Submitted by: Allison Nelson, M.D.
Since not everyone requires fertility tests, the different parts of the workup, or the diagnostic examination, are often unfamiliar to many women. Testing of various hormones, including the thyroid hormone, as well as a semen analysis for the male partner, are common first steps. As the workup continues ,there are often recommended tests that patients have never heard of before. Having a working knowledge of these tests prior to an appointment can definitely help a patient and her partner get the most out of their consult. I sat down with Dr. Ellen Hayes, from Vios Fertility Institute, to discuss fertility testing, focusing on the tests that patients are oftentimes less familiar with.
Diagnosing Infertility Q & A
Why Is the Anti-Mullerian Hormone Level Important?
Dr. Nelson: Most infertility workups will start with lab tests. While most women have heard of thyroid-stimulating hormone, follicle-stimulating hormone, and prolactin, many patients have never heard of Anti-Mullerian hormone or AMH. How do you describe or explain this particular test to your patients?
Dr. Hayes: An AMH, or Anti-Mullerian hormone, level is produced by cells that surround the resting eggs in the ovaries. The AMH can be measured with a simple blood test on any day of a woman’s menstrual cycle and can give your doctor information about your egg supply, or “ovarian reserve.” A normal AMH level can be reassuring that a proficient number of eggs remain in the ovaries. If the AMH level is low or high, your doctor can explain how this may impact your ability to get pregnant naturally and recommend treatment options to help.
Moreland OB-GYN and Vios Fertility Institute hosts “Before the Bump,” an awesome event that details different topics to consider when attempting to get pregnant, including fertility tests and treatment. If you attend “Before the Bump,” you have the opportunity to learn about the following and have the chance to ask fertility experts your own questions about preconception wellness!
What Is a Hysterosalpingogram Test?
Dr. Nelson: There are obviously a number of reasons that patients struggle to conceive. I speak with my patients about checking off boxes when we discuss fertility testing: eggs/ovulation, male factor/sperm, fallopian tubes, and the uterus. Determining fallopian tube patency (being open) is a critical step in diagnosing infertility and I’m always surprised by how few women have heard of a hysterosalpingogram, a test that gives us a lot of useful information and can be done by most gynecologists. Can you tell us a little more about what a hysterosalpingogram is?
Dr. Hayes: A hysterosalpingogram (HSG), also referred to as “the dye test” is a procedure performed in the x-ray department that gives your doctor valuable information about your fallopian tubes and uterus. For this test, a speculum is placed into the vagina allowing a thin, flexible catheter to be placed through the cervix. A small amount of contrast dye (a liquid that looks white on x-ray images) is injected through the catheter to fill the uterine cavity and the fallopian tubes. If the dye spills out from the ends of the tubes this means that they are open. If it does not, it can diagnose tubal blockage.
The dye that fills the uterus can also detect abnormalities of the inner cavity of the uterus such as polyps, fibroids, scarring, or shape abnormalities of the uterus that might require an outpatient surgery to treat. While this test is being performed, which typically takes less than five minutes, you may feel moderate cramping like menstrual cramps, so in order to minimize discomfort, a patient’s doctor may recommend that they take some ibuprofen an hour before the test.
How Is a Sonohysterogram Procedure Performed?
Dr. Nelson: Of course when women think of their gynecologist, they usually think ‘ultrasound’ over x-rays. We also have an ultrasound test we use in the process of diagnosing infertility, a sonohysterogram. How do you describe this particular test to your patients?
Dr Hayes: A saline sonohysterogram or “sonohyst” is a procedure performed in the doctor’s office using ultrasound to evaluate the uterus. This test gives your doctor a very good image of the uterine cavity where implantation of a pregnancy should occur. First, a speculum is placed into the vagina and a thin catheter is passed through the cervix. A vaginal ultrasound is then placed allowing your doctor to evaluate the uterus as it fills with a small amount of saline (saltwater). This test is done to look for uterine polyps, fibroids, scarring, and uterine shape abnormalities using 3D ultrasound imaging.
The ultrasound also allows your doctor to check the ovaries and fallopian tubes providing a great deal of information about the reproductive organs. This test usually only takes a few minutes to complete, however, your provider may recommend that you take a dose of ibuprofen about an hour prior to this test to minimize any discomfort.
Let Us Be Your Fertility Resources
If you or someone you know have been struggling to conceive, there are so many resources and help available to you. I encourage you to reach out to your gynecologist or a fertility specialist. Even an initial consultation can give patients their optimism and hope back for success.
Do you need a gynecologist who can speak in depth about fertility, the diagnostic exams, and treatment? Come see me or one of my colleagues at Moreland OB-GYN for an appointment!
Have you already seen a specialist but have questions regarding the fertility tests or treatment plan? Consider a second opinion with Dr. Hayes at Vios Fertility Institute. No matter what you do, know that there are options out there and physicians who are waiting to help you find them.
Until next time, be well!