Male and Female Infertility Testing
We have repeated one key aspect throughout our website, and that is the fact that a single prescription will not fit all! Each patient is unique and each patient is likely to require a custom treatment protocol based on her own history of infertility, history of fertility testing and/or treatments. The more information we have about your infertility history, the more we can comment on your specific needs and requirements. We can broadly analyze fertility testing in two categories as female and male testing:
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 [source: National Institutes of Health].
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.
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:
|HORMONE MEASURED||NORMAL RANGE|
|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|
|AMH||< 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 FSH level of 2 will not mean anything as an FSH of 2 ng/ml indicates optimal level of fertility while an FSH of 2 pmol/l indicates a level of fertility which is almost undetectable.
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. 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
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.
On the bottom, you will find links to the pages that will direct you to factors causing female infertility, factors causing male infertility, how infertility assessment can be made as well as how to identify the right treatment method for your unique condition. For any queries you may have about any of these subjects, please use the contact form below to contact us with your questions and we will be happy to answer…