Investigations
There are many causes for infertility and it is clearly important to identify what is preventing your pregnancy before commencing treatment. In some cases there are one or more causes for your infertility and in those circumstances it is even more urgent that these are identified as treatment of only one identified problem can lead to unnecessary delay and reduction in your chances of having a baby.
We provide assessment of your fertility which includes consultation and then the appropriate tests, some of which you may already have had done and may not therefore need repeating. We will advise that you be seen with basic tests initially and thereafter your consultant will guide you to avoid unnecessary testing.
Tests for Women:
- Hormone Profiling between day one and four of your cycle (LH, FSH and oestradiol): This tells us whether your egg quantity and quality is satisfactory or beginning to decline which will make a great difference to the treatment you are advised.
- Pelvic Ultrasound Scan (usually transvaginal): to assess the follicles, uterus and lining of the uterus. Best around the middle of the month to indicate whether enough follicles are developing to maturity.
- Day 21 Progesterone: This is often used to tell us whether you have ovulated and the quality of the ovulation.
- Fallopian Tube Patency Checks. Hycosy (ultrasound scan guided check).
- Hysterosalpingogram (x-ray guided check of the fallopian tubes).
- Laparoscopy with Dye introduction at the time of a hysteroscopy: The advantage of this is that the pelvis can be assessed more thoroughly to rule out lesions such as endometriosis or infection which can stop you conceiving. A hysteroscopy (inspection of the lining of the uterus) usually done at the same time to exclude polyps or fibroids or other lesions within the uterus which can act like a coil preventing implantation even if they are very tiny and these may not always be seen at ultrasound scan or x-ray assessment. The dye is inserted through the cervix and the rate of appearance through the ends of the tubes into the pelvis can be assessed to see whether there is any hold up or evidence of blockage and whether these areas would be amenable to surgery.
- Hysteroscopy: This is a camera inspection to check the lining of the uterus (see above). It is usually done under a general anaesthetic so that any abnormalities can be corrected there and then without the need for a further procedure. This will depend upon your bleeding pattern and also the ultrasound scan findings.
Blood tests:
- Anti-Mullerian Hormone (AMH): gives an indication as to your ovarian reserve ie. number of eggs left in your ovaries. This can tell us what the chances of pregnancy are and how quickly we need to move.
- Prolactin: This is a hormone produced in the pituitary which if too high can prevent follicle development and ovulation.
- Insulin Resistance Tests (Glucose tolerance test with insulin levels): to assess whether your insulin levels are excessive, which can reduce egg quality and implantation. Signs of insulin resistance are polycystic ovaries, a tendency to put on weight around your tummy, previous repeated miscarriages, carbohydrate cravings and a family history of diabetes, or personal history of glucose intolerance in pregnancy or hypoglycemia.
- Thyroid Function: Abnormal levels of thyroxine can interfere with egg quality and implantation and also your ability to maintain the pregnancy.
- Full Blood Count and Iron levels: This tells us whether you are anaemic or whether your iron levels are too low for your blood cells to work efficiently as a developing embryo and baby will require optimal levels of oxygen to ensure continued growth.
- Autoimmune Profile: This is particularly useful in couples where repeated miscarriage (failure to implant properly or maintain a mother baby connection) occurs.
- Chromosome Testing: This is usually advised if there have been three or more miscarriages or if there are absent eggs or absent sperm in one of the partners or if there is a strong family history of an autoimmune condition which may be affecting your ability to conceive.
- Rubella Status: Immunity is advised prior to conception as infection in early pregnancy can cause problems.
- HIV Tests: These are usually advised prior to IVF only.
Tests for Men:
- For men we undertake a semen analysis: to measure the number and quality of sperm. This is important in deciding the best treatment for you. Where both the male and female have a problem which may affect their fertility this will obviously reduce the chances further and the correct treatment is of paramount importance.
- Insulin Resistance Tests (Glucose tolerance test with insulin levels): to assess whether your insulin levels are excessive which can affect the male sperm. Signs of insulin resistance are a tendency to put on weight around your tummy, carbohydrate cravings and a family history of diabetes, or personal history of glucose intolerance or hypoglycemia.
- Autoimmune Profile: This is particularly useful in couples with repeated miscarriage.
- Chromosomes: This is usually advised if there is a family history of a genetic problem or where the previous tests indicate that a chromosomal problem may be influencing the ability to produce good quality sperm.
Please call 01483 454 016 to discuss your fertility questions with our specialist consultants