Ultimate guide to fertility
Hi everyone.
I am Dr Randy Morris.
I am a board certified fertility expert.
If you have not been able to get pregnant and you see your doctor, he or she will want
to do testing on you and your partner to try to figure out the reason or reasons why.
Today on InfertilityTV I will go through the basic tests that any good fertility specialist
will do and explain what they test and what a normal or abnormal result looks like,
First we will talk about the female side.
Test #1 Documenting ovulation - There are a variety of ways to document ovulation.
If you have already documented ovulation by using a home ovulation test, your doctor may
skip this.
A common way in which fertility doctors verify a woman is ovulating is by checking a hormone
called progesterone.
This is a blood test.
Progesterone levels in women are low before ovulation and increase after.
In most labs a progesterone greater than 2.5 ng/mL indicates ovulation.
A very important tip, progesterone levels vary at different times after ovulation so
scheduling this test correctly is essential.
Watch this video for more information.
If a person is not ovulating, then there are a number of additional blood tests that should
be done to try to determine the cause.
Test #2 Ovarian reserve testing.
Women produce all of the eggs they are ever going to have in their lives before they are
born.
Over time the eggs degenerate causing the number left to drop.
Because of this, older women generally have a lower amount of eggs and this makes it more
challenging to become pregnant.
Eggs from older women are also of lower quality.
This also makes it harder to become pregnant.
There are three tests that we commonly use to help us to estimate a woman’s reserve
of remaining eggs.
Two are blood tests.
AMH and FSH.
These blood tests should be obtained on the 2nd or 3rd day of a period.
Day 1 is the first day of full flow bleeding - not spotting.
Generally, you want your AMH levels to be high and your FSH levels to be low.
A normal FSH in most labs is less than 10.
AMH varies by age.
Use this graph to see what an average AMH is for your age group.
If you are average for your age or higher that is good.
The third test for ovarian reserve is an ultrasound of the ovaries.
Here is an ultrasound of an ovary.
These little black circles are called follicles.
Each follicle is a tiny cyst which contains a single egg.
By counting the number of follicles that are visible with ultrasound, we can get a rough
idea of a woman’s reserve.
A higher number of follicles is better.
A normal level is generally considered to be 10 or more follicles on each ovary.
Watch this playlist for more information about AMH and ovarian reserve testing
Test #3 Thyroid testing.
The thyroid gland produces hormones that are involved in all your body functions including
reproduction.
A thyroid gland that is producing too much or too little of these hormones can interfere
with your ability to get pregnant.
The function of the thyroid can, for nearly everyone, be measured by one hormone blood
test called TSH.
A TSH that is too low, less than 0.4, indicates an overactive thyroid.
A TSH level that is too high, more than 4 or 5 indicates an underactive thyroid.
An underactive thyroid is a much more common problem.
Either way, thyroid problems can be treated with medication.
To learn more about treating thyroid problems, watch this video.
Test #4 The Hysterosalpingogram - The uterus and fallopian tubes can each have abnormalities
that can interfere with the ability to become pregnant.
Uterine abnormalities can be divided into those that you are born with and those which
develop later.
Watch this video to learn more about uterine abnormalities.
In order to conceive on her own a woman must have at least one fallopian tube which is
open.
An open fallopian tube captures the egg from the ovary at the time of ovulation, allows
sperm up from the uterus and provides a place for the egg to be fertilized.
A blockage prevents these things from happening.
There is a test that allows your fertility doctor to see your uterus and fallopian tubes
at the same time.
This is an X-ray test called a hysterosalpingogram or HSG for short.
This test is done shortly after the bleeding from your period has ended but before you
ovulate.
The doctor will place a tiny catheter into the uterus and squirt some fluid inside.
This fluid is clear, like water, but it shows up on x-ray.
In this way, we can detect problems with the shape of the uterus or determine if there
are any masses inside.
If the fallopian tubes are not blocked, we will see the fluid flow through the tubes
and out the far end.
If there is a blockage, then the fluid flows up to that point and then stops.
At an advanced infertility treatment center like mine, we can actually open some kinds
of blocked tubes at the same time as the test.
Watch this video to learn more about opening blocked tubes
For the male partner, there isn't as much testing.
Basically, there are three questions that we want to answer about the male partner.
First, does he have any sperm?
Second, does he have enough moving normal sperm so that at least some sperm can reach
the fallopian tubes?
Finally, are the sperm able to fertilize an egg once it reaches one in the fallopian tubes.
To answer the first two questions, we do a test called a semen analysis.
For this test, a man ejaculates into a cup.
We take the fluid and look at it under a microscope.
We can see if there are sperm and if there are, we can calculate how many sperm there
are and all sorts of information about the movement.
Then, under much higher magnification, we can look at the shape of the sperm and calculate
what percentage look normal.
Around the world, fertility doctors use slightly different cutoff numbers to determine what
is normal.
A commonly used system states that normal fertility is a concentration of greater than
20 million sperm per milliliter, 50% moving and 25% with fast, forward movement and at
least 4% that look normal under the microscope.
Watch this video on how to interpret your semen analysis results.
Since the semen analysis does not tell us about the ability of sperm to fertilize eggs,
at IVF1, we also like to do a sperm function test like the Cap Score.
Learn more about that test in this video.
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