The most important aspect of female fertility are ovaries. Ovaries should release healthy eggs and reproductive tract must allow them to pass into fallopian tubes in order to join sperm and fertilized. Then the fertilized egg has to travel on to the womb and implant in the lining. Tests for female infertility try to determine whether any of the above processes are impaired.
Except of the regular gynecological exam, specific fertility tests may include:
- Ultrasound scans
- Transvaginal ultrasound scan to look for fibroids and cysts in the uterus and ovaries.
- Basal Antral follicle count (AFC): a transvaginal ultrasound study that measures women’s ovarian reserve, or remaining egg supply. Ovarian reserve reflects fertility potential.
- Blood tests
- Anti-Müllerian hormone (AMH): a hormone secreted by the small follicles in women’s ovaries. It is a new and better way to measure ovarian reserve, a concept that correlates the number and quality of eggs that are available in the ovaries. It would be ideal to combine AMH results with other ways of measuring ovarian reserve such as age, basal Antral follicle count and cycle day 3 FSH levels as no single test is perfect, nor cannot it predict with 100% accuracy what is going on in a woman’s body.
- Cycle Day 3 Follicle-stimulating hormone (FSH) levels: the main hormone involved in producing mature eggs in the ovaries, produced by the pituitary gland at the base of the brain. When a women goes into menopause she is running out of eggs in her ovaries. The brain senses that there is a low estrogen environment and signals the pituitary to make more FSH hormone. More FSH is released from the pituitary in an attempt to stimulate the ovaries to produce a good follicle and estrogen hormone. As women approach menopause their baseline (cycle day 3) FSH levels will tend to gradually increase over the years. When they run out of follicles capable of responding, their FSH will be high and they stop having menstruation. If happens in women under 40 years old, we can call it premature ovarian failure or primary ovarian insufficiency.
- TSH/Thyroid antibody: Thyroid dysfunction has been shown to adversely affect fertility. The thyroid has an autoimmune function, which many studies have linked to conception failure. Among the various influences on infertility are immunologic factors, which may play an important role in the reproduction processes of fertilization, implantation and fetal development.
- Genetic testing for infertility: Genetic testing helps determine whether there is a genetic defect causing infertility of pregnancy loss . Approximately, 10% of the fertility problems experienced by couples, can be explained by genetics.
- Hysterosalpingosonography (HSSG): an X-ray procedure used to evaluate the status and patency of a woman’s fallopian tubes, the two structures that carry eggs from the ovaries to the uterus. During HSSG, X-ray contrast is injected into uterus and an X-ray is taken to determine if the uterine cavity has normal shape and size, to identify uterine malformations, adhesions, polyps or fibroids and to check whether the fluid passes out of the uterus and spills out of fallopian tubes. In a few women, the test itself can improve fertility, possibly by flushing out and opening the fallopian tubes.
- Post-coital test: doctor takes a sample of mucous from the woman’s vagina. Test must take place during woman’s fertile days and within 12 hours after intercourse. The test will tell the doctor if the man’s sperm can survive in the woman’s cervical mucous.