Infertility Testing

Preliminary Screening Tests

Several tests are required prior to initiating infertility treatment with Dr. Frattarelli and Dr Karmon. These tests are designed to look for problems that could have an adverse impact on your infertility treatment or subsequent pregnancy. The testing is based on guidelines from the American College of Obstetrics and Gynecology and the American Society for Reproductive Medicine. If you have had any of the tests listed below with in the last 6-12 months, please make the results available during your initial evaluation. Depending upon the test, you may not need to have the test repeated immediately prior to your cycle. Depending upon the type of therapy planned, some tests may not need to be done.

Female Testing

  1. Blood Tests
    • FSH / LH / Estradiol: This combination of FSH (follicle stimulating hormone), LH (luteinizing hormone) and estradiol drawn on day 2, 3 or 4 of the cycle is a reflection of the female partner’s ovarian reserve, or how well we expect her ovaries to respond to stimulation. This is done because women may have “normal” cycles, but not be able to become pregnant for about 6 years before menopause (average age 50-51). These tests will help to determine which procedures and protocols are most appropriate.
    • AMH (Anti-Mullerian Hormone): A hormone produced by the ovarian follicles, Anti-Mullerian Hormone (AMH) can be tested to check ovarian function. A low AMH level may indicate problems with ovarian function.
    • Infectious Screen (chlamydia, hepatitis, syphilis (RPR), HIV, gonorrhea: Having one of these infections could adversely affect the outcome of your procedure or your pregnancy should you become pregnant. All of these infections (except gonorrhea) have one thing in common: you may be infected, but asymptomatic for long periods of time. Thus, it is imperative that these be completed prior to initiation of therapy.
    • Pregnancy Screen: (Blood type and Rh Factor, Rubella titer, Varicella titer, complete blood count). Determining Blood type can be helpful if there are problems with a pregnancy. Rubella and Varicella are both infections that can cause serious birth defects if they occur while you are pregnant. However, some people have not been immunized or their immunization is no longer working. These tests determine if immunization is needed. A complete blood count screens for anemia and other blood disorders and can tip us off about certain inherited disorders.
    • Prolactin, TSH: These hormonal tests screen for subtle abnormalities that could affect your treatment or your pregnancy. Both hormones are made by the pituitary gland in the brain. Prolactin is a hormone that helps to stimulate milk production during breastfeeding. Some women will secrete too much prolactin when not breastfeeding. TSH (thyroid-stimulating hormone) is the most sensitive test of thyroid function. It can detect either overactivity or underactivity of the thyroid gland.
    • Genetic Testing: ACOG recommends that ob-gyns make DNA screening for cystic fibrosis and other genetic tests available to couples seeking preconception or prenatal care.

  2. Uterine Testing
    • Hysterosalpingogram (HSG): is a test typically performed in a radiology suite and provides information on the patency of the fallopian tubes.
    • Sonohysterography (Saline Sonography): a procedure performed in our office where a small amount of fluid is placed into the uterine cavity while performing a transvaginal ultrasound. This will provide information regarding the uterus and uterine cavity.
    • Baseline ultrasound: this is done at the initial visit. It allows us to look at the muscle of the uterus and assess the ovaries.
    • Office hysteroscopy: This is a process where a very small camera is inserted into the uterine cavity to directly visualize the cavity for any abnormalities which might adversely affect fertility. We are one of only a few clinics offering in-office hysteroscopy. This allows us to do a minimally invasive diagnostic hysteroscopy in the office with minimal discomfort, often preventing the need to undergo a more invasive surgery with anesthesia.

Male Testing

  1. Semen Analysis and Anti-sperm Antibodies:
    • A semen analysis is needed to determine how the sperm is to be delivered to the egg. Options for sperm delivery include appropriately timed intercourse, intrauterine insemination, in vitro fertilization (IVF) and IVF with ICSI (intracytoplasmic sperm injection). Anti-sperm Antibodies are proteins in the blood made by white blood cells. Their normal role of antibodies is to help us fight off infections. Sometimes the immune system recognizes normal things (in this case sperm) as foreign and makes antibodies to attack them. The presence or absence of these antibodies will help us determine what method of sperm delivery is appropriate for you.
  2. Infectious Screening:
    • (HIV, syphilis, hepatitis) with these diseases you may be infected, but asymptomatic for long periods of time. All of these can be passed along through the semen. There are, however, no reports of HIV ever being transmitted with artificial insemination or in vitro fertilization.
  3. Special Male Testing. Men with certain infertility problems may be asked to get any of the following tests:
    • Karyotype: this is a test that evaluates the chromosomes. In some conditions, the rate of chromosomal abnormalities is increased. Finding a chromosomal abnormality would mean that the sperm of that individual would not be used.
    • Y-Deletions Testing: in some men with very low sperm counts, the problem is due to structural abnormalities in the segment of the Y-chromosome that controls sperm development. Pregnancy can occur (via IVF with ICSI), but these abnormalities can be passed on to any male children.
    • Genetic Testing: ACOG recommends that ob-gyns make DNA screening for cystic fibrosis and other genetic tests available to couples seeking preconception or prenatal care.