The genetic screening of embryos prior to embryo transfer has greatly improved over the past decade. Today we can accurately test all expanded blastocysts prior to the selection of an embryo for transfer. Pre-implantation genetic testing (PGT) tests for the number of chromosomes present in an embryo and it identifies the sex chromosomes, which reveal the gender. Testing of embryos prior to the selection of an embryo for transfer allows one to transfer an embryo with the correct number of chromosomes thereby increasing the pregnancy rate and decreasing the miscarriage rate. Many patients find this genetic information helpful in planning their desired family.
After initial consultation with one of our fertility specialists, your physician will outline a series of tests in attempts to identify the cause(s) of your fertility problems. If a specific problem is identified, efforts will be directed at correcting the defect. In many cases there may not be a single factor causing infertility. We carefully investigate all possible causes and try to optimize each variable. The tests may include some of the following:
Anti-Müllerian hormone is a blood test that measures your ovarian reserve. This hormone is made by all the follicles present within the ovaries. With advancing age the number of follicles decline, causing AMH levels to fall. The AMH level can be used to predict the number of eggs to be produced per IVF or egg freezing cycle. The level can be an early indicator of declining ovarian reserve and advanced ovarian aging.
The level of FSH early in the menstrual cycle (when the estrogen level is low) is also a measure of ovarian reserve. A high level of FSH indicates decreased ovarian reserve and predicts a lower response to ovarian stimulation. The FSH level can fluctuate from month to month but a persistently elevated level is an indicator of decreased ovarian reserve or ovarian insufficiency.
Transvaginal ultrasound with Antral Follicle Count
A transvaginal ultrasound is an essential component of the female fertility evaluation. The ultrasound allows your doctor to visualize the uterus and ovaries to determine whether there are abnormalities such as uterine fibroids or ovarian cysts that could impact your ability to conceive. Additionally, an antral follicle count will be performed during the ultrasound. Similar to the AMH level, the antral follicle count is a measure of ovarian reserve and declines with advancing age, but it can vary quite a bit from woman to woman. This count is a helpful predictor of the number of eggs that could be retrieved during an egg freezing or IVF cycle, and low numbers can be an indicator of ovarian aging. It is used in combination with the AMH level to determine whether you are a good candidate for fertility procedures like IVF and egg freezing.
This is a basic test of sperm quality and quantity and provides important information on the functional capacity of sperm. If decreased parameters are found attention will be given to improving the sperm quantity and quality.
This is a specialized x-ray to evaluate the female reproductive tract, namely the uterus and fallopian tubes. This test is performed in a radiology suite, where a catheter is placed into the cervix using a speculum and dye is injected through the catheter while the X-ray machine takes pictures. This test can identify structural defects in the uterus that can interfere with embryo implantation or predispose to miscarriage, and can determine whether the fallopian tubes are open.
Sonohysterogram or hydrosonogram
This is a special type of transvaginal ultrasound which can identify structural abnormalities of the uterine cavity (the innermost space of the uterus, where pregnancy implants). This test is done in the clinic, where a catheter is placed into the cervix using a speculum and sterile water is injected into the uterus while a transvaginal ultrasound is performed, allowing your doctor to visualize the contour of uterine cavity. This test can identify important uterine abnormalities such as polyps, fibroids, intrauterine scar tissue (aka Asherman’s), and uterine septum, but unlike the hysterosalpingogram described above, it is not meant to test whether the fallopian tubes are open. If intrauterine abnormalities are present, surgery may be recommended to correct the abnormalities.
Additional fertility tests may also be recommended depending on the complexity of your case. At California Fertility Partners, we provide a detail-oriented and individualized approach to the diagnosis and treatment of every patient and couple in order to achieve the highest chance of success.