Infertility Tests for Females
Medically Reviewed by Dr K. Hari Chandana MBBS, MS
Infertility Tests for Females: When assessing female infertility, various tests and evaluations may be conducted to identify potential causes or contributing factors. Here are some common tests used to evaluate female fertility:
Medical history and physical examination:
A detailed medical history interview, including menstrual history, sexual history, past pregnancies, surgeries, and any relevant symptoms, helps provide valuable information. A physical examination may involve a pelvic examination to evaluate the reproductive organs and identify any visible abnormalities.
Ovulation tracking:
Methods such as tracking menstrual cycles, monitoring basal body temperature, and using ovulation predictor kits can help determine if ovulation is occurring regularly.
Hormone testing:
Hormone testing plays a vital role in assessing infertility in women. It helps to evaluate the function of the reproductive system, identify hormonal imbalances, and determine potential causes of infertility. Here are some of the key hormones commonly tested in women undergoing infertility evaluations:
- Follicle-Stimulating Hormone (FSH): FSH is responsible for stimulating the growth and development of follicles in the ovaries. Elevated levels of FSH may indicate reduced ovarian reserve or ovarian dysfunction.
- Luteinizing Hormone (LH): LH triggers ovulation, causing the release of a mature egg from the ovary. LH levels are typically measured to determine the timing of ovulation and assess the quality of the menstrual cycle.
- Estradiol: Estradiol is the primary form of estrogen in women. It is produced by the developing follicles and is important for the growth of the uterine lining. Estradiol levels are evaluated in conjunction with other hormones during the menstrual cycle.
- Progesterone: Progesterone is produced by the corpus luteum, which forms after ovulation. It helps prepare the uterus for implantation and supports early pregnancy. Progesterone levels are often measured to confirm ovulation.
- Anti-Mullerian Hormone (AMH): AMH is a hormone produced by small follicles in the ovaries. It is used as an indicator of ovarian reserve, reflecting the quantity of eggs remaining in the ovaries.
- Thyroid-Stimulating Hormone (TSH): TSH is involved in regulating thyroid function. Thyroid disorders, such as hypothyroidism or hyperthyroidism, can impact fertility and menstrual regularity.
- Prolactin: Prolactin is primarily associated with lactation. High levels of prolactin in non-pregnant women can disrupt ovulation and menstruation.
Ovarian reserve testing
Ovarian reserve testing is an important component of female infertility evaluations. It helps to assess the quantity and quality of a woman’s remaining eggs (oocytes) and indicates her reproductive potential. Here are some common methods used to test ovarian reserve:
- Anti-Mullerian Hormone (AMH) Test: This blood test measures the levels of AMH, a hormone produced by the small follicles in the ovaries. Since AMH reflects the number of follicles available, it serves as an indicator of ovarian reserve. Lower levels of AMH may suggest a lower quantity of eggs remaining.
- Follicle-Stimulating Hormone (FSH) Test: This blood test measures the levels of FSH, which stimulates the growth and development of follicles in the ovaries. Elevated levels of FSH may indicate diminished ovarian reserve or ovarian dysfunction.
- Antral Follicle Count (AFC): This ultrasound-based test involves counting the number of small follicles present in the ovaries at the beginning of the menstrual cycle. The AFC provides an estimate of the number of follicles available and can be indicative of ovarian reserve.
- Ovarian Reserve Testing with Clomiphene Citrate Challenge Test (CCCT): This test combines FSH testing with a challenge involving the medication clomiphene citrate. FSH levels are measured on day 3 of the menstrual cycle, and then clomiphene citrate is administered for five days. FSH levels are measured again on day 10. Elevated FSH levels after the challenge indicate diminished ovarian reserve.
- Inhibin B Testing: Inhibin B is a hormone produced by the developing follicles in the ovaries. Inhibin B levels can be measured in blood samples and may provide additional information about ovarian reserve when combined with other tests.
Hysterosalpingography (HSG):
Hysterosalpingography (HSG) is a diagnostic test performed on women to evaluate the structure and patency of the fallopian tubes and the shape of the uterine cavity. It is commonly used in infertility evaluations to assess potential causes of fertility issues.
Here’s an overview of the HSG test:
Procedure: During an HSG, a contrast agent (usually a radiopaque dye) is injected into the uterus through the cervix. The dye fills the uterus and then flows into the fallopian tubes. X-ray images are taken while the contrast is flowing, allowing visualization of the shape, size, and condition of the uterine cavity and fallopian tubes.
Purpose of using HSG:
- Uterine Abnormalities: HSG can detect uterine abnormalities such as polyps, fibroids, scar tissue (adhesions), or the septum (a wall-like structure inside the uterus). These abnormalities can interfere with implantation or the development of a pregnancy.
- Fallopian Tube Blockage: HSG helps identify any blockages or abnormalities in the fallopian tubes that can hinder the fertilization process or the passage of a fertilized egg toward the uterus.
- Tubal Patency: By observing the flow of contrast dye through the fallopian tubes, HSG can determine if the tubes are open and functioning properly. Blocked or damaged fallopian tubes may result in infertility.
Transvaginal ultrasound:
Ultrasound imaging can help evaluate the uterus, ovaries, and follicle development, as well as detect any structural abnormalities or conditions like polycystic ovary syndrome (PCOS).
Laparoscopy:
In some cases, a minimally invasive surgical procedure called laparoscopy is performed to directly visualize the reproductive organs and identify conditions like endometriosis, adhesions, or ovarian cysts.
Genetic testing:
Genetic testing is recommended if there is a family history of genetic disorders or if certain genetic conditions are suspected.
Endometrial biopsy:
This test involves taking a small sample of the uterine lining to evaluate the thickness, receptivity, and presence of any abnormalities.
It’s important to note that not all tests are performed for every individual, and the specific tests recommended will depend on the patient’s history, symptoms, and initial evaluations. A fertility specialist or reproductive endocrinologist will assess the situation, determine the appropriate tests, and guide individuals through the diagnostic process.
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