Infertility affects millions of Americans. In fact, 1 out of every 8 couples will experience an issue with infertility. Nevertheless, advances in assisted reproductive technology (ART) have made it possible for the great majority of couples who have been diagnosed with infertility to realize their dreams of having a family.
At Fertility Specialists of Texas, we perform a comprehensive evaluation to establish the cause of infertility and begin treatment in a stepped approach. In most cases, simple tests performed by our physicians can ascertain the cause of infertility within a couple of weeks. Based on the outcome of these tests, treatment can be as straightforward as utilizing medication to induce ovulation or more advanced treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
As a premier fertility clinic in North Texas, we offer a full scope of services designed to deal with each patient’s unique needs. Our services incorporate the latest technologies intended for correcting hormonal imbalances, surgical treatments, optimizing male infertility and IVF with blastocyst transfer.
Additionally, we perform semen analysis and donor insemination from various sperm banks that are FDA Approved and Certified. Some procedures, such as blood testing, are fairly simple; others, such as a hysterosalpingogram (HSG) or surgery, can be more invasive.
Blood Test Screening for Ovarian Reserve
Day 3 Follicle Stimulating Hormone (FSH) and Estradiol: Measuring the FSH on day 3 of the menstrual cycle is a good way to evaluate egg quality. Estradiol measurements confirm the accuracy of the test. FSH should be less than 12. This hormone is necessary for the maturation of an egg each month, and elevated levels may indicate diminished ovarian reserve. Estradiol on day 3 of the cycle should be greater than 10 but less than 68. An elevated estradiol may indicate the presence of an ovarian cyst or other fertility-related concerns. Very low levels may indicate that the ovaries are suppressed and may not respond to stimulation.
Anti-Mullerian Hormone (AMH): AMH is a substance produced by granulosa cells in ovarian follicles. With increasing female age, the size of the pool of remaining follicles decreases and the AMH levels and the number of ovarian antral follicles also decrease on ultrasound. Research shows that the size of the pool of growing follicles is strongly influenced by the size of the pool of remaining primordial follicles which are “resting”. AMH blood levels are thought to be a marker of the size of the remaining egg supply or ovarian reserve.
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An HSG is an X-ray that shows the interior contour of the uterus and fallopian tubes. This test is important because it can detect irregularities inside the uterus that could interfere with fertility. It also lets us know if the tubes are open so the sperm and egg can meet.
The HSG is performed by injecting a special dye through the cervix and observing the flow of the dye through the uterus and tubes on X-ray. This procedure is performed at our Frisco, Dallas and Grapevine locations by a reproductive endocrinologist.
An HSG must be done between menstrual cycle days 6 and 10. To schedule the procedure, please call our nurse on day 1 or 2 of your period and she will assist you. You will be given an antibiotic to take for 5 days beginning 2 days before the HSG to reduce the risk of any infection. We also recommend that you take 2-3 ibuprofen tablets 1 hour before your appointment because some women experience mild to moderate cramping during the procedure. Patients are usually able to drive themselves home, but you may wish to have someone accompany you.
A pelvic ultrasound will be performed at your first appointment by your physician who will be able to review the findings with you at that time. Ultrasound monitoring is often performed during the course of fertility treatment to evaluate impending ovulation and assess the thickness and pattern of the endometrial lining. Polyps, fibroids and ovarian cysts can also be identified on ultrasound.
Saline Infusion Sonohysterogram (SIS or SHG)
This test may be performed to evaluate the uterine cavity specifically. This test involves injecting a saline solution through the cervix into the uterus while imaging the uterus with a sonogram. This test may also be performed in the office. This allows the physician to visualize any irregularities that might interfere with fertility. It does not evaluate the tubes and does not take the place of an HSG. SIS fills the uterine cavity with saline, outlining the polyp which could not be discretely seen with routine ultrasound.
Genetic testing is offered to all women on their first visit to screen for common inheritable genetic disorders. The American College of Obstetricians and Gynecologists (ACOG) recommends that genetic testing for cystic fibrosis be offered to all couples attempting conception. If your family tree holds a genetic problem or birth defect, you’ll probably want to have genetic testing done. If you are a known carrier of a disease such as Tay-Sachs, cystic fibrosis or sickle cell anemia, you will want to have your partner tested, as well. These are recessive diseases, and therefore only if both partners are carriers are you at risk of having an affected child. If both partners are carriers for cystic fibrosis, preimplantation genetic diagnosis (PGD), can be performed on embryos from an IVF cycle. Unaffected embryos can be transferred to the uterus or frozen for future transfer.