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. 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.
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.
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 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.