Infertility Diagnostic Process

Common components of the evaluation and diagnostic process

• Day 3 Labs (Day 2-5 Of Menstrual Cycle) (FSH, LH, Estradiol)

• TSH
• Prolactin
• Rubella Titer (Checking for Immunity)
• Blood Type and Rh
• CBC
• CMP
• Trans-Vaginal Ultrasound
• Hysterosalpingogram
• Hysterosonogram
• Infectious Diseases (For Patient and Male Partner)
• Semen Analysis
• Pap-Smear (Performed by Your Primary Or OB/GYN)
• Genetic Screening (Blood Test)
• Physical Examination
• Medical Records from Previous Practices

Other tests/requests may include Androgens, Recurrent Pregnancy loss panel, Hemoglobin Electrophoresis; Karyotype, medical clearance and any other test that may help provide infertility answers or create a more detailed treatment plan for you. Any above test that has been completed in the last few months elsewhere will be accepted by IHR to avoid duplicated tests and reduce costs.

In general, with the onset of your period, we can do all the lab tests in one visit (anytime between day 2 and 5 of your menstrual cycle).  The first day of full flow is considered day 1.  We ask that you call with your period during business hours, Monday-Friday between 8 am-4pm, to schedule an appointment for the next business day.  During this visit, you will also have an ultrasound to evaluate your ovaries and uterus, do not worry if you are on your cycle for the ultrasound.

If your period begins on Friday evening or over the weekend, you do not need to call after hours or on weekends.  You can simply come in on Monday morning and we will take care of you.  There is no need to panic as we can complete these labs tests up to day 5 of your period. 

Estrogen / FSH (follicle stimulating hormone) / LH (luteinizing hormone)

The assessment of these three hormones together during the early part of your menstrual cycle helps us evaluate the communication between your pituitary gland and your reproductive organs.  The pituitary gland, located in the base of the brain, controls egg and hormone production.  Some ovulatory disorders, as well as declining ovarian function, can be identified by characteristic patterns in the hormones.  The best assessment of these hormones is between your menstrual cycle days 2-5.  You may hear them referred to as “day 3 labs”.

TSH (thyroid stimulating hormone)

This test evaluates thyroid function.  Both high and low thyroid function can affect reproductive health including miscarriage or prevention of pregnancy.

Prolactin

Prolactin is another hormone produced by the pituitary gland that is responsible for promoting breast milk production.  Sometimes this hormone can be elevated with abnormalities in the pituitary gland.  A Prolactin level can be elevated without the presence of discharge from the breasts (galactorrhea).  Elevated prolactin levels can cause ovulatory dysfunction.

AMH level

AMH (anti-mullerian hormone) blood levels are thought to reflect the size of the remaining egg supply – or “ovarian reserve”.  With increasing female age, the size of their pool of remaining microscopic follicles decreases.  Likewise, their blood AMH levels and the number of ovarian antral follicles visible on ultrasound also decreases.

Women with many small follicles, such as those with polycystic ovaries have high AMH hormone values and women that have few remaining follicles and those that are close to menopause have low AMH hormone levels.