Infertility investigations for women

This booklet is aimed for women undergoing fertility investigations. Its aim is to provide you with some useful information regarding your investigations. We hope you find this booklet helpful. You will be advised to have some or all of the following tests: Hormone blood tests Follicular bloods tests These routine blood tests are usually taken between days two and four of your menstrual cycle (Follicular Phase). Day one is the first day of your period. They may also be taken at any time if your periods are either infrequent or completely absent. The tests are particularly useful if you do not have a period every month. Staff in the clinic may use the following terms: l Amenorrhoea - No periods for six months or more l Oligomenorrhoea - When the periods are occurring three or four times a year l Irregular cycle - Periods that vary in length The following blood tests are used to investigate whether ovulation (production of an egg) is occurring each month and also to help determine which fertility treatments to offer. FSH (Follicle Stimulating Hormone) In women, follicle stimulating hormone (FSH) helps controls the menstrual cycle and the production of eggs. FSH stimulates the ovaries to produce follicles (fluid filled sacs) which grow, develop, and release an egg. The FSH test is done on the second to fourth day of the menstrual cycle. It can be used to measure the egg supply in the ovaries. LH (Luteinising Hormone) In women, luteinising hormone (LH) is linked to ovarian hormone production and egg maturation. LH is used to measure a woman s ovarian reserve (egg supply). It causes the follicles to grow, mature and release the eggs for fertilisation. It reaches its highest level (the LH surge) in the middle of the menstrual cycle 48 hours prior to ovulation i.e. days 12-14 of a 28 day cycle. Luteal blood tests The luteal phase of the cycle is from ovulation to the start of a woman s period. The egg sac becomes a structure called the corpus luteum after the egg has been released. The corpus luteum produces progesterone for two weeks then disappears. Blood test progesterone during the luteal phase to test for ovulation. Progesterone Progesterone is a female hormone produced by the ovaries after ovulation. It causes the endometrial lining of the uterus to get thicker, making it receptive for a fertilised egg. Progesterone levels increase after ovulation, reaching a maximum level seven days before the start of the next period. The progesterone test is used to test whether a woman is ovulating (releasing an egg). In a regular 28 day cycle, the progesterone test is taken on day 21 of a woman s cycle. If a woman s cycle is longer or shorter than 28 days the test will be taken later or sooner. Occasionally the test will be performed weekly if the time of your period cannot be predicted. 1 2

Prolactin and thyroid function Prolactin is a hormone produced by the pituitary gland (in the base of the brain) and may be requested if your periods are infrequent or absent. Too much prolactin hormones can stop a woman ovulating and having periods regularly. Abnormalities of the thyroid gland may also result in a failure to ovulate regularly. This test will only be performed in women who have other symptoms of thyroid disease. Androgens These are male hormones that are present in small quantities in women. The most well-known androgen is testosterone. The level of testosterone and other androgens may be higher in women with Raised BMI and lead to polycystic ovarian syndrome (PCOS). High levels of testosterone can result in acne and abnormal hair growth (hirsutism). We test for high androgen levels using a test called free androgen index (FAI). Imaging tests Ultrasound scans The trans-vaginal (internal) ultrasound scan is one of a number of investigations used when assessing your fertility. The scan can give extremely useful information about your uterus (womb) and ovaries that will help make decisions about your fertility management. It is important that you have an empty bladder for this investigation therefore it is advisable to empty your bladder immediately before the scan. The examination will take approximately 5-10 minutes and is similar to having a smear test. A probe is inserted into the vagina and images of the uterus (womb) and ovaries can be seen on the scan monitor. HSG (Hysterosalpingogram) A hysterosalpingogram or HSG is an x-ray procedure performed to determine whether the fallopian tubes are open and to see if the shape of the uterine cavity is normal. This is done by inserting a speculum (similar to a smear) into the vagina and by inserting a fine tube into the uterus. A fluid contrast (dye) is then injected through this tube. This contrast then enters the tubes, and spills out of the ends if they are open. This procedure is an outpatient procedure and takes less than 30 minutes to perform. It is usually done following your period but before ovulation to prevent any interference with an early pregnancy. This procedure is carried out in the x-ray department. Some women may experience mild discomfort when the dye is introduced and we would recommend you take antiinflammatory painkillers such as ibuprofen at least 30 minutes before the procedure. Further information will be given by the x-ray department if required. HyCoSy (Hysterosalpingo- Contrast Sonography) This test is an ultrasound investigation carried out to check whether your fallopian tubes are open (clear) to allow the egg to pass through. At the same time it also allows us to look at the uterus (womb) and ovaries. Timing and preparation Ideally the HyCoSy should be performed around day 5-12 of your menstrual cycle (a week following your period). This is before ovulation occurs to avoid displacing an early pregnancy. However a pregnancy test will be performed before the procedure. 3 4

The procedure The doctor or nurse will explain the procedure to you prior to the examination. You will be asked to sign a consent form. Initially a trans-vaginal (internal) scan would be performed to assess your uterus, tubes and ovaries. Following this a speculum is passed into your vagina (similar to a smear) and a thin tube (catheter), is inserted through your cervix (neck of the womb) into the uterus. This may take a couple of minutes and may be a little uncomfortable. Once the catheter is in place the speculum can be removed. The ultrasound probe is then placed into the vagina and the contrast (fluid) is injected very slowly into the catheter, allowing the doctor to observe flow into the fallopian tubes. The procedure will take approximately 10-20 minutes. Risks There is a very small chance of a pelvic infection following the test. Occasionally the test may cause some light bleeding but this should settle after a couple of days. Benefits of HyCoSy and HSG Some patients may feel slight discomfort or period type pain whilst the contrast is injected. Any discomfort will only last for a few minutes. Some women may also experience sweating, nausea, headaches and dizziness. If HyCoSy is required you will receive further written patient information. Other tests Rubella (German Measles) antibody levels It is important to look for evidence of immunity, as rubella infections in pregnancy can lead to various abnormalities of the developing baby. If you are not immune the vaccination should be arranged. Chlamydia tests It is important we screen for any cause of pelvic infections/ Chlamydia prior to undergoing HSG or HyCoSy. Vaginal swabs will be taken on your first visit if they have not been taken via the GP within the past 6 months. Please ask a member of staff if you have any questions about any of your investigations. Contact information Gynaecology Clinic M1 Erica Wilson (Sister) Secretary to Dr Umapathy Notes 0161 206 5224 0161 206 1480 0161 206 0095 0161 206 5312 5 6

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