Diagnosis begins with the first visit, when the couple’s relevant medical history is reviewed and a physical exam completed. We have set the standard with the most thorough initial assessment in the area. This prevents wasting precious time and money pursuing incomplete or ineffective treatment because of an initially incomplete data set.
Diagnosis for the female includes day two or three blood work, a transvaginal ultrasound within the first 7 days of the cycle, another blood draw on day 10, and a HSG (hysterosalpingogram). The blood work obtained provides a baseline of relevant prenatal labs, a thorough hormonal evaluation, and finally a thorough assessment of ovarian reserve (egg supply/quality). The HSG is an invaluable tool not only for assessing tubal patency and possible presence of tubal adhesions, but also for assessing whether or not the uterine cavity is normal.
Diagnosis for the male includes a semen analysis and possible additional immunological sperm testing or endocrine testing based on initial results.
Fortunately, many insurance companies will cover the initial diagnostic visits and testing, even if they don’t cover treatment of infertility at all (we will have made contact with your insurance company and summarize the extent of your coverage, as provided by your insurance company, prior to your first visit).
The diagnostic procedures we perform include, but are not limited to:
AMH (Anti-Mullerian Hormone)
- Our practice was the first in the area to offer AMH testing, which helps determine fertility potential and ovarian reserve. AMH is secreted by the “resting follicles” between ~2-9mm and is a numerical measure of ovarian activity. More info on AMH
Transvaginal Ultrasound
- Transvaginal Ultrasound is a technique which enables the physician to visualize your ovaries and uterus using sound waves. The ultrasound probe is placed in the vagina. It gives off an intermittent, high-pitched sound out of the normal hearing range, which is reflected off the pelvic organs. These echoes are recorded and a picture is created on a TV screen/monitor. The procedure is usually painless. 3D/4D technology is now available at ORH!
- Transvaginal Ultrasound is used for assessment of ovarian reserve, as well as screening for abnormalities such as polyps, fibroids, ovarian cysts, including endometriomas and the presence of scar tissue. It is also used to monitor the growth of follicles in the ovary throughout the cycle, and to confirm ovulation. Finally, it is invaluable in verification of success, meaning a viable intrauterine pregnancy.
Hysterosalpingogram (HSG)
- We set the standard by becoming the first clinic in the area to offer this procedure in the office. The advantages include superior imaging techniques, convenience, and the performance of the procedure by a highly trained subspecialist rather than a general radiologist. The HSG is one of the primary tests used to reveal tubal or uterine problems contributing to infertility. Conveniently performed at our clinic, the procedure has two steps. First, a dye is injected into the uterine cavity. Then a series of x-ray pictures are taken. As the dye moves through the organs, the physician can assess the condition of the cervical canal, uterus and fallopian tubes. Hysterosalpingogram (HSG)
Sonohysterogram (SHG)
- This is an office procedure which evaluates the uterine cavity for polyps, fibroids or scar tissue. A catheter is placed into the uterus and sterile saline is injected while transvaginal ultrasound visualizes the cavity. SHGhandout.pdf
Post-Coital Test (PCT)
- A sample of mucus is removed from the cervix at the time of ovulation. The couple will have had intercourse on the preceding evening, that morning, or both. The gross characteristics of the mucus are noted. It is then examined microscopically, observing the quality of the mucus and the number of sperm and their motility in the mucus. The test determines whether adequate mucus is being produced at the time of ovulation and whether sperm are entering and surviving in the mucus.
Endometrial Biopsy
- A small sample of the lining of the uterus is removed a day or two before menses is expected. The specimen is obtained by passing a plastic tube through the cervix into the uterine cavity. Suction is applied and the tube is removed. The resulting small piece of tissue is then examined microscopically in the pathology lab. The procedure may cause cramping. This procedure is used to diagnose abnormal cellular changes of the uterine lining which may be associated with abnormal bleeding. It was previously used to look at the development or maturation of the lining in patients with infertility or recurrent pregnancy loss, but has mostly been replaced with a carefully timed serum progesterone.
Semen Analysis
- While not particularly popular, the semen analysis is a critical part of a couple’s initial evaluation. Obviously, the male partner is 50% of the fertility equation. Furthermore, male factor issues are just about as common as those affecting the female. Thus, it is important that a high quality analysis be performed, in a fertility center, where specially trained andrologists using specialized equipment are available. We perform semen analysis with MicroCell counting chambers, using polarized light microscopy and reporting morphology (shape of the sperm, which is reflective of functionality) using the Kruger strict morphology standard, the optimum grading score, in our opinion. A MAR screening test for sperm antibodies is also included- important, but not done routinely at many centers
Immunobead test
- A confirmation test for a positive MAR screening test, it detects the presence or absence of antibodies on the sperm surface, particularly useful in case of a vasectomy reversal or with a history of testicular injury or infection.
Hysteroscopy
- Hysteroscopy is an outpatient procedure. But unlike laparoscopy, it does not require an abdominal incision. The cervix is dilated and the uterine cavity is distended with fluid. The hysteroscope, basically a long tube with a light and lens system and a channel for placing instruments, is passed through the cervix and permits the examination of the inside of the cervix and uterus. It is particularly useful in the diagnosis of adhesions (scar tissue) within the uterus as well as fibroid tumors or polyps. These conditions will generally be treated at the time of the initial hysteroscopy.
Laparoscopy
- This is an outpatient surgical technique used for diagnostic purposes and for the treatment of certain diseases or conditions. Performed under general anesthesia, laparoscopy involves making a small incision, usually through the navel, to minimize scarring. The abdominal cavity is then observed through the laparoscope, a long tube with a light and lens system for viewing the intra-abdominal organs. Conditions such as tubal disease, adhesions (scar tissue), endometriosis, or the location of cysts or tumors can be accurately diagnosed. If an abnormality or disease is found, specialized instruments or lasers may be employed to correct the problem at the time of diagnosis. Additional small incisions in the lower abdomen may make it possible to remove adhesions, cysts or endometriosis, or even open obstructed Fallopian tubes. A diagnostic laparoscopy examination typically takes less than one hour and causes only mild discomfort for a day or two. Operative laparoscopy can take two or more hours, but still only causes mild discomfort for a day or two.
Fertility Snapshot
This panel of tests is designed to give women of all ages an assessment of their current reproductive potential. Allowing us to determine how difficult it will be in the future for her to conceive with her own eggs. Recommended for women ages 35 and older, anyone with a history of infertility in their family, or anyone who is considering starting a family in the future and wants to know their individual biology.
