Current Patients - Infertility Tests

1. Hysterosalpingogram (HSG)
2. Home Ovulation Predictor (LH Surge) Kit
3. Post Coital (PCT) Test
4. Endometrial Biopsy
5. Semen Analysis
6. Ovarian Reserve Testing
7. Hydrosonography

1.  Hysterosalpingogram (HSG)

This x-ray procedure will evaluate the uterine cavity and will determine whether or not the fallopian tubes are open. You should call the office between 8am and 4:30pm the first business day after your period starts. The HSG will be done approximately 1 week after your period starts. You will be given specific instructions when you call. You should take a non-steroidal medication (Motrin, Aleve, Advil, etc) 30 minutes prior to the procedure as this x-ray usually causes some uterine cramping.  More information.

2.  Home Ovulation Predictor (LH Surge) Kit

These kits can be purchased over the counter at any pharmacy or grocery store. No prescription is needed.  You should start checking your urine for the LH surge beginning on cycle day 11.  You should ovulate the day after you detect the urinary LH surge.  This test is used to schedule procedures such as inseminations, PCT’s and endometrial biopsies.

3.  Post Coital (PCT) Test

This test will determine whether or not sperm are able to penetrate the cervical mucus. The test is performed the morning after you have an LH surge. You should call the office the day you have an LH surge. If you surge during the night or weekend, call the after hours pager. You should have intercourse late in the evening of the day your surge is positive. You will come to the office the next morning for the test. The test is not painful and involves taking a sample of cervical mucus and observing it under the microscope.

4.  Endometrial Biopsy

A small catheter will be inserted through your cervix and into the uterine cavity. A small piece of the endometrium (uterine lining) will be removed for analysis. The test is generally performed 11-13 days after a positive LH surge. You should call the clinic the 1st business day after you have a positive surge and schedule this test. It is advisable to use barrier contraception or abstain from intercourse during the cycle in which the biopsy is to be performed. A pregnancy test will be performed prior to the biopsy, but an early pregnancy could be missed. This procedure can be associated with some cramping. You should take a non-steroidal medication (Motrin, Aleve, Advil, etc) 30 minutes prior to the procedure.  More information.

5.  Semen Analysis 

Your husband should abstain from intercourse/ejaculation for 3-4 days prior to the semen analysis. You may call the office to schedule this during any weekday. We have facilities in our office for collecting the sperm. If you would like to collect the sample at home and bring it to the office, please let the secretary know when you call to schedule the test. You will be given specific instructions on how to collect the sample at home.  More information.

6.  Ovarian Reserve Testing

Day 3 lab:  Blood will be drawn on the 3rd day of your menstrual period for FSH, LH, and estradiol. These tests will evaluate your ovarian reserve. The 1st day of full menstrual flow is considered day 1 (do not count any days of premenstrual spotting). You should call the clinic when your period starts to schedule this test. If your period starts on the weekend, you should call the after hours number and the physician on call will tell you when to come in. There is some flexibility on when this test can be performed. It can be performed on day 2, 3, or 4 of your cycle.

Clomiphene Challenge Test:  This is an extension of day 3 lab testing. Blood work is done on day 3 for FSH, LH and estradiol. Clomiphene citrate, an oral fertility medication, is taken from day 5 through 9. Blood work for FSH, LH and estradiol is repeated on day 10. This test may be slightly more sensitive than day 3 lab alone in detecting a decrease in ovarian reserve. We do not perform this test on all patients, but rather do it selectively on patients we feel may be at higher risk for decreased ovarian reserve.

Antral Follicle Count:  This is an ultrasound study that assesses the number of follicles (eggs) we can see in the ovaries. Antral follicles are follicles between 2-10mm in diameter. We count the number of these follicles on each ovary with the ultrasound. The antral follicle count gives us an estimate of how the ovaries will respond to ovulation induction, especially with IVF. The antral follicle count is best done on day 3 of the menstrual cycle.

Anti-Mullerian Hormone (AMH):  AMH is made by certain cells within the ovary and is a marker of ovarian reserve. It is measured in the blood and does not fluctuate during the menstrual cycle so it can be measured at any time of the month. Some studies suggest it may be better than day 3 lab in assessing ovarian reserve.

A Note About Ovarian Reserve Testing

No single test is 100% accurate in predicting ovarian reserve. We often use a combination of the above tests along with the patient’s age and her past response (if any) to ovulation induction to estimate her ovarian reserve.

7.  Hydrosonography

This is a special type of ultrasound in which fluid is injected into the uterine cavity while a vaginal ultrasound is performed. The purpose of this test is to evaluate the uterine cavity for abnormalities. It is performed in the 1st half of your cycle; after your period stops, but before the expected day of ovulation. You should call the clinic when your period starts to schedule this test. Some uterine cramping should be expected when this test is performed, so you should take some Motrin or Advil prior to this procedure.