Blood Tests and Scans
When people have been trying to conceive for 12 months or more (will vary depending on location, age and doctor) they will be sent for their first initial blood tests and sperm test.
Female Blood Hormonal Profile
You will be requested to visit the nurse to have blood taken on specific times of her cycle. Day 1,2 or 3 of her menstrual bleed and day 21 of her cycle to confirm ovulation has occurred. (Please be aware that day 21 is based on an average 28-day cycle therefore with clients that experience longer cycles this test may be inaccurate).
Day 1-3 of cycle
- Follicle-stimulating hormone (FSH) – This hormone is responsible for stimulating the ovaries to produce follicles prior to ovulation. The lower the reading the better. A high reading may be due to the ovaries struggling or if messages are not getting through properly, so the pituitary has to produce more hormone to get a response.
Less than 6 = Excellent
6-8 = Normal
8-10 = OK
10-12 = Reduced egg quality
12-17 = Low live birth rates
17 and over = Very poor response to stimulation
- Thyroid Stimulating hormone (TSH)
Every cell in the body depends upon thyroid hormones to work efficiently. It controls metabolism, blood calcium levels, energy production, oxygen utilisation and balance of hormones and weight management.
An underactive thyroid can affect fertility in the following ways, non-ovulatory cycles, luteal phase defect, early miscarriage, high prolactin levels and irregular ovulation.
TSH ranges should ideally be between 0.4-2
- Luteinizing hormone (LH)
This hormone surges just before ovulation. It is the hormone that is tested with the ovulation tests strips. This hormone ideally needs to be on a 1:1 ratio with FSH. Therefore, if you have an FSH level of 7 then the LH needs to be around this figure for optimum chances.
- Testosterone
Testosterone is tested to see if Polycystic ovaries are likely (also confirmed through an ultrasound).
0.22 – 2.9 nmol/L
- Oestradiol (Oestrogen)
Oestradiol is primarily sex hormone of childbearing women. It Is formed from developing ovarian follicles. It is responsible for female characteristics and sexual functioning. It is important for bone health and contributes to most gynaecological problems such as fibroids and endometriosis. Oestrogen is used as an indicator of ovarian reserves, and the results are usually defined as normal or poor. A poor result may indicate a low egg reserve, therefore, the quality of the eggs may be affected,
Follicular phase 72-529
Ovulatory 235-1309
Luteal 205-786
Postmenopause less than 118
- Prolactin
Prolactin is a hormone that is normally produced when a mother is breastfeeding to prevent ovulation from occurring so that the mother is not able to fall pregnant. However, when elevated levels of Thyroid Releasing Hormone and low levels of thyroxine (T4) are present prolactin levels can be disrupted. Stress can also trigger high levels of prolactin. High levels of prolactin can suppress FSH and LH production therefore ovulation is disrupted and can stop completely.
Female 59-619 IU/ml
Day 21 of cycle (or 7 days after ovulation)
- Progesterone
Progesterone levels should be tested 7 days after ovulation. A value of over 30 confirms ovulation has occurred efficiently.
STI’s
- Chlamydia
Chlamydia is the most common sexually transmitted infection in the UK. This urine test / swab test is quite commonly carried out now for both male and female when you start your fertility journey. If present it can be treated with a course of antibiotics.
Female Scans
Ultrasound
An ultrasound scan is performed by a Sonographer they will check for any structural abnormalities of the uterus, cervix and fallopian tubes. If a transvaginal scan takes place a probe is placed in the vagina to see the structures more clearly.
The scan can detect conditions such as fibroids, polycystic ovaries, and very severe endometriosis. It may also be able to detect any blockages in the fallopian tubes.
Hysterosalpingpgram (HSG)
An HSG is an X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them.
During the HSG a dye (contrast material) is put through a thin tube that is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes.
The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg.
A hysterosalpingogram also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.
Reasons for a HSG
- Check for a blocked fallopian tube. The test often is done for a woman who is having a hard time becoming pregnant. An infection may cause severe scarring of the fallopian tubes and block the tubes, preventing pregnancy. Occasionally the dye used during a hysterosalpingogram will push through and open a blocked tube.
- Find problems in the uterus, such as an abnormal shape or structure, an injury, polyps, fibroids, adhesions, or a foreign object in the uterus. These types of problems may cause painful menstrual periods or repeated miscarriages.
- See whether surgery to reverse a tubal ligation has been successful.
Hysterosalpingo-Contrast-Sonography (HyCosSy)
A HyCosSy scan is a short procedure to detect whether the fallopian tubes are damaged or blocked. It is sometimes called a Tubal Patency Test or a Dye Test and can be a substitute for a HSG (Hysterosalpingography) or Laparoscopy and Dye, without the use of X-rays.
The procedure involves passing a small thin catheter is passed through the cervix into the uterus and ultrasound contrast medium is passed through the fallopian tubes. The progress of the fluid can be monitored by ultrasound and any blockages or abnormalities can be detected. This may cause some discomfort and feels similar to the uterine cramps experienced during menstruation. The procedure takes approximately 30 minutes to complete and no anesthetic is required.
The HyCoSy should be performed after menstruation in the first half of the cycle, sometime between days five and twelve.
The HyCosSy procedure is a safe and reliable alternative to the conventional hysterosalpingogram (HSG) which uses X-rays. No radiation or iodinated contrast material is used for a HyCoSy test.
Pelvic Laparoscopy
A laparoscopy is a type of keyhole surgery. It is the most common way to diagnose endometriosis. During a laparoscopy, a small telescope (laparoscope) is inserted into the abdomen to look directly at the internal tissue. Laparoscopies are always carried out under general anaesthetic. During a laparoscopy, various procedures can be performed in order to destroy or remove the endometriosis, endometriotic cysts and release scar tissue (adhesions). This is called an ablation (burning off the endometriosis).
Sperm Analysis
Semen will be tested to determine whether you have a low sperm count, low sperm mobility or abnormal sperm.
Semen analysis is basically the microscopic examination of the semen to see how many sperm there are and whether they function correctly. The results of all the semen analysis tests will indicate whether or not a malefactor is involved.
To perform this test, the man has to masturbate into a small sterile container. Specimen collection is usually done at home, as long as the hospital is not too far away as the sample will need to be analyzed within 90 minutes of the specimen being produced.
To provide the best sample, you should:
- Provide a complete sample. The first part of the sample contains most of the sperm so if some is lost it will affect the overall test.
- Abstain from ANY sexual activity for 2-5 days beforehand.
- Deliver the sample in a container provided or recommended by the laboratory
- The sample must be analyzed within 90 minutes otherwise the sperm will begin to die off.
Basic Semen Analysis
A poor semen analysis is normally the first sign that something is not quite right. Changes in sperm can be due to many external factors and it is important at this stage to try and eliminate any possible causes.
A basic NHS report tends to analyse the following parameters: –
- Sperm Volume – This is the amount of sperm produced in the sample. Needs to be 2-4ml
- Sperm concentration – Or sperm count in millions per mL of semen. This is done under the microscope using a specialized counting chamber. Normal range 13-17 millions per ml or more.
- Sperm motility – Sperm are graded on their ability to swim. The fast-forward swimming sperm being the most fertile. The normal range is when approximately 30% are moving forwards.
- Sperm morphology – The shape and size of the sperm are assessed and the number which are normal are reported. Normal range is anything over 4% normal or more.