Ovarian reserve testing (egg quality tests)
Ovaries not only produce eggs, but they also secrete the female reproductive hormones estrogen and progesterone. The production of these female hormones is dependent on the biological health of one's eggs. Normal egg quality equates to normal levels of estrogen and progesterone.
Egg quality is the most important factor in determining 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.
A combination of transvaginal ultrasound examination of the ovaries and an assessment of reproductive hormone levels will determine the most appropriate treatment for you.
Ultrasound examination of the ovaries will assess the number of antral follicles (seen as small dark circles) within each ovary. Their number is related to the quality of the eggs. Ideally, there should be approximately a total of 20 antral follicles in both ovaries combined. Too few or too many antral follicles mean that normal quality eggs may be infrequent or even absent within the ovaries. The majority of women will have 12 to 24 antral follicles.
Follicle Stimulating Hormone (FSH), estradiol (estrogen, E2), and Anti-Mullerian Hormone (AMH) blood levels relate to the egg quality.
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 directly related to egg quality. FSH should ideally be less than 7.0 and estradiol less than 30 in a blood sample drawn during a menstrual period.
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.
Most women will have normal ovarian testing results. An abnormal result does not necessarily mean that one cannot get pregnant. If the test results are abnormal, they should be repeated.
Evaluation of the uterus and the Fallopian tubes
The 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.
Saline ultrasound can be used to assess the endometrial cavity. 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.
Patency of the Fallopian tubes is commonly evaluated by an x-ray of the uterus and the Fallopian tubes, a hysterosalpingogram (HSG) performed by a radiologist. The HSG is not necessary if your infertility investigation concludes that In Vitro Fertilization is the most appropriate treatment. IVF bypasses the function of the Fallopian tubes.