Couples Fertility Test

One of the first steps before embarking on fertility treatment is an assessment to understand accurately the fertility levels of the couple trying for a baby. At Fertility Plus we offer a couples fertility test that includes all the important fertility tests.

Our couples fertility test includes accurate and comprehensive female blood hormone (AMH) testing combined with an ultrasound scan to reliably predict the ovarian reserve of the eggs. In addition to this a sperm test is also undertaken on the male partner.

These tests are all undertaken with a consultation with our specialists and an explanation of results.

Ovarian Reserve testing

Ovarian reserve is the female fertility potential i.e how long you have left to have a baby. Usually this naturally decreases with age but sometimes it can decrease faster or slower than expected. Ovarian reserve is also extremely helpful in fertility treatment planning as it important as it can indicate what the response will be to the stimulation of the ovaries and the potential for success.

Ovarian reserve testing relates to the tests undertaken to understand a woman’s ovarian reserve. In particular, there are two key tests when undertaking ovarian reserve testing; antral follicle count and AMH blood tests. Together these two tests provide an accurate assessment of the female reproductive potential.

Antral Follicle Count

The antral follicle count is the number of antral follicles that are present at the beginning of the cycle and have the potential to grow and become competent follicles (antral follicles are small follicles (2-9 mm) that we can see. measure and count. These can, with reasonable accuracy, be counted through vaginal ultrasound examination. The sum of the antral follicles in the ovaries can indicate what the fertility potential is of the woman and importantly what the response will be to treatment involving stimulation of the ovaries, particularly for in-vitro fertilization (IVF). Therefore, this is an important test in planning fertility treatments and understanding the success potential, for example:

• An antral follicle count of less than five usually indicates a low ovarian reserve, resulting in the need for relatively high doses of medication in order to produce a reasonable number of eggs for IVF.
• An antral follicle count of greater than 15, seen in such conditions as polycystic ovary syndrome, indicates a very good chance of harvesting a good number of eggs. This usually demands only a moderate dose of stimulating medication.
• Antral follicles may vary in women with lower egg count from cycle to cycle

Anti-Mullerian Hormone (AMH) Blood Test

Anti-Mullerian Hormone (AMH) hormone is a hormone produced by the ovarian follicles, therefore levels of AMH often relate to the number of antral follicles in the ovary but AMH levels in isolation depict the remaining lifespan of the ovaries, ie how much time is there left. The level of AMH in the blood can thus indicate how many egg-containing follicles are available in the ovaries with the potential to ovulate. In other words, the AMH level can tell us the size of the ‘ovarian reserve’.

AMH declines naturally with age and high levels can suggest polycystic ovaries, which is important when considering fertility treatments such as IVF.

Fertility Plus offers a complete package for ovarian reserve testing (initial egg count package) either to determine your fertility potential and how much time there is left or to help with fertility treatment planning.

• Up to 45 minute consultation with consultant fertility specialist
• AMH blood test
• An ultrasound scan to assess the follicles in your ovaries
• Results review with consultant fertility specialist

3D/4D Ovarian Reserve Testing Assessment

It is important to know the ovarian reserve or, more precisely, the number of eggs in their follicles (antral follicles) that are available for stimulation at the beginning of a cycle with the potential to ovulate in that cycle.

With the improvement in technology and 3D scanning technology, the number of antral follicles that are present at the beginning of the cycle can now be fairly accurately counted through vaginal ultrasound examination.

The sum of the follicles in the ovaries can indicate what will be the response to treatment involving stimulation of the ovaries, particularly for in-vitro fertilization (IVF) can give a rough guide to the chances of a successful treatment. This enables the planning of the treatment doses.

An antral follicle count of less than five usually indicates a low ovarian reserve, resulting in the need for relatively high doses of medication in order to produce a reasonable number of eggs for IVF.

An antral follicle count of greater than 15, seen in such conditions as polycystic ovary syndrome, indicates a very good chance of harvesting a good number of eggs. This usually demands only a moderate dose of stimulating medication.

HyCoSy

HyCoSy is a hystero-salpingo contrast sonography to check the uterine cavity and the patency of the Fallopian tube.
Aqua scan (saline infusion sonography) is an ultrasound examination of the uterine cavity to exclude any pathologies such as fibroids, polyps or abnormalities in the uterine cavity.

When is it done?

It is usually done between day six and day 12 of your cycle (when you have stopped bleeding) and before ovulation occurs. The reason is to avoid the chance of being pregnant at the time of the procedure.

The HyCoSy procedure

You must have an empty bladder prior to the procedure. You will be asked to lie down on the examination couch and a speculum is inserted into the vagina and a thin catheter is fed into the opening of the cervix. A vaginal ultrasound probe is inserted and sterile fluid is injected into the cavity to examine the cavity (aqua scan). This part of the examination is called a saline infusion, sonohysterography or hydrosonohysterography. Following this, a contrast medium is injected into the catheter. The solution is used to examine whether the Fallopian tubes are patent (open or blocked). If the examination of the tubes is carried out, the whole procedure is called a hystero-contrast sonography, HyCoSy. You may experience some cramps and discomfort at this point when the dye is injected.

The procedure takes about ten to 15 minutes and does not require anaesthesia. If you feel that speculum examinations are very painful, then this procedure can be done under general anaesthesia or sedation and this would be subject to additional costs.

The ultrasound scan is a 3D scan of the womb, its lining, endometrium and the ovaries, reviewing the antral follicular count (the egg reserve).

After the procedure you will be asked to remain for about ten to 15 minutes in the waiting room to ensure you do not have any reactions to the contrast and are safe to go home. It is advisable that somebody accompany you to the clinic to drive you home in case you feel unwell after the procedure, and also so that you can rest at home for a few hours. You should be able to return to work on the same day. The dye may cause some spotting, so sanitary towels may be needed. Do not use tampons, as this may increase the risk of any infection.

When will the results be available?

After the procedure all the results including the antral follicular count and the tubal test will be discussed alongside the next plan for treatment.

Are the any side effects of the HyCoSy procedure?

You may experience cramping and abdominal pains following the procedure, and there is the possibility of light bleeding following the examination. This should stop within 24 to 48 hours, if the pain continues more than 48 hours, please contact us.

What are the risks of the HyCoSy procedure?

It is possible that infection maybe develop after the procedure and could be apparent days later but this is very rare. If you develop any symptoms of fever, foul smelling discharge and pain, please contact us as soon as possible. In those cases we may do a swab and give you antibiotics. We routinely give Azithromycin one gram as a single dose after the procedure.

Important information

Please abstain from sexual intercourse from the first day of your period until after the procedure. This is to prevent any chance of pregnancy before having the procedure. It is very important to have the chlamydia test before having the procedure to ensure that the infection is not present in the cervix which can be introduced into the womb and then into the tubes.

Please inform us if you have any known allergies to contrasts/shellfish or iodine before the procedure. You may get a mild reaction which will make you feel a bit faint or have abdominal pain.

Fallopian Tube Testing

Fallopian tubes are an integral part of natural conception as the sperm and egg meet and fertilise in the fallopian tube and then transported by tube to the womb for implantation. Any damage or blockage in the tube could interfere with natural conception.

Tubal patency can be checked by HSG- Hysterosalpingogram or HYCOSY- ultrasound guided dye test in a clinic without the need of anaesthetics. Laparoscopy still remains the gold standard and offers more detailed analysis, but requires a general anaesthetic. Laparoscopy also offers the significant advantage of correcting any blocks, if possible, during the same operation.

Hormone Blood Test

Female hormones fluctuate throughout the natural menstrual cycle as well as during the fertility treatment cycle.

Blood tests performed on specific days during a menstrual cycle help us understand the hormone levels and to plan and monitor a treatment cycle with accuracy.

E2 (Estradiol), FSH (Follicle Stimulating Hormone), LH (Leuteinising Hormone), AMH (Anti Mullerian Hormone), Progesterone, Prolactin, Thyroid Function Test are some of the more common hormones checked. Some women may need more specific hormones checked for conditions such as polycystic ovaries (PCO).

Men may also need the FSH, LH, testosterone levels checked with a blood test if the sperm count is very low, or even completely absent. These tests can sometimes help to determine the cause of infertility.

Male Fertility Test

Male fertility relies on the quality and quantity of the sperm; if not enough sperm are produced (or ejaculated) or the quality of the sperm is poor this may result in issues trying to conceive.

Male fertility issues can be due to poor or absent sperm count, poor sperm motility, testicular problems, genetic problems and blockage along the sperm pathway. Male fertility issues are not uncommon with an estimated one in 20 men with a fertility issue relating to low sperm and account for approximately 1/3 of the cases where couples are unable to conceive.

Fertility issues are often invisible, presenting no symptoms as the quality and appearance of the ejaculated sperm would appear normal to the naked eye. The only known ‘symptom’ would be lack of successful conception if trying for a baby, therefore if you are experiencing issues conceiving the male partner should also be investigated to rule out male fertility issues.

This are some common misconceptions associated with male fertility issues:

• Lack of libido indicates male fertility issues: No, a lack of libido is not a sign of poor sperm but may cause infertility by less sexual intercourse.
• Abstinence improves sperm quality: No, evidence suggests that sperm DNA may improve if long periods of abstinence are avoided.

At Neogenesis Fertility we offer a male fertility test that will help determine if there are fertility issues associated with the male partner and that nature of the specific fertility issue. The male fertility test package includes:

• 30 minute initial consultation with a consultant fertility specialist
• sperm test
• results review with consultant fertility specialist