Center for Reproductive Medicine

Initial Infertility Evaluation

Initial Infertility Evaluation

CRM suggests having an infertility evaluation if you have been having intercourse without contraception for one year and not conceived. If the female partner is 35 years of age or older she should consider an evaluation after 6 months of unprotected intercourse without a conception.

The initial evaluation can be completed in one menstrual cycle and usually consists of blood tests to evaluate ovarian reserve, testing of the uterus and fallopian tubes and a semen analysis to evaluate the male factor.

Ovarian Reserve Testing

Because ovarian reserve can impact fertility potential and the possible success of infertility treatments, its evaluation is usually part of every patient’s assessment. The quantity and quality of a woman’s eggs can be average for her age, better than average, or worse than average.

  • Ovarian reserve testing can tell us quite a lot about the remaining quantity of eggs, but it tells us little about the quality of those eggs.
  • Age is still the best way we have at this time to determine egg quality. We have no reliable tests that adequately reflect egg quality.

A number of tests reflect the remaining ovarian egg supply and thus attempt to identify those patients who have poor ovarian reserve.

  1. Cycle day 2 or 3 FSH and Estradiol levels.
    The FSH level reflects how hard the brain has to stimulate the ovaries to ovulate. Thus it is an indirect test of ovarian reserve. These tests are inexpensive, but the required timing is often inconvenient. The results vary from cycle to cycle and this test is generally insensitive. It is only helpful if the result is abnormal, as many patients with DOR will have normal levels and the diagnosis missed.

  2. Anti-Müllerian Hormone, (AMH).
    AMH is a hormone that is primarily produced directly by the pool of early growing follicles, which reflects the number of primordial follicles (ovarian reserve). Its major advantages are that it does not vary significantly throughout the menstrual cycle or from cycle to cycle. It is more sensitive test for detecting DOR. Levels will be low in DOR.

  3. Basal Antral Follicle Count (BAF).
    Transvaginal ultrasound can be used to count the number of early stage growing ovarian follicles (2mm to 10 mm diameters). This direct marker has been shown to correlate strongly with number of remaining primordial follicles, therefore ovarian reserve.

  4. Response to ovarian stimulation medications.
    Ultimately none of the predictive tests are as good at reflecting ovarian reserve as is the ovary’s ability to respond well to stimulation medications. Ovaries that respond inadequately to high dose injectable stimulation medications definitely demonstrate DOR. Thus, it is the most accurate predictive finding. 

Age

Average AFC (each ovary)

Range (25-75%)

20

15

11-21

25

13

9-18

30

11

8-15

35

9

6-12

40

7

5-10

45

5

4-7

None of the above diagnostic studies accurately predicts pregnancy rates.  They are most closely correlated with the number of eggs that may be produced in response to ovarian stimulation.

Hysterosalpingogram Procedure 

A hysterosalpingogram (known as an HSG) is an X-ray procedure that takes images of your uterus and fallopian tubes.  When your period starts, call CRM during Monday-Friday office hours to schedule an HSG.  The procedure should be done after your period is completely over but before you ovulate or anytime that you are on active birth control pills.

Saline Infusion Sonogram (SIS)

The sonogram is performed by your physician at the CRM clinic with the assistance of ultrasound.  The purpose of the sonogram is to evaluate the uterine cavity and to ascertain uterine measurements in preparation for an embryo transfer.  The physician will insert a small amount of fluid into the uterine cavity and will be able to observe and evaluate the uterine cavity on the ultrasound screen.

Semen analysis

The semen analysis is one of the first tests ordered. The male partner will typically be asked to provide a semen sample by masturbating into a sterile specimen container after 2-7 days of abstinence.

The semen analysis provides the following information.

  • How much semen is produced (volume)
  • The number of sperm in each milliliter of semen (concentration)
  • The percentage of sperm that are moving (motility)
  • The percentage of sperm that are the right shape (morphology)

The semen analysis can also suggest if there is an infection in the reproductive system.

Additional tests may be ordered based on the results of the first test.

If masturbation is not culturally acceptable, the lab can provide you with a special condom in which to collect semen during intercourse.