About Fertility Tests FAQ

Hormone Tests FAQ

What are the baseline fertility hormone tests?


Fertility hormone tests are blood tests. FSH (follicular stimulation hormone) and LH (luteinising hormone) are the hormones released by the pituitary gland (a part in the brain). FSH travels through the bloodstream to the ovaries where it stimulates the growth of follicles. A normal FSH level is somewhere between 2 and 8.9, this is enough to support the growth of one follicle and is how nature normally limits us to singleton pregnancies. FSH levels vary through the cycle it must be measured in the first few days of menstruation (day 2-5 of the cycle). When bleeding starts is considered as day 1 of the period. Estradiol is an ovarian hormone. It is tested along with FSH and LH. It helps to understand whether low FSH is a result of high estradiol or low production of FSH by pituitary.




What is the test for ovulation (release of an egg)?


The most commonly used test for ovulation is a progesterone hormone test. It is a blood test. After ovulation, this hormone is released by the ovary. After 7 days of ovulation (release of the egg) progesterone levels reaches to peak, which is 7 days before next expected period. Therefore progesterone test is advised on day 21 of the period based on the cycle length of 28 days. If the cycle is 30 days long, progesterone should be done on day 23. If cycles are irregular, sometimes, it is advised on two occasions in a cycle. Value more than 20, normally indicates ovulation (always check local laboratory standards and reference range). Another reliable test for ovulation is use of ultrasound to check the growth and release of follicle. It is expensive as compared to blood test.




What is AMH (anti-mullerian hormone) test?


AMH test is a blood test which can be done at any time during the cycle. AMH is a hormone produced by the growing follicles in the ovaries and is a direct marker of the number of follicles. Therefore, it is used as an ovarian reserve marker. AMH varies with age. Normal levels are interpreted with age. AMH <5pmol/ml is considered as a poor ovarian reserve. Lower levels are indicative of poor reserve and higher levels associated with, but not diagnostic of, polycystic ovaries. AMH varies less through the period cycle and so can be measured at any time. AMH should not be measured with long term use of contraceptive pills, it may show lower levels than normal.




Does AMH tell chances of natural conception?


No. AMH is not a good predictor for chances of natural conception.




How does AMH help for IVF?


AMH gives an idea of number of eggs in the ovary. Broadly speaking AMH = quantity of eggs in the ovary (high value of AMH, high number of eggs) Age= quality of eggs. (Higher the age, lower is the quality) The stimulation protocols are based on age and AMH results. At p4 fertility, we analyse all factors including AMH and age to personalise the IVF protocols.





 

Tube Test FAQ

What are the baseline fertility hormone tests?


Fertility hormone tests are blood tests. FSH (follicular stimulation hormone) and LH (luteinising hormone) are the hormones released by the pituitary gland (a part in the brain). FSH travels through the bloodstream to the ovaries where it stimulates the growth of follicles. A normal FSH level is somewhere between 2 and 8.9, this is enough to support the growth of one follicle and is how nature normally limits us to singleton pregnancies. FSH levels vary through the cycle it must be measured in the first few days of menstruation (day 2-5 of the cycle). When bleeding starts is considered as day 1 of the period. Estradiol is an ovarian hormone. It is tested along with FSH and LH. It helps to understand whether low FSH is a result of high estradiol or low production of FSH by pituitary.




What is the test for ovulation (release of an egg)?


The most commonly used test for ovulation is a progesterone hormone test. It is a blood test. After ovulation, this hormone is released by the ovary. After 7 days of ovulation (release of the egg) progesterone levels reaches to peak, which is 7 days before next expected period. Therefore progesterone test is advised on day 21 of the period based on the cycle length of 28 days. If the cycle is 30 days long, progesterone should be done on day 23. If cycles are irregular, sometimes, it is advised on two occasions in a cycle. Value more than 20, normally indicates ovulation (always check local laboratory standards and reference range). Another reliable test for ovulation is use of ultrasound to check the growth and release of follicle. It is expensive as compared to blood test.




What is AMH (anti-mullerian hormone) test?


AMH test is a blood test which can be done at any time during the cycle. AMH is a hormone produced by the growing follicles in the ovaries and is a direct marker of the number of follicles. Therefore, it is used as an ovarian reserve marker. AMH varies with age. Normal levels are interpreted with age. AMH <5pmol/ml is considered as a poor ovarian reserve. Lower levels are indicative of poor reserve and higher levels associated with, but not diagnostic of, polycystic ovaries. AMH varies less through the period cycle and so can be measured at any time. AMH should not be measured with long term use of contraceptive pills, it may show lower levels than normal.




Does AMH tell chances of natural conception?


No. AMH is not a good predictor for chances of natural conception.




How does AMH help for IVF?


AMH gives an idea of number of eggs in the ovary. Broadly speaking AMH = quantity of eggs in the ovary (high value of AMH, high number of eggs) Age= quality of eggs. (Higher the age, lower is the quality) The stimulation protocols are based on age and AMH results. At p4 fertility, we analyse all factors including AMH and age to personalise the IVF protocols.





Ultrasound FAQ

What is 3D ultrasound scan and how does it help as a test for fertility


3 D ultrasound scan is performed same as routine scan. The probe and machine have special features to produce a 3 dimensional image of the womb and ovaries. It gives better picture of various anomalies of the womb.




What is a follicle mean? How the follicles are monitored during IVF cycle


Follicles are fluid filled sacs in the ovaries which grows. The egg is inside the follicle. You cannot see an egg on ultrasound scan. What you see is a fluid filled sac called follicles. Therefore, follicle size is measured. Follicle development is checked with regular ultrasound scans during IVF cycle. These scans are internal scans. With ultramodern scan machines, we check the follicles where eggs develop for size and other characteristics. When follicles reach to a certain size, we plan egg collection during IVF cycle.




What is scan or USG or ultrasound scan?


Why is it important for fertility test?Ultrasound scan (USG) is one of the most important fertility tests. An ultrasound scan can be used to check your ovaries, womb and fallopian tubes. Certain conditions that can affect the womb, such as endometriosis, polyps and fibroids, can prevent pregnancy. During a transvaginal ultrasound scan, a small ultrasound probe is placed in your vagina. The scan can be used to check the health of your womb and ovaries and for any blockages in your fallopian tubes. Any abnormalities of the womb can be diagnosed using a scan. Our policy is to have a chaperone (someone else present) when you have any internal scans.Ultrasound scan showing polyps.





 
 

Sperm Test FAQ

What kind of doctor does a male / a man see for fertility?


Fertility specialist consultants treat men and women as a couple for subfertility. It is advised to see a fertility expert (expert in IVF, ICSI and surgical sperm retrieval) first who may then get input from endocrinologist or urologist if required depending on the reason for subfertility. The plan of fertility treatment is made by a fertility expert.




How you diagnose male subfertility or male infertility? What tests are done for male fertility?


Two important steps to diagnose the problem in men 1. General physical examination and medical history. – Clear medical history about your sexual habits and about your sexual development during puberty, further history on any inherited conditions, childhood conditions causing damage to testicles, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Where necessary, clinical examination of about your sexual habits and about your sexual development during puberty. 2. Semen analysis also called a semen test or sperm test




What is Sperm Test or semen analysis?


Sperm test is the key test for fertility. A complete semen analysis measures the quantity and quality of the fluid released during ejaculation. Sperm test checks the liquid portion, called semen or seminal fluid, and the microscopic, moving cells called sperm. Sperm are reproductive cells in semen that have a head, midsection, and a tail and contain one copy of each chromosome (all of the male's genes.




What is tested in a semen analysis? When to repeat sperm test?


Each semen sample is between 1.5 and 5.5 millilitres of fluid. A typical semen analysis measures: Volume of semen Viscosity - consistency or thickness of the semen Sperm count - total number of sperm concentration (density) - number of sperm per volume, Sperm motility - % able to move as well as how vigorously and straight the sperm move, Number or % of normal and abnormal (defective) sperm in terms of size and shape (morphology), Coagulation and liquefaction - how quickly the semen turns from thick consistency to liquid Fructose - a sugar in semen that gives energy to sperm pH – measures acidity Number of immature sperm Number of white blood cells (cells that indicate infection). ). Occasionally there is an abnormal result on the first semen test. If this happens a repeat test should be offered, ideally 3 months later. However, if it looks as though your sperm count is very low or you have no sperm at all, the test should be repeated as soon as possible.




How the test results are interpreted?


According to world health organisation 2010, a normal semen sample has the same or better than,




What can cause problems in sperm test or semen analysis? What are the causes of male subfertility or infertility?


In many cases, it's not obvious what causes a low sperm count. Below are some of the lifestyle choices that can damage a man’s sperm and cause male infertility, all these can reduce both sperm counts and the ability to move. Smoking Regular use of marijuana and other recreational drugs Chronic high alcohol intake Anabolic steroid use and high-intensity exercise- can cause testicular shrinkage Exposure to environmental hazards and toxins such as pesticides, lead, paint, solvents, radiation and heavy metals. Regular high card fast-food diet with too few vitamins Stress Age Certain conditions can cause problems with sperm test results like A hormone imbalance, such as hypogonadism (reduced hormone production) A genetic problem such as Klinefelter syndrome, Y chromosome microdeletions, cystic fibrosis gene. Having had undescended testicles as a baby. A structural problem – for example, the tubes that carry sperm being damaged and blocked by illness or injury, or being absent from birth A genital infection such as chlamydia, gonorrhoea or prostatitis (infection of the prostate gland) Varicoceles (enlarged veins in the testicles) Previous surgery to the testicles or hernia repairs The testicles becoming overheated Certain medications, including testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some antibiotics and some antidepressants




What are additional tests if the sperm test is not normal?


Genetic tests Hormonal tests to check hormone balance




Which genetic tests are advised when the sperm count is too low or no sperms seen and why?


Men with no sperms in the sample (azoospermia) or very low count (severe oligozoospermia, <5 million sperm/mL ejaculate fluid) could have genetic abnormalities. Genetic testing, including karyotype/cytogenetic testing, Y chromosome microdeletion (YCMD) testing, congenital hypogonadotropic hypogonadism (HH) mutation screening, and cystic fibrosis transmembrane conductance regulator (CFTR) gene screening, may reveal the cause and likelihood of successful treatment, and potential risks to the baby. Informed discussion with the patient about the role of genetic testing and the prognostic and psychological effects of genetic findings should be completed before testing. We discuss the genetic testing risk and refer to genetic counselling where it is appropriate. It is important to find out if there is any genetic issue as some of them has the potential to affect the baby.




What is surgical sperm retrieval? What are the risks?


Men who are found to have no sperms in semen (azoospermia), often require a surgical procedure to obtain the sperms. Sperms can be obtained from small tubes at top of testicles, the technique is called by percutaneous epididymal sperm aspiration (PESA). This can be done under local anaesthetic by numbing the area or general anaesthetic (putting patient to sleep). Sperms can be extracted from testicles by aspirating testicle (TESA) or by small biopsy of testicles (TESE). The risk involved in these procedures is the risk of infection or bleeding. To avoid the risk of blood collecting in the testicle, scrotal support is advised after the procedure. When the microscope and microsurgical technique are used is called, microdissection of testicles, it is done after putting the patient to sleep. However, this facility may not be present in all units. P4 fertility consultant will discuss the process in detail.




Is there any treatment to improve the sperm count? How do you fix low sperm count?


Lifestyle changes including stopping smoking, healthy lifestyle, weight loss, vitamins supplements may help to improve sperm count. Clinical consultation and diagnosis of why sperm test results are not normal are important before discussing further treatment. At p4 fertility, we personalise the treatment plan based on the diagnosis. If the sperm count is low due to the hormonal issue (hypogonadotropic hypogonadism), we advise hormonal treatment. There is no specific treatment to improve the sperm count in general when it is from testicular failure.




Is there a role of tablets to improve sperm count?


Men with semen abnormalities due to unknown causes should not be offered anti-oestrogens, gonadotrophins, androgens, bromocriptine or kinin-enhancing drugs because they are not effective. Over the counter medications and supplements including herbal medications are not supported by robust evidence to improve sperm count.




What is the anti-sperm antibody? Is there a role of steroid treatment with anti-sperm antibody is seen in the semen sample?


The significance of antisperm antibodies is unclear and the effectiveness of systemic corticosteroids is uncertain.




What is donor sperm treatment?


Donor sperm is used in a different type of fertility treatments where sperms from donor individuals are used for assisted conception. The type of fertility treatment you will receive depends on your circumstances and medical history. For further independent information visit https://seedtrust.org.uk





 

Hysteroscopy FAQ

What is hysteroscopy (OPH)?


Hysteroscopy is a procedure that involves examining the inside of your uterus (womb). This is done by passing a thin telescope-like device, called a hysteroscope, that is fitted with a small camera through the neck of your womb (cervix). The healthcare professional doing the procedure can then see whether there are any problems inside your uterus that may need further investigation or treatment.




What are polyps or fibroids in the cavity?


· Polyps are formed as a result of overgrowth of the lining of the uterus · Fibroids are knots in the muscle of the uterus that are non-cancerous (benign). · They can sometimes bulge like a polyp into the lining of your uterus and your doctor may advise removal to help with your symptoms. · Before fertility treatment it is important to remove any polyps present in the cavity.




What happens during a hysteroscopy?


A hysteroscopy is usually carried out on an outpatient or day-case basis under anaesthesia. This means you do not have to stay in hospital overnight. A general anaesthetic may be used if you're having the treatment during the procedure or you would prefer to be asleep while it's carried out. A hysteroscopy can take up to 30 minutes in total, although it may only last around 5 to 10 minutes if it's just being done to diagnose a condition or investigate symptoms. Most women feel able to return to their normal activities the following day, although some women return to work the same day. You may wish to have a few days off to rest if general anaesthetic was used.




Is a hysteroscopy painful?


This seems to vary considerably between women. Some women feel no or only mild pain during a hysteroscopy, but for others, the pain can be severe. If you find it too uncomfortable, tell the doctor. They can stop the procedure at any time.




What are the risks during Hysteroscopy?


Pain during or after outpatient hysteroscopy is usually mild and similar to period pain. Simple pain relief medications can help. On occasion, women may experience severe pain. Feeling or being sick or fainting can affect a small number of women. However, these symptoms usually settle quickly. Bleeding is usually very mild and is lighter than a period, settling within a few days. It is recommended that you use sanitary towels, not tampons. If the bleeding does not settle and gets worse, contact your healthcare professional or nearest emergency department. Infection is uncommon (1 in 400 women). It may appear as a smelly discharge, fever or severe pain in the tummy. If you develop any of these symptoms, contact your healthcare professional urgently. Damage to the wall of the uterus (uterine perforation) – rarely, a small hole is accidentally made in the wall of the uterus. This could also cause damage to nearby tissues. This happens in fewer than 1 in 1000 diagnostic hysteroscopy procedures but is slightly more common if someone has a polyp or fibroid removed at the same time. It may mean that you have to stay in hospital overnight. Usually, nothing more needs to be done, but you may need a further operation to repair the hole.




Do I need to use contraception before hysteroscopy?


The procedure must not be performed if there is any chance that you are pregnant. To avoid this possibility, it is important to use contraception or avoid sex between your last period and your appointment. You may be offered a urine pregnancy test on arrival at your appointment.





 

Laparoscopy FAQ

What are the baseline fertility hormone tests?


Fertility hormone tests are blood tests. FSH (follicular stimulation hormone) and LH (luteinising hormone) are the hormones released by the pituitary gland (a part in the brain). FSH travels through the bloodstream to the ovaries where it stimulates the growth of follicles. A normal FSH level is somewhere between 2 and 8.9, this is enough to support the growth of one follicle and is how nature normally limits us to singleton pregnancies. FSH levels vary through the cycle it must be measured in the first few days of menstruation (day 2-5 of the cycle). When bleeding starts is considered as day 1 of the period. Estradiol is an ovarian hormone. It is tested along with FSH and LH. It helps to understand whether low FSH is a result of high estradiol or low production of FSH by pituitary.




What is the test for ovulation (release of an egg)?


The most commonly used test for ovulation is a progesterone hormone test. It is a blood test. After ovulation, this hormone is released by the ovary. After 7 days of ovulation (release of the egg) progesterone levels reaches to peak, which is 7 days before next expected period. Therefore progesterone test is advised on day 21 of the period based on the cycle length of 28 days. If the cycle is 30 days long, progesterone should be done on day 23. If cycles are irregular, sometimes, it is advised on two occasions in a cycle. Value more than 20, normally indicates ovulation (always check local laboratory standards and reference range). Another reliable test for ovulation is use of ultrasound to check the growth and release of follicle. It is expensive as compared to blood test.




What is AMH (anti-mullerian hormone) test?


AMH test is a blood test which can be done at any time during the cycle. AMH is a hormone produced by the growing follicles in the ovaries and is a direct marker of the number of follicles. Therefore, it is used as an ovarian reserve marker. AMH varies with age. Normal levels are interpreted with age. AMH <5pmol/ml is considered as a poor ovarian reserve. Lower levels are indicative of poor reserve and higher levels associated with, but not diagnostic of, polycystic ovaries. AMH varies less through the period cycle and so can be measured at any time. AMH should not be measured with long term use of contraceptive pills, it may show lower levels than normal.




Does AMH tell chances of natural conception?


No. AMH is not a good predictor for chances of natural conception.




How does AMH help for IVF?


AMH gives an idea of number of eggs in the ovary. Broadly speaking AMH = quantity of eggs in the ovary (high value of AMH, high number of eggs) Age= quality of eggs. (Higher the age, lower is the quality) The stimulation protocols are based on age and AMH results. At p4 fertility, we analyse all factors including AMH and age to personalise the IVF protocols.