The first step toward a healthy and happy new baby is a complete Fertility Evaluation, starting with a thorough medical history – for both the woman and the man. The Evaluation, which may occur over multiple visits, consists of a 2D & 3D vaginal sonogram, hysterosalpingography (HSG, or the “dye” x-ray test), semen analysis, ovarian reserve evaluation, and possibly a saline infusion sonogram, or SIS.
An invaluable diagnostic tool, the vaginal sonogram provides a complete and comprehensive view of the uterus and ovaries. Occurring on your initial visit, this minimally invasive and well-tolerated 10-minute procedure provides a “medical image” of the uterus and ovaries that is imperative for a proper diagnosis.
Tubal obstruction is a frequent cause of infertility. To determine if the fallopian tubes are impeded or “blocked,” an HSG (also known as the “dye” x-ray test) is performed. A well tolerated procedure, HSG’s are not considered a surgery, and are performed on an outpatient basis. In fact, most women return to their normal daily activity right after having the procedure.
Most couples are surprised to learn that 40% of infertility is male-factor related. Conducted at the outset, a semen analysis will determine if there is a low sperm count, or low sperm motility (the percent of sperm actively motile, or “swimming”), or other abnormalities.
Women are born with a finite number of eggs, or oocytes – about 1 to 2 million. At puberty that number has already been reduced to approximately 500,000. Each month, during a process known as atresia, many eggs also die. Meanwhile, women ovulate only one egg each month, and it’s believed that women ovulate their best eggs at a younger age. When a woman is diagnosed with diminished ovarian reserve (DOR), hence the name, she has fewer eggs available. With a DOR, a woman can still become pregnant, though more fertility treatments may be required.
Here are the three primary methods to evaluate a woman’s ovarian reserve:
To determine if there is a diminished ovarian reserve as a result of a low antral follicle count, or AFC, a sonographic procedure is conducted to measure the overall size (or volume) of the ovaries. Since each small cystic structure (antral follicle) in the ovaries contains one egg, a count is also helpful to determine a woman’s ovarian reserve. While younger women generally have a higher AFC, a low AFC level indicates a diminished ovarian reserve. Interestingly, women with Polycystic Ovary Syndrome (PCOS) frequently have a very high AFC.
Early in the menstrual cycle (Day 2, 3 or 4 of the menstrual period), blood is drawn for hormonal testing (both FSH and elevated estradiol) as well as testing for a low AMH (anti-mullerian hormone), which would indicate a diminished ovarian reserve.
Offering a more specific diagnosis, a Saline Infusion Sonogram may be performed following a Basic Fertility Evaluation. Also referred to as a “sonohysterogram,” an SIS is an in-office ultrasound procedure to evaluate the uterine cavity for polyps, fibroids, uterine adhesions (Asherman’s Syndrome), and uterine abnormalities such as a bicornuate uterus. Like 2D & 3D vaginal sonography, a medical image is created without ionizing radiation from an x-ray.