DIAGNOSIS



Female Testing

General Screening Tests (Infectious, Genetic)

  • Infectious Screen (Chlamydia antibody, Gonorrhea, Hepatitis B, Hepatitis C, Syphilis serology, HIV): having one of these organisms or viruses could adversely affect your treatment outcome, pregnancy, and your general health if left undiscovered or untreated. All of these infections with the exception of gonorrhea may go undetected for periods of time without adequate testing.
  • Pre-Pregnancy Screen (Complete Blood count, Blood type & Rh Factor, Rubella titer). These tests are performed in order to avoid serious complications to the fetus during pregnancy and screen for anemia and possible other heritable disorders. While most people have been immunized for Rubella, in some cases a booster will be required to provide adequate coverage.
  • Pituitary/Thyroid Screening (Prolactin, TSH, Free thyroxin): hormonal tests which screen for abnormalities that can effect your treatment or pregnancy.
  • Genetic (Tay Sach's, Cystic fibrosis, Sickle Cell): if your history suggests that you may be at risk for certain genetic, autoimmune diseases, or medical diseases, other tests may be ordered prior to initiating the cycle.
  • Pap Smear: should be up-to-date per American College of Obstetric & Gynecology standards (usually within the year).
  • Breast Screening Mammogram: age appropriate.

Ovarian Function and Ovarian Reserve Screening

Ovarian disorders account for approximately 30-35% of female related infertility. Testing is aimed at giving us information on whether or not you are ovulating; if so, how well do you ovulate or what is the egg quality. Some women may have regular, ovulatory periods, but the egg quality may still be reduced. This is a natural phenomenon.

  • Baseline Ultrasound: Performed on day 2, 3, or 4 of the cycle. Provides information on the overall size and volume of the ovaries as well as the antral follicle count (number of early, potential immature eggs available per menstrual cycle) in the early part of the menstrual cycle, just after onset of the menstrual bleed.
  • FSH, LH, Estradiol: By looking at hormone levels such as FSH (follicle stimulating hormone) and Estradiol drawn at the beginning of the menstrual cycle (days 2, 3, or 4), Dr. Chang will get a good indication of a woman's "ovarian reserve." This is a measure of how well the ovaries are expected to respond to stimulation with fertility medication. 
     
  • Clomiphene Citrate Challenge Test (CCCT): Changes that decrease a woman's chances to reproduce may start many years before early menopause. These changes include but are not limited to decreases in the number of oocytes (eggs), as well as increased number of chromosomal abnormalities within the oocytes. While age itself is an important factor, not all women of the same age have the same reproductive potential. All women age 35 and over, as well as those who have a medical history suspicious for possible decreased ovarian reserve will be asked to undergo a CCCT. In order to complete the CCCT, blood is drawn on day 3 and 10 of the menstrual cycle (FSH, Estradiol), while taking a medication called Clomiphene Citrate (100mg) on days 5 through 9 of her cycle.

Tubal Evaluation

Issues with the fallopian tubes may account for approximately 30% of female infertility problems. Common problems we see are related to tubal blockage or scarring from previous, sometimes undiagnosed, pelvic infection, abdominal infections like appendicitis, prior surgeries, prior ectopic pregnancy, or endometriosis. Prior tubal ligation (tying of the tubes) for contraception would also fall under this category.

  • Hysterosalpingogram (HSG): This is a diagnostic X-ray test that will be performed in which a small amount of dye is put through the uterus and tubes in order to determine if the tubes are open. Some structural defects of the uterus may also be visible with the HSG, but the primary role for the HSG is to determine if the tubes are open.

Uterine Evaluation

The uterus is lined by a specialized layer of cells called the endometrium. It is to this lining that embryos implant and begin to develop in pregnancy. It is critical to thoroughly evaluate the uterine cavity for potential defects or obstacles to implantation of the embryo. Examples of such would be uterine scar tissue (from previous pregnancies or procedures), polyps (benign glandular growths), fibroids, or other structural defects in the uterus. Depending on your specific situation, the evaluation may include the following tests:

  • Complete physical examination and external palpation of the uterus. This will also include a Pap's Smear (if not done within the last year), breast examination, and cervical cultures.
  • Baseline Pelvic Ultrasound: this is a transvaginal ultrasound examination usually performed at the onset of your menstrual cycle on Day 2, 3, or 4. It provides Dr. Chang with further information on both the uterus and the ovaries.  
  • Hysterosalpingogram (HSG): as described in the tubal evaluation, may provide some information on structural defects of the uterine cavity.
  • Sonohysterography (saline sonography): sonographic evaluation of the uterine wall and inner uterine cavity performed while filling the uterus with a very small amount of sterile fluid. Performed by Dr. Chang in the office, this test provides information on abnormalities of both the uterine wall and endometrial cavity which may affect implantation of an embryo, increase miscarriage rates, and interfere with subsequent delivery of the baby. In some cases, findings on this test prompt the physician to recommend further evaluation with diagnostic hysteroscopy or proceed to surgical correction of an abnormality.