Infertility Tests
Bay IVF - Advanced Reproductive Care                                Palo Alto  650-322-0500

 

Infertility Tests

Your reproductive history, together with the result of your testing, will determine which treatment will most likely and inexpensively result in pregnancy.

We plan your fertility testing around the three categories of infertility factors:

  • Male factor infertility
  • Ovulation and egg quality disorders
  • Uterine and Fallopian tubes factors

 

As much as possible, we try to make use of reproductive test results done prior to your becoming a patient at Bay IVF to minimize your cost without compromising your treatment outcome. The following reproductive tests are an example of the most commonly performed tests at Bay IVF.

  • Semen evaluation

    A significant portion of all infertility is due to male factor infertility, and the presence of male infertility has a major impact on the direction of fertility testing and treatment.

    Unless semen evaluation results are highly abnormal (i.e., a concentration less than 3 million, total motility less than 3%, and normal morphology less than 3%), the test results cannot be reliably used to assess the male fertility potential.

    We use your semen assessment to guide us in selecting the optimal method for semen preparation in your upcoming treatment.

  • Ovarian reserve testing (egg quality tests)

    Ovaries not only produce eggs, but they also secrete the female reproductive hormones estrogen and progesterone. These hormones are produced by granulosa cells which line the inside of the ovarian follicles in which the eggs mature.

    The function of granulosa cells and the production of the female hormones are dependent on the biological health of the eggs inside the follicles. Normal egg quality equates to normal levels of estrogen and progesterone.

    Egg quality is the most important factor in determining the female fertility potential.

    At birth, a newborn girl has approximately two million eggs within her ovaries. By the time she starts ovulating, she has about 400,000 eggs remaining. From that point on, the ovaries lose approximately 1,000 eggs a month. When only approximately 100,000 to 150,000 eggs are remaining around the age of 40, the biologically "perfect" eggs have already been depleted. This is why successful conceptions end years before menopause.

    At Bay IVF, we utilize a combination of transvaginal ultrasound examination of the ovaries and an assessment of reproductive hormones levels: Ovarian Reserve Assay (ORA) to estimate your "biological age." The results of these tests will determine the most appropriate treatment for you.

    During your initial visit at Bay IVF, you will have an ultrasound examination of your ovaries to determine the number of antral follicles (seen as small dark circles) within each ovary. The number of antral follicles is related to the quality of the eggs. Ideally, there should be approximately a total of 20 antral follicles in both ovaries. Too few or too many antral follicles mean that normal quality eggs may be infrequent or even absent within the ovaries.

    There must be a total of four or more antral follicles in both ovaries combined for the reproductive treatments to have a chance of success. The majority of women will have 12 to 24 antral follicles.

    ORA assesses the likelihood that normal quality eggs can be produced. It consists of the measurement of Follicle Stimulating Hormone (FSH), estradiol (estrogen, E2), and Anti-Mullerian Hormone (AMH) blood levels.

    FSH stimulates the ovaries to produce eggs. If the ovaries cannot produce normal quality eggs, the FSH level is increased. Estradiol production by the ovaries influences FSH secretion and is also related to the egg quality. FSH should ideally be less than 7.0 and estradiol less than 30.

    Interpretation of ORA results depends on the total number of your antral follicles seen during your initial ultrasound at Bay IVF.

     

    Number of antral follicles in both ovaries combined:
    4 to 9

     

      FSH
    10.0 or Lower
    FSH
    10.1 to 11.0
    FSH
    11.1 or Higher
    E2
    50 or Lower
    OK OK X
    E2
    51 to 75
    OK X X
    E2
    76 or Higher
    X X X

     

     

     

    Number of antral follicles in both ovaries combined:
    10 to 20

     

      FSH
    11.0 or Lower
    FSH
    11.1 to 12.0
    FSH
    12.1 or Higher
    E2
    50 or Lower
    OK OK X
    E2
    51 to 75
    OK X X
    E2
    76 or Higher
    X X X

     

     

     

    Number of antral follicles in both ovaries combined:
    21 to 30

     

      FSH
    11.0 or Lower
    FSH
    11.1 to 12.0
    FSH
    12.1 or Higher
    E2
    50 or Lower
    OK OK X
    E2
    51 to 90
    OK X X
    E2
    91 or Higher
    X X X

     

     

     

    Number of antral follicles in both ovaries combined:
    31 or greater

     

      FSH
    10.0 or Lower
    FSH
    10.1 or Higher
    E2
    Any Level
    OK X

     

     

     

Your treatment can start if:

  1. Your initial ultrasound at Bay IVF indicated between 4 and 9 antral follicles (total for both ovaries combined), and your FSH was 10.0 or less, and E2 was 75 or less OR your FSH was 11.0 or less, and E2 was 50 or less.

     

  2. Your initial ultrasound at Bay IVF indicated 10 to 20 antral follicles (total for both ovaries combined), and your FSH was 11.0 or less, and E2 was 75 or less OR your FSH was 12.0 or less, and E2 was 50 or less.

     

  3. Your initial ultrasound at Bay IVF indicated 21 to 30 antral follicles (total for both ovaries combined), and your FSH was 11.0 or less, and E2 was 90 or less OR your FSH was 12.0 or less, and E2 was 50 or less.

     

  4. Your initial ultrasound at Bay IVF indicated 31 or more antral follicles (total for both ovaries combined), and your FSH was 10.0 or less.

 

AMH level also reflects the quality of eggs, and the result should ideally be 2 to 3. Lower or substantially higher levels signify less than optimal egg quality. AMH result is used to optimize your ovarian stimulation.

Most women will have normal Ovarian Reserve Assay results. An abnormal result does not necessarily mean that you cannot get pregnant with your own eggs. If the test results are abnormal, we typically recommend repeating the test up to three times.

  • Evaluation of the Uterus

    Your endometrial cavity must be free of polyps, scarring, and myomas (fibroids) before any treatment can be initiated. The presence of any of these structures inside the uterus could significantly compromise the likelihood of embryo implantation.

    We use a Sonohysterogram (saline ultrasound) to assess the endometrial cavity of your uterus. A thin, soft catheter is passed through the cervix into the uterus, and a small amount of sterile saline solution is gently instilled. A transvaginal ultrasound is used to confirm the absence of polyps, scarring, or fibroids inside the uterus.

    This ultrasound image shows a normal endometrial cavity. Polyps and fibroids (myomas) would show as lighter shade "filling defects" within the dark saline-filled endometrial cavity.

Sonohysterogram

 

  • Testing Required by the State of California and FDA

    Hepatitis B-Surface Antigen, Hepatitis C-Antibody, HIV I&II, HTLV I&II, and RPR screening are required as prerequisites for advanced reproductive treatments. In addition, Chlamydia and Gonorrhea tests are required for sperm and egg donors.

Typically, all necessary testing can be performed within two to four weeks, and then the most appropriate treatment can be initiated.

Your physical condition (both partners) can have a significant impact on your fertility. Optimizing your fertility potential could make a difference between achieving a successful pregnancy and going through years of frustration.

 

Please use the following links for information about reproductive treatments at Bay IVF and to request a consultation.

 

Request Information
or a Consultation
with Dr. Polansky

 

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