Female Infertility Testing
Ovulatory disorders are a major cause of female infertility, and the diagnostic workup includes fertility tests to determine if ovulation is regular and effective. One objective of these tests is to predict the time of ovulation, which facilitates timed intercourse.
Urinary Ovulation Predictor Test Kits
Urinary test kits are the preferred means of predicting ovulation because they accurately measure the surge of luteinizing hormone (LH). Ovulation occurs approximately 36 hours after the LH surge, and intercourse can be planned around these times.
We usually recommend daily testing between 10 a.m. and 1 p.m., starting from approximately Cycle Day 8 and depending on the length of the natural menstrual cycle.
Rising levels of progesterone in the luteal phase of the cycle indicate that effective ovulation occurred. Progesterone is produced by the follicular structure remaining after ovulation, known as the corpus luteum. Low levels of progesterone may signal the presence of a luteal phase defect.
Basal Body Temperature Measurements (BBT)
Historically, the BBT was the primary means to assess and document ovulation. The BBT requires a woman to take her temperature immediately upon waking in the morning, prior to getting out of bed, using a sensitive thermometer. The daily temperature values are charted. Because progesterone, which is secreted only after ovulation, causes a small increase in body temperature, a clear biphasic temperature pattern is highly suggestive of regular ovulatory cycles. However, by the time an increased basal body temperature has been noted, ovulation has already occurred; therefore, timing of highly fertile days is retrospective. Predicting impending ovulation is better performed using urinary LH test kits.
If treatments fail to establish ovulation, the best treatment choice, and in some cases the only choice, is donor egg IVF.
The post-coital fertility test (PCT) examines sperm after they have been exposed to the cervical mucus. This test determines the capacity of sperm to survive and move within the female reproductive tract, specifically the cervix. The presence of motile (moving) sperm in the cervical mucus is considered a normal post-coital test. Absence of sperm, or the presence of a high percentage of non-motile sperm, is considered abnormal. The PCT is conducted as part of the infertility evaluation to determine if cervical factor infertility is affecting conception.
Timing the PCT
Cervical mucus is normally receptive to sperm only during the periovulatory time of the cycle, so timing the PCT is very important.
The correct pre-ovulatory time can be determined by monitoring the presence of luteinizing hormone (LH). Approximately 36 hours before ovulation, the pituitary gland secretes a burst of LH known as the LH surge. LH is excreted in the urine, and thus provides an easy means to test for its presence and determine/predict ovulation. Call the office once the LH surge is detected.
hCG is an injectable medication used to trigger ovulation. It is usually administered at a specific time of the day, most often around 10:00 p.m. It is administered 36 to 38 hours prior to ovulation, and normal intercourse should take place two to four hours before arriving for your appointment at our clinic.
Other Fertility Tests for women may include
- HSG, Hysteroscopy: The hysterosalpingogram and hysteroscopy are used to determine if the uterus is normal and if the tubes are open and unobstructed.
- Day 3 hormone evaluation: The levels of FSH, LH, estrogen and other hormones are determined on day 3 of the menstrual cycle. Women with highly abnormal FSH levels may be candidates for our donor egg program.
- Ultrasound: An ultrasound has many uses, including monitoring the development of ovarian follicles, measuring endometrium thickness, confirming a fetal heartbeat, and more.
- Laparoscopy: The laparoscopy allows the physician to visualize the internal reproductive organs and determine if endometriosis or adhesions are present. Reproductive specialists often treat conditions during a diagnostic laparoscopy.
- Endometrial biopsy: The endometrium must be in phase with the reproductive cycle and ready to accept an embryo. The biopsy allows the physician to evaluate the development of endometrial cells.
- Clomid Challenge: This test is used as an assessment of ovarian reserve.