Start Your Journey with Fertility Testing
Do we/ I need fertility testing? When is the right time for testing? What if we just try a little longer and see if we get pregnant?
Fertility testing is often the first step for many patients on their journey to become a parent. For that reason, it can also be scariest. The board certified fertility specialists at the Los Angeles Reproductive Center (LARC), are here to quell those fears. Dr. Nurit Winkler and Dr. Marc Kalan, are highly trained experts in the diagnosis and treatment of fertility related issues. Approachable, warm, honest and caring, the doctors are happy to help determine if fertility testing is right for you.
When a patient begins fertility testing at LARC, their doctor will conduct a thorough history and physical to identify potential fertility limiting conditions and order the appropriate tests to further explore each issue. Every patient and/or couple at LARC is treated as a unique case, deserving of an evaluation that reflects their specific situation, condition and desires. The fertility evaluation can be divided into 4 main categories:
- Egg testing
- Uterus/fallopian tube testing
- Sperm testing
- Other testing
Egg testing includes tests designed to reveal the quantity and quality of a patient’s egg supply, this is also known as an ovarian reserve evaluation. To test this, Drs. Nurit Winkler and Dr. Marc Kalan may use blood tests for hormones such as cycle day 3 follicle stimulating hormone (FSH) and estradiol (E2) as well as levels of AMH (anti mulerian hormone), Inhibin and more. These blood tests provide information on the reserve supply of eggs which remain available in a patient’s ovaries, (AKA, the ovarian reserve).
Another way of testing the eggs is through the antral follicle count (AFC). To check the AFC, a transvaginal ultrasound us used to count the number of follicles within each ovary. The more follicles that are present, the greater number of eggs a patient may produce in response to ovarian stimulating medications.
Uterus / Fallopian tube testing
A requisite for natural conception is that the fallopian tubes must be open and the uterus be without abnormalities. To test the tubes and uterus, depending on a patient’s history and symptoms, Drs. Kalan and Winkler may use a variety of techniques including one or more of the following:
Hysterosalpingogram (HSG) is a radiological procedure in which a special dye is injected into the uterus and fallopian tubes while x-ray images are taken. The path of the dye illustrates if the inside contour of the uterus (the endometrial lining) is smooth and if the fallopian tubes are open.
Hydrosonogram is an ultrasound procedure in which sterile water is injected into the uterus while an ultrasound is conducted. As the sterile water distends the cavity of the uterus, the doctor can evaluate the endometrial lining for abnormalities such as polyps, fibroids or adhesions. A hydrosonogram can be augmented with a special device that creates air bubbles within the sterile water to evaluate to patency of the fallopian tubes.
Hysteroscopy is a minor surgical procedure in which a small camera is inserted into the uterus to directly evaluate the endometrial lining. During a hysteroscopy, small instruments can be used to repair most abnormalities of the uterine lining. Hysteroscopy can be combined with laparoscopy (the insertion of a small camera into the abdominal cavity) to evaluate the fallopian tubes.
Sperm testing generally begins with a semen analysis (SA). A semen analysis evaluates many components of an ejaculate. It is important to know that there can be significant variation in the results of a semen analysis from one lab to another. Drs. Winkler and Kalan are experts in the interpretation of semen analysis. The four most important components of a SA include:
Volume: The total amount of fluid that comes out during and ejaculation is normally between 1.5 and 4 ml, but can vary depending on the circumstance.
Concentration: The sperm count, or concentration, is measured in the number of million sperm per millimeter of ejaculate fluid. Normally there are at least 15-20 million sperm per ml.
Motility: The percentage of sperm that are moving is usually around 40% or more. Often the moving sperm are further characterized on how well they propel themselves through the ejaculate fluid.
Morphology: The vast majority of sperm in an ejaculate are abnormally shaped. Sperm can be abnormal due to oversized heads, short tails, elongated bodies, double or triple tails and more. Morphology refers to the percentage of sperm that are perfectly shaped. A potentially confusing aspect of the morphology assessment is that there are two competing sets of criteria that a lab may use to judge a sperm. The Kruger (strict) criteria, sets a higher standard for any individual sperm to be considered normal. Thus, if a lab is using Kruger criteria, only 4% or more sperm need to meet criteria, for an ejaculate to be considered normal. The second set of criteria, the WHO (World Health Organization) criteria, is easier for a sperm to be considered normal. Thus 30% or more normal sperm must meet criteria for the ejaculate to be considered normal with the WHO standards.
Advanced sperm testing
Sperm DNA fragmentation testing is an advanced form of sperm testing in which the DNA within the sperm is evaluated for damage. This newer form of sperm testing is not indicated for all couples but can be very informative in some situations. The Doctors at the Los Angeles Reproductive Center are experts in knowing which tests to use and how to interpret their results.
Other fertility tests:
In addition to the above mentioned fertility testing, the specialists at LARC are adept in more advanced testing for those patients in whom it is required. Some of these tests include evaluation for: immunologic fertility issues, PCOS (polycystic ovarian syndrome), endometriosis, endometrial receptivity issues, recurrent pregnancy loss and more.
If you are interested in learning more about your fertility potential, weather you are considering conception or not, contact the fertility specialists at the Los Angeles Reproductive Center. We will be happy to answer your questions and help you learn more about fertility testing.