy follicles mature, they produce increasing amounts of estrogen, which helps to stimulate endometrial development. The endometrium must thicken and become more vascular to support the implanting embryo. Fertility tests to evaluate the endometrium might include an endometrial biopsy.
- Progesterone stimulates and supports endometrial development and levels are elevated after successful ovulation. The “leftover follicle”, or corpus luteum, initially produces progesterone followed by placental production. Low levels of progesterone during the luteal phase of the cycle may lead to poor endometrial development, which is sometimes termed a “luteal phase defect”.
- Once the follicles mature, the eggs are ovulated and travel into the fallopian where fertilization occurs.
- The fallopian tubes must be open and free of obstructions in order for the fertilized eggs to reach the opening into the uterus. The hysterosalpingogram is an x-ray examination that examines the tubes and uterus. Other fertility tests, such as the laparoscopy are also used to evaluate the tubes.
- The reproductive organs must be free of significant scar tissue or endometriosis, which can attach to the pelvic organs and impair the fertilization process. A laparoscopy may be performed to examine the reproductive organs including the tubes, ovaries, uterus and other organs and to treat conditions such as endometriosis.
- The male must produce a sufficient quantity of “quality” sperm that are ejaculated into the vagina.
- The semen analysis is a fertility test that examines many sperm characteristics and is mandatory for all male partners.
- Once the sperm are ejaculated, they must travel “in” the cervical mucus through the vagina, cervix, and into the uterus. The post-coital fertility test (PCT) examines sperm after it has been exposed to the cervical mucus. Numerous dead or non-motile sperm may indicate the presence of antisperm antibodies. Since the cervical mucus is receptive to sperm only during the 3-4 days leading up to ovulation, the timing of the PCT is very important. Timing can be based upon the LH surge or when hCG is administered.
- The sperm must pass through the uterus to the end of the fallopian tubes where fertilization occurs. A sperm must attach to and penetrate the egg’s cell membrane.
- Once the sperm’s genetic material has combined with the egg’s, cell division begins and ultimately, a fetus is formed. The embryo must be free of genetic defects such as an abnormal number of, or broken chromosomes. The only way to document fertilization is during an in vitro fertilization cycle where it can be observed by the embryologist.
- The embryo travels into the uterus and imbeds in the endometrial lining. The lining must be vascular and thick to support the developing embryo. Progesterone supports endometrial development and is continually secreted by the placenta after a pregnancy is established.
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