Female Infertility Testing:
Female infertility testing begins with a series of hormone testing along with a sonogram. This is most often the first step in female fertility assessment unless there is a reason to begin investigation elsewhere.
1- Hormone testing: One of the most important pieces of information when it comes to female fertility is ovarian assessment. Ovarian assessment refers to gathering information about the patient’s ovarian reserves and her likely oocyte quality. The hormones that are related to the female patient’s reproductive function are as follows:
Follicle Stimulating Hormone (FSH): This specific hormone is produced by the pituitary gland. The FSH hormone stimulates the granulosa cells found in the ovaries and triggers production of estrogen. Elevated FSH levels are an indication that a woman’s egg supply (ovarian reserve) is diminishing, or diminished, therefore, the pituitary releases more to compensate for this loss. Typically, FSH levels begin to rise naturally years before a woman enters menopause, and postmenopausal women may have levels of FSH that fall between 25.8 and 134.8 mIU/ml.
Luteinizing Hormone (LH): LH hormone is also produced by the pituitary. In females, ovulation of mature follicles on the ovary is induced by a large burst of LH secretion, therefore, the LH hormone is responsible for maturation and the final rupture of the oocyte.
Estradiol (E2): Estradiol is a form of the hormone estrogen. In women, estradiol is produced in the ovaries, and adrenal glands. It is also produced in the placenta during pregnancy. Estradiol helps with the growth of the female sex organs, and is also indicative of a woman’s ovarian function.
Thyroid Stimulating Hormone (TSH): TSH production involves a chain of events. The hypothalamus produces a hormone called TRH, which then triggers the pituitary to release TSH. This hormone helps us assess thyroid gland problems. Thhyroid problems can cause a number of symptoms as well as affecting your fertility.
Anti-Mullerian Hormone (AMH): AMH levels indicate the growth of small follicles in the ovaries. AMH is produced directly by the granulosa cells in ovarian follicles. AMH, therefore, is accepted as a more accurate measure of the ovarian reserves compared to the FSH. This is especially true for women in more advanced age brackets. For patients older than 35 years of age, hormone test results without an AMH measurements will not provide a complete assessmebt of the fertility level.
Ideally, the hormone tests are done on day 2 or day 3 of your menstrual period for an accurate assessment. The normal range of these hormones are as follows:
Normal Range for Hormone Tests:
Test Normal Range Measurement unit
FSH 2.9 – 12.0 mUI/ml
LH 1.5 – 8.0 mUI/ml
Estradiol 18.0 – 147.0 pg/ml
Prolactin 5.0 – 35.0 ng/ml
TSH 0.25 – 5.0 mUI/ml
< 0.3 ng/ml Very low level of fertility
0.3 – 1.0 ng/ml Low level of fertility
1.0 – 3.0 ng/ml Optimal level of fertility
> 3.0 ng/ml Risk of PCOS
Note that there are more than one scale of measurement. Your laboratory may measure your hormone levels in ng/ml, pmol/l or mIU/ml or any other scale. This means that the numbers alone will not make any sense unless the number are provided with a measurement scale. For instance, an AMH level of 5 will not mean anything as an AMH level of 5 ng/ml indicates optimal level of fertility, with the possibility of PCOS while an AMH level of 5 pmol/l indicates a level of fertility which is almost undetectable. Furthermore, you should also keep in mind that even though the measurement scales and units of measurement may be the same, the reference values given by the kit used at your laboratory may be different from the values provided above. You should only use the above numbers for reference purposes and let our IVF specialists interpret what these numbers suggest in order to avoid any confusion.
2- Baseline Ultrasound Scan: A base-line ultrasound scan is a scan performed on day 2 or day 3 of your menstrual period, which is exactly when the hormone tests need to be administered. Therefore, a single trip to your gynecologist’s office will suffice to have all your preliminary infertility assessment done. The scan results will indicate the size of your ovaries, uterus, the number of antral follicles as well as the appearance of endometrium. Your antral follicle count indicates how many follicles are “ready” to be recruited for ovulation during IVF treatment. Usually, a total antral follicle count of 5/6 and above is an indication of an acceptable level of ovarian reserves. If the number of antral follicles exceeds 12 in each ovary, then the patient should be considered a potential candidate for PCOS and examined further for a proper diagnosis. PCO or PCOS can also be indicated by an LH/FH ratio that is markedly higher than an average value of 1. Apart from the antral follicle count, the ultrasound scan also gives us a chance for ovarian and uterine assessment. Should there be a major problem in the uterus or the ovaries that can interfere with a successful pregnancy, it should be visible during this scan.
Male Infertility Testing:
Male infertility testing begins with a semen analysis. The semen analysis will evaluate the sperm sample with respect to several parameters such as sperm count, concentration, motility, morphology, round cell count, pH and etc. These parameters will be indicative of the sperm’s capacity to fertilize the egg. A semen analysis will produce more accurate results if it is done following 3 or 4 days of abstinence (no sexual activity). Ideally, you should not consume excessive alcohol or tobacco products a few months prior to your planned pregnancy. The WHO criteria for normal sperm values are as follows:
Volume: > 2.0 ml
Concentration: >20 million/ml (This is also referred to as the “sperm count”)
Motility: > 50%
Morphology: >30% with normal morphology
White Blood Cells (Round Cells): < 1 million/ml
Further testing may or may not be necessary depending on your history of infertility, testing and or treatments. While the above parameters are the minimum requirements in a sperm sample established by the World Health Organization (WHO), they refer to the normal values that should be present in a sperm sample for obtaining a natural pregnancy through intercourse. During IVF treatments, we often work with sperm samples that have much lower sperm count, motility and morphology. Sperm samples which fall below the standard requirements established by WHO can be categorized as follows:
Oligozoospermia refers to the number of sperm cells in the ejaculate that have been tested to be lower than the normal parameters established by WHO. The normal range of the sperm count is above 20 million/ml, therefore, men whose sperm analyses indicate a sperm count less than 20 million/mL are considered to belong in the oligospermia (oligozoospermia) category.
Astenozoospermia refers to the sample of sperm whose motility has been found to be lower than 50%. Sperm’s ability to move is directly related with its ability to swim through the cervical pathways, reach the fallopian tubes and fertilize the oocytes. The lower the motility, the lower the capability of sperm cells to reach and fertilize the eggs on its own. However, with IVF/ICSI technologies, this is one of the infertility factors that can easily be corrected.
Teratozoospermia refers to a diminished level of sperm cells that are of normal form. In other words, teratospermia (teratozoospermia) refers to a high level of sperm cells in the ejaculate that are considered to be “abnormal”. These abnormalities can correspond to head, tail or mid-piece defects. Depending on the sperm abnormality present, and depending on the other parameters of the sperm, certain treatment methods such as ICSI or the MicroFluidic Chip can provide a solution.
Azoospermia is a condition characterized by the total absence of sperm cells in the sperm. Azoospermia can be classifies as obstructive azoospermia or non-obstructive azoospermia. Depending on your diagnosis, surgical sperm extraction methods may be employed and a successful IVF treatment can be carried out.