Diagnostic Testing for Fertility

Below are "key ingredients" for getting pregnant and how we evaluate them:

1. Uterus: In order for implantation to occur, there must be a healthy endometrium (uterine lining) and uterus. A pelvic ultrasound is the most common way to evaluate the uterus. An HSG or SHG can also be used to get a closer look at the lining of the uterus - common issues that can be identified during these tests include fibroids or polyps that are distorting the lining. If these are found during your evaluation, your doctor will talk to you about whether or not they need to be addressed. Your doctor will also specify whether an HSG or SHG is more appropriate for you.
2. Ovaries: The pelvic ultrasound also gives us another important piece of information — antral follicle count (AFC), or the number of small follicles on the surface of your ovaries. This gives us a general sense of how many eggs remain in your ovaries, since you are born with a certain number of eggs that decreases over time until menopause. Other tests that are used to evaluate this "ovarian reserve" include the anti-Mullerian hormone (AMH) and the follicle stimulating hormone (FSH), which are blood tests.
3. Tubes: At least one open tube is needed for sperm and egg to meet. In addition to telling us about the uterus, the HSG also provides information on whether or not the tubes are open. If your doctor recommends a SHG for uterine evaluation instead, we can also add an additional step to the procedure called the FemVue, which specifically looks at whether or not your tubes are open at the same time as the SHG.
4. Sperm: If you have a partner who will be providing sperm, they should undergo a semen analysis by producing a specimen through masturbation. This can be done in our office or at home as long as the sample can be brought to the office within an hour. We look at the sperm under the microscope and count the number of sperm as well as their motility (how well they move) and several other parameters. They can call 610-902-4989 to schedule, and we recommend no ejaculation for two-to-five days prior to the test.

Your doctor may also recommend additional testing depending on your specific circumstances, but these are the basic pieces of the fertility workup. You can find more information about the HSG and SHG/FemVue in "The Hysterosalpingogram and Sonohysterogram".