Basic Infertility Evaluation
The first step in helping you achieve pregnancy is through evaluation to identify the cause – or causes – of your inability to conceive. You may need some, or all, of the tests described in this information. Most of these tests must be done at specific times of your menstrual cycle and therefore cannot be scheduled until the onset of your next period. Remember that your first full day of menstrual bleeding (flow that starts before 3:00pm) is considered day # 1 of your cycle. We ask that you call on the first day of your next cycle at which time you will be given an appointment for no later than day three or four of that cycle. If your next period starts on a weekend, please call first thing Monday morning. During this visit, our nursing staff will schedule the remainder of your testing.
Your testing will consist of a carefully timed series of evaluations which will “follow” you through a normal monthly reproductive cycle. Below is a description of each of the tests. Remember that your individual testing may differ from the “routine” and that Dr. Acuña and our staff will outline your particular tests in detail.
Day 3 (Day 2 or 4 OK)
A blood test will be done to test 3 hormones at the beginning of your cycle: Estradiol, LH, and FSH. These hormones must be tested no later than day # 4 of your cycle. These tests will give us an idea of your ovarian reserve – the ability of your ovaries to produce good quality eggs. At the same time, blood will be drawn to check other hormones including thyroid, and prolactin as well as to assess your immunity to rubella and to confirm your blood type. In some patients a male hormone panel will be performed. This will help to detect such conditions as polycystic ovarian disease.
During your baseline lab visit, our nursing stall will discuss the remainder of your tests to help you schedule them.
Hysterosalpingogram – HSG
Day 9 (+ or – 2 days)
One of the essentials of an infertility evaluation is an examination of the uterine cavity and a careful study of the fallopian tubes. Normal fertilization requires open and healthy fallopian tubes, while normal implantation of the fertilized egg requires a healthy uterine lining.
HSG – This test can evaluate the uterine cavity and is the only test which can determine if your fallopian tubes are open. The HSG is an x-ray and is performed at VASC (Valley Ambulatory Surgery Center) or at DCH (Delnor Community Hospital).
The test is done by injecting dye through your cervix during an exam much like a pap smear. While injecting the dye, we watch through x-ray as the dye flows through your uterus and hopefully into and out of your tubes. Dr. Acuña will show you your x-rays and discuss the results of this exam as soon as it is completed.
It is normal to experience some cramping during this exam. On rare occasions, the cramping may be moderate to severe. We have found that the HSG is much better tolerated if our patients take 3-4 Advil (Ibuprofen) one hour before the scheduled time of the procedure.
A course of antibiotics will be prescribed prior to your testing. The purpose of the antibiotics is to help prevent any chance of infection. It is important that you take the Advil/Ibuprofen and antibiotics as directed.
Sonohysterogram – HSN
(Only if indicated)
This test is done instead of the HSG when evaluation of the tubes is not important. The HSN gives us an excellent view of the uterine cavity. On rare occasions, both the HSG and HSN are done. This examination does not require x-ray. Sterile water is injected into the uterus while an ultrasound is performed to study the uterine cavity. This test may also cause some cramping, although it is usually minimal. You will be asked to take 3-4 Advil/Ibuprofen an hour before the procedure, and you will be given a prescription for antibiotics to help prevent any infection.
A technique using sound waves to view the follicles in the ovaries. It is performed in the office transvaginally and usually takes about 30 minutes. Full bladder is NOT required. These tests are particularly important when there is a question of whether ovulation is occurring regularly. We will also measure your uterine lining to confirm that it is maturing normally. A blood test is done to check your hormone levels. It may be necessary to repeat these preovulatory tests a few days later if the first tests are inconclusive.
A microscopic examination of freshly ejaculated semen to evaluate the number of sperm (count), the percentage of moving sperm (motility), and the size and shape of sperm (morphology). This test may be done anytime during your cycle. You and your partner will be given a set of very important instructions regarding scheduling, collecting, and transporting of the semen specimen.
This is the hormone produced after ovulation by the ovary during the second half of the menstrual cycle. It prepares the lining of the uterus to accept implantation of a fertilized egg. The results of this blood test can give us important information whether or not you ovulated.
High Risk Infertility
In addition to standard infertility causes, Dr. Acuña also treats patients that are considered to have high risk infertility issues. There are many reasons as to why a pregnancy can be considered high-risk. Those patients that require the assistance of fertility treatment will at times also have a high-risk pregnancy. This can be due to multiple gestations, patient age, and other chronic medical issues that a patient may already have prior to becoming pregnant. Dr. Acuña has a great deal of experience working with high-risk pregnancies, including those that are conceptualized by the assistance of fertility treatment. Each patient will have a unique history and pregnancy, and Dr. Acuña looks forward to caring for these patients, and tailoring their pre-natal care for each individual. Should you have further questions please do not hesitate to contact the office to set up an appointment.
* Based on 28 day cycle
** Semen analysis can be done at any time but preferably during menses