|
|
Reproductive endocrinologists/fertility specialists such as Dr. Blauer and Dr. Heiner will order several tests to evaluate the common causes of infertility. Even if one specific cause is suspected, or known (such as low sperm counts or blocked fallopian tubes), the basic fertility tests evaluating the main causes of infertility will still usually be recommended because more than one cause is often present. Generalists will often try drugs, such as clomiphene citrate (Clomid), when a woman has irregular cycles and presumed infrequent or sub optimal ovulation is present. However, Clomid cannot work if other causes of infertility are present and not treated. This can result in the loss of precious treatment time and unnecessary expense.
Fertility specialists always request a semen analysis for the male partner at the beginning of the evaluation. Our andrology laboratory routinely performs semen analyses using the Kruger Strict Morphology criteria. Reliable studies document that some degree of male infertility is present in almost half of all couples with infertility. No treatment of the female can be successful in the absence of enough” quality” sperm.
In order for successful conception and pregnancy to result, several biologic processes must occur. It is these “processes” that are evaluated by fertility testing. A brief discussion of these processes is included here with links to the appropriate fertility tests.
- A woman must have viable eggs within her ovaries. These eggs must be capable of fertilizing normally and developing into embryos. Age diminishes egg quality ultimately leading to the menopause where no viable eggs are present. Ovarian reserve is the term used to “describe” the ability of the ovaries to release viable eggs
- Ovulation must occur regularly each month. The hypothalamus releases gonadotropin releasing hormone (GnRH) which travels to the pituitary and causes the production and release of follicle stimulating hormone (FSH). FSH stimulates and supports the development of ovarian follicles each of which usually contains one egg. As healthy follicles develop they produce increasing amounts of estrogen which is monitored by the hypothalamus. FSH release is modulated accordingly. Fertility Tests-Hormonal Evaluation, Progesterone Levels to Document Ovulation
- Androgen (male hormones) hormone levels may be measured to help evaluate conditions such as polycystic ovarian syndrome (PCOS).
- The lining of the uterus (endometrium) must thicken and become more vascular during the monthly ovulatory cycle. This development is critical for successful embryo implantation and growth. Estrogen and progesterone provide hormonal support for endometrial development. Progesterone is initially produced by the corpus luteum which is the “leftover follicular structure” remaining after ovulation. Once pregnancy is established the placenta begins to produce progesterone to support the pregnancy. “Too little” progesterone after ovulation is known as a “luteal phase defect”. A woman will often had a short luteal phase (less than 12 days from the time of ovulation to the time menstrual bleeding begins) which can be effectively treated with increased ovarian stimulation or with progesterone containing fertility drugs. Fertility Tests- Endometrial biopsy, Ultrasound, Progesterone levels
- Once the eggs (ovum) mature, they must be released (ovulated) from the ovaries and “picked up” by the fallopian tubes. At ova maturity, the hypothalamus signals the pituitary to release a surge of luteinizing hormone (LH). This spike of LH initiates the final stages of follicular development and causes ovulation 34-42 hours after the beginning of the surge. Fertility Tests- LH Levels, Home Ovulation Predictor Kits
- After the eggs are ovulated, they must be “picked up” by the distal end of the fallopian tubes (by fingerlike projections called fimbria) and make their transit to the proximal end of the tube, where it meets the uterus. Any condition, such as scar tissue (adhesions) or salpingitis isthmica nodosa (SIN), that blocks or impedes this transport can lead to infertility. Fertility Tests- Hysterosalpingogram, Laparoscopy,
- Once the egg reaches the fallopian tube, the site of fertilization, a single sperm must penetrate the egg membrane (zona pellucida) and mix the genetic material (DNA) of both partners resulting in an embryo with a normal chromosome number (23 pairs). This embryo continues it’s journey to the uterine cavity and embeds in the endometrium in order to continue its development. Fertility Tests- Ultrasound, Observe fertilization in IVF, Preimplantation Genetic Diagnosis(PGD) to Rule Out Specific Identifiable Genetic Diseases, Semen Analysis
- The sperm must “swim through” the cervical mucus while avoiding the numerous “dead end” side channels or cervical crypts in the cervix. The mucus must be relatively free of antisperm antibodies and be of the correct consistency (thin and watery). Cervical mucus also provides nourishment to the sperm cells. Fertility Tests- Post Coital Test.
- The uterus must be normal and free of large obstructions such as polyps and fibroids. The embryo must be able to implant and grow in an unrestricted environment. Fertility Tests- Ultrasound, Hysteroscopy, Laparoscopy
- The male must produce “quality sperm” that can be ejaculated and, swim through the cervix. Once in the lower part of the uterus the sperm must traverse the approximately 5-6 cm (2 inch) uterine cavity to reach the entrance (ostia) into one of the two fallopian tubes. It must then find it’s way up the tube (10-12 cm or 4 inches long) while searching for an egg to fertilize. The sperm must penetrate the egg shell (zona pellucida) and cause fertilization and it must be free of genetic defects. Semen Analysis, Male Infertility, Kruger Strict Morphology
Reproductive Care Center offers complete testing for infertility. In addition to Utah, our infertility clinic serves patients from Idaho, Montana, Wyoming and other areas. We always try to make accommodations for patients who travel long distances for our infertility diagnostic and treatment services.
|
