Everything You Need to Know About Fertility Testing
Fertility testing has evolved over the past 30 years. Many tests purported to be important in understanding causation have not stood the test of time. The advent of IVF has revolutionized therapy with pregnancy success rates in ‘Centers of Excellence’ far exceeding those of natural fecundity. Consequently, testing necessary to implement effective therapy has been simplified to minimize cost to pregnancy. Here is a brief overview on everything you need to know about fertility testing.
Male Fertility Testing
Testing in the male has always centered around the semen analysis. There are three major components of the semen analysis:
- Count (>20 Million)
- Motility (>60%)
- Morphology (>4% by Kruger assessment)
- In cases where the count is less than 10 Million (severe oligospermia), additional testing may be warranted. Blood tests for infectious disease such as HIV I & II, Hepatitis B & C, and an RPR are also obtained on both the male and female.
- In cases where donor sperm is needed, the FDA requires that Hep B core and Type & Rh be obtained on the male and CMV IgG & IgM and Hep B Core be obtained on the female.
- In cases where donor egg is needed, the FDA requires that the male have testing for Hep B Core and HTLV I & II and the female recipient have testing for CMV IgG & IgM, Hep B Core, and Urine for GC and Chlamydia.
Fertility Testing for Women
Testing in the female should include the following blood tests often collected between cycle day 2-4:
- Anti-Mullerian Hormone (AMH)
- Follicle Stimulating Hormone (FSH)
- Thyroid Stimulating Hormone (TSH)
- Blood Type & Rh
- HIV I & II
- Hep B & C
- Rapid Plasma Reagin (RPR)
- Pelvic Ultrasound
An intrauterine structural study such as a SonoHSG should also be performed after cessation of menses to look for intrauterine filling defects, fibroids, polyps, ovarian cysts, hydrosalpinx, and for free fluid in the pelvis.
What Does AMH Mean For Your Fertility?
AMH is produced by granulosa cells surrounding each oocyte in the developing ovarian follicle. It is produced primarily by the preantral and small (less than 8 mm) antral follicles in the ovary. Since these follicle numbers decline with age the production and serum levels of AMH at any given time are reflective of a woman’s ovarian reserve. AMH is not predictive of pregnancy but is predictive of a woman’s response to gonadotropin stimulation with the lower the AMH the lower the ovarian reserve and thus the higher the dose of medication needed to try and achieve a mature oocyte at the time of oocyte retrieval with IVF.
Genetic testing should also be performed on one of the partners depending on racial/ethnic ancestry but at a minimum at least for Cystic Fibrosis (CF) and Spinal Muscular Atrophy (SMA) since they occur in 1 in 25 and 1 in 50 of the general population. If a mutation is found then of course the partner should be tested for the same mutation.
Ovulation Dysfunction Testing
If ovulation dysfunction is suspected then additional testing is advised. This testing includes:
- Fasting Insulin and Glucose
- Hgb A1c
In addition to the above blood tests and ultrasounds, age, weight, menstrual cyclicity and smoking history will give the clinician ample data in which to formulate an effective treatment plan.
Fertility declines over time with age. Fortunately, with infertility treatments you have the option to take more control over your fertility. If you have more questions on fertility testing or you are experiencing difficulty getting pregnant, please contact us for a free initial consultation. We are here to help.