Instructions for Fertility Testing

Ovarian Reserve Testing

A decrease in egg quality and/or quantity (diminished ovarian reserve) can lead to infertility. Although diminished ovarian reserve is more common among women entering their mid to late 30s and 40s, younger women can have problems with their ovarian function as well. Ovarian reserve testing can help your doctor diagnose a cause of infertility, as well as guide the dose of medication if treatment is desired.

Blood work

Your doctor may order blood work to test for problems with ovarian reserve. The tests are usually done at the beginning of the menstrual cycle and are testing hormones produced by the pituitary at the base of the brain and the ovary. The tests may include FSH, LH, Estradiol, and AMH blood levels.

How the test is performed: A simple blood draw is done early on in the menstrual cycle. You should contact the Fertility Institute of Hawaii on day 1 of your menstrual cycle to schedule these tests if your doctor has ordered them.
How to prepare for the test: There is no preparation needed.
How the test will feel: You may feel a small pinch during the blood draw.
How the test is interpreted: A high FSH value and low AMH value can be indicative of diminished ovarian reserve. Your doctor will receive the results of your ovarian reserve testing and interpret them. Each test is like a piece of a puzzle, and your doctor will take all results into account when making decisions with you about your treatment plan.

Ultrasound

Your doctor may perform an ultrasound to evaluate the number of antral follicles visible in the ovaries. Antral follicles are small follicles (2-8mm in diameter) that contain eggs. The number of follicles seen on ultrasound correlates with ovarian reserve.How the test is performed: A transvaginal ultrasound is done to assess the ovaries. During the ultrasound, the number of antral follicles will be counted and recorded. Other findings noted during the ultrasound such as ovarian cysts or uterine fibroids will also be noted and discussed with you.

How to prepare for the test: You will be asked to empty your bladder prior to the ultrasound.
How the test will feel: Some women may find the vaginal ultrasound uncomfortable but it should not be painful. Please let your provider know how you feel and if you have any concerns during the test.
How the test is interpreted: A low antral follicle count may be indicative of diminished ovarian reserve. An abnormally high antral follicle count may be also associated with conditions that can impact fertility such as PCOS. Your doctor will interpret the results of your antral follicle count along with the other ovarian reserve testing to determine if diminished ovarian reserve may be contributing to your trouble getting pregnant. Your doctor will also use this information to guide a treatment plan.

Uterine testing

Abnormalities within the uterus such as scarring, fibroids, polyps, and uterine anomalies can be associated with infertility and miscarriage. Some uterine problems are also associated with lower success rates after in vitro fertilization. Although a simple ultrasound may be suggestive of a uterine abnormality, it is usually not enough to make a definitive diagnosis.

Sonohysterogram

Your doctor may order a sonohysterogram to determine if a uterine abnormality is contributing to your trouble getting pregnant. This test may also be ordered prior to a fertility treatment cycle to ensure that a problem within the uterus will not lower your chances of conceiving.

How the test is performed: This test is usually done early in the menstrual cycle. A speculum is placed and a very thin catheter is inserted through the cervix into the uterus. A small amount of salt water is pushed into the uterus. A vaginal ultrasound is done at the same time.
How to prepare for the test: You will be asked to empty your bladder prior to the test. A urine pregnancy test will also be done prior to performing the test. You should contact the Fertility Institute of Hawaii on day 1 of your menstrual cycle to schedule your sonohysterogram if your doctor has ordered it.
How the test will feel: You may feel some cramping. Mild cramping during this procedure can be normal, and does not suggest that you are being injured. Any discomfort usually only lasts for a few moments and goes away after the procedure is over. Please let your provider know how you feel and if you have any concerns during the test.
How the test is interpreted: The provider performing your sonohysterogram will interpret your test while it is being done. If there are any abnormalities noted during the test, you will find our immediately and a full explanation will be provided. Depending on the type of abnormality noted, additional testing and/or treatment such as a hysteroscopy or pelvic MRI may be necessary.

Hysteroscopy

Your doctor may order a hysteroscopy to further evaluate and treat a potential uterine abnormality. This procedure is usually ordered after an abnormal sonohysterogram. Hysteroscopic procedures can be done to treat polyps, fibroids, uterine scarring, and certain uterine anomalies.How the procedure is performed: This procedure is usually done in the operating room. You will have a preoperative consult with your physician prior to having the procedure. During a hysteroscopy, a camera is inserted through the cervix into the uterus. The uterine abnormality can be directly visualized and treated in this way.

How to prepare for the procedure: You will be given detailed instructions on how to prepare for this procedure. You should not eat or drink anything starting at midnight the night before your procedure.
How the procedure will feel: This procedure is usually done under anesthesia and is therefore painless. After the procedure, most women feel well but may have some mild cramping or bleeding. The recovery time after the procedure is very short, and most women return to work the next day. You will also be given thorough post-procedure instructions depending on what type of uterine abnormality was found.
How the test is interpreted: Your physician will interpret the findings of your procedure based on direct visualization with a hysteroscopic camera. Depending on the type of uterine abnormality noted, biopsies may be taken and sent to pathology for additional testing.

Fallopian tube testing

After ovulation each month, an egg travels from the ovary into one of the fallopian tubes where it is fertilized by a sperm. The early embryo then continues to travel through the fallopian tube until it reaches the uterus and implants. A fallopian tube obstruction can hinder this process and negatively impact fertility.

Hysterosalpingogram (HSG)

Your doctor may order a hysterosalpingogram to determine if your tubes are open. The test utilizes an x-ray to determine if one or both of your fallopian tubes are open.How the test is performed: A speculum is inserted through the vagina and a thin catheter is placed through the cervix into the uterus. A dye will be pushed through this catheter and an x-ray will be taken at the same time. If the fallopian tubes are open, dye will fill the tubes and spill into the pelvic without difficulty.

How to prepare for the test: This test is usually done early in the menstrual cycle. If your doctor has ordered a hysterosalpingogram, please call the Fertility Institute of Hawaii on day one of your menses to schedule the test and obtain further instructions.

How the test will feel: You may feel some cramping. Mild cramping during this procedure can be normal, and does not suggest that you are being injured. Any discomfort usually only lasts for a few moments and goes away after the procedure is over. Please let your provider know how you feel and if you have any concerns during the test. This information will help guide the type of fertility treatment that will work best for you.

How the test is interpreted: This test is usually performed by a radiologist who will send a report of the results to your doctor.

Sonohysterosalpingogram (Sono HSG)

Your doctor may order a Sono HSG to help determine if one or both of your fallopian tubes are blocked. This test is similar to HSG but does not utilize x-ray.How the test is performed: A speculum is inserted through the vagina and a thin catheter is placed through the cervix into the uterus. A mixture of air bubbles and water are pushed through the catheter and a vaginal ultrasound is done at the same time. If the fallopian tubes are open, air bubbles will be seen on ultrasound spilling out the tubes into the pelvis.

How to prepare for the test: You will be asked to empty your bladder prior to the test. A urine pregnancy test will also be done prior to performing the test. You should contact the Fertility Institute of Hawaii on day 1 of your menstrual cycle to schedule your Sono HSG if your doctor has ordered it.

How the test will feel: You may feel some cramping. Mild cramping during this procedure can be normal, and does not suggest that you are being injured. Any discomfort usually only lasts for a few moments and goes away after the procedure is over. Please let your provider know how you feel and if you have any concerns during the test.

How the test is interpreted: The provider performing your Sono HSG will interpret your test while it is being done. If there are any abnormalities noted during the test, you will find our immediately and a full explanation will be provided. Depending on what is found, your doctor may order an HSG to obtain more information about your fallopian tubes.

Male fertility testing

Problems with male fertility account for a large proportion of infertility. Male fertility testing can help determine a cause of infertility, as well as help guide treatment. There are various treatment options for couples with male factor infertility, including intrauterine insemination (IUI) and IVF with intracytoplasmic sperm injection (ICSI).

Semen analysis

A semen analysis quantifies the number, motility, and shape of sperm present at the time of ejaculation. Although semen parameters may fluctuate from day to day, consistently low numbers may indicate that a sperm problem is contributing to your infertility.

How the test is performed: A member of the andrology staff will escort you into a private collection room. You will collect your specimen sample by masturbation into a specimen container that we will provide. Lubricants including saliva should not be used as they are toxic to sperm. Once you have collected your entire specimen, you will place your container into a small receptacle in the wall.

How to prepare for the test: You should abstain from ejaculation for 2- 7 days prior to your semen analysis. Call the Fertility Institute of Hawaii to schedule your semen analysis.

How the test will feel: You should not experience any discomfort or pain.

How the test is interpreted: The lab will examine the specimen and analyze the volume of ejaculate, the number of sperm, the motility of the sperm, and the morphology (shape) of the sperm. These results will then be communicated with your ordering physician and will be available within a few days.

Testing for recurrent pregnancy loss

Recurrent pregnancy loss is defined as having suffered from 2 or more miscarriages. Aside from the usual fertility testing, your doctor may order some additional tests to determine if there is a treatable cause of your miscarriages.

Blood tests

Your doctor may order blood work to help find the cause of your miscarriages. This usually involves testing for problems with the immune system (antiphospholipid syndrome) as well as karyotype testing (looking at the number of chromosomes in female and male patients).

How the test is performed: A simple blood draw is done.
How to prepare for the test: There is no preparation needed.
How the test will feel: You may feel a small pinch during the blood draw.
How the test is interpreted: Your doctor will receive the results and interpret them with you. Depending on the abnormality, treatment may include blood thinners or preimplantation genetic diagnosis. Your doctor will thoroughly review your results and treatment options with you at a follow-up visit.

Endometrial biopsy

Your doctor may order an endometrial biopsy. This procedure involves taking a tissue sample from the lining of the uterus and checking it for any abnormal cells or signs of inflammation.

How the test is performed: A speculum will be inserted into the vagina and a thin, hollow plastic tube is inserted through the cervix into the uterus. Gentle suction removes a sample of the endometrial lining. The sample that is obtained is part of the lining that you shed every month during menses. A pathologist will examine the specimen under a microscope.
How to prepare for the test: A urine pregnancy test will be done prior to performing the test. You should contact the Fertility Institute of Hawaii on day 1 of your menstrual cycle to schedule your endometrial biopsy if your doctor has ordered it.
How the test will feel: You may feel some cramping. Mild cramping during this procedure can be normal, and does not suggest that you are being injured. Any discomfort usually only lasts for a few moments and goes away after the procedure is over. Please let your provider know how you feel and if you have any concerns during the test.
How the test is interpreted: The tissue will be analyzed by a pathologist to ensure that there are no abnormalities or inflammation. The pathologist will send a copy of the results to your doctor. If any inflammation is seen, you may be prescribed antibiotics.