EVALUATION PROCESS FOR WOMEN

 

Hormone tests: These are simple blood tests to check if there is a hormonal imbalance. These tests may include any or all of the following:

Hormones:

luteinizing hormone (LH)
follicle stimulating hormone (FSH)
estradiol (E2)
progesterone
prolactin
thyroid stimulating hormone (TSH)
free T3
free thyroxine
total testosterone
DHEAS
androstenedione
sex-hormone binding globulin
17-Hydroxyprogesterone

.

Insulin resistance (IR) testing: Insulin resistance is precursor to diabetes that can cause weight gain and is often seen in those with PCOS. Testing should be done on overweight infertility patients and anyone suspected of having PCOS, What happens is that the body starts producing excess insulin (hyperinsulinemia) in order to keep glucose levels normal. Testing glucose levels alone won't indicate insulin resistance until it is fairly advanced -- what's needed is fasting glucose and insulin levels, or a glucose tolerance test (preferrably also checking insulin). More info is at http://www.inciid.org/faq/pcos.html.

Pelvic exam: A physical exam to check for signs of infection as well as obvious physical abnormalities. Pretty much the standard feet-in-stirrups event.

Abdominal ultrasound: A transducer is passed over the bare skin of the abdomen in order to view the uterus and ovaries. Cysts, fibroids and uterine abnormalities may be visible.

Trans-vaginal ultrasound: A transducer wand is inserted into the vagina to view the cervix, uterus and ovaries. Provides greater detail than abdominal ultrasound.

Post-coital test (PCT): A sample of cervical fluid is obtained by gently scraping the cervix within a few hours of intercourse. The fluid is checked under a microscope to see if motile sperm are present. Must be done with fertile mucus at ovulation time.

Endometrial biopsy (EMB): Used to "date" the lining in relation to ovulation and to test for infection or pre-cancerous cells. To date the lining, the test is generally performed a few days prior to expected menses. A thin catheter is inserted through the cervix and a small sample of the uterine lining is removed.

Hysterosalpingogram (HSG): People often call this the dye test. A catheter is inserted through the cervix and a small amount of dye is pushed into the uterus while x-rays are being taken (usually continuous motion as well as a few stills). The shape of the uterus is observed, as well as how the dye flows through the fallopian tubes.

Laparoscopy: This surgery is usually done under general anesthesia to look for structural abnormalities, endometriosis and adhesions as well as possibly repair any problems found. The abdomen is inflated with carbon dioxide and a scope is inserted through a small incision below the navel. A second incision just above or below the pubic hairline is used to insert a tool to help manipulate the organs for better viewing with the scope. Patients may be able to get a videotape of the surgery.

Hysteroscopy: The cervix is dilated just enough to insert a small scope used for viewing the inside of the uterus. Minor abnormalities can be fixed during this procedure, which can be done under local or general anesthesia. Often done in conjunction with a laparoscopy.

Personal experiences with EMBs, HSGs, laparoscopies and hysteroscopies are posted in the Invasive Infertility Tests FAQ at http://www.fertilityplus.org/faq/itests.html.

Infectious disease testing: Some physicians will test for a variety of sexually transmitted and other infectious diseases including ureaplasma, mycoplasma, gonorrhea, chlamydia, syphilis, toxoplasmosis, rubella (German measles), cytomegalovirus virus, Hepatitis b&c and HIV I & II.

Immune testing: Some of the tests mentioned below are still controversial, but more and more doctors are seeing the benefits of checking into and treating immune disorders which affect fertility.

Lupus (SLE) tests (includes commonly tested for lupus anti-coagulant):
Activated Partial Thromboplastin Time (APTT)
Kaolin clotting time
Platelet Neutralization Assay
Dilute Russel viper venom time

Anti-phospholipid antibodies (APA) tests (includes IgM, IgG and IgA markers):
Anticardiolipin antibodies (ACA)
Phosphoethanolamine
Phosphoinositol
Phosphatidic acid
Phosphoglycerol
Phosphoserine
Phosphocholine

Anti-nuclear antibodies (ANA) tests:
ssDNA
dsDNA
Sm
RNP
SSA
SSB
Histone
Scl-70

Anti-thyroid antibodies (ATA):
Thyroglobulin
Thyroid microsomal (thyroid peroxidase) autoantibodies

Anti-sperm antibodies (ASA): These can be either autoimmune or alloimmune. They are a blood test, usually indicated by a specimen at IUI-time behaving abnormally. If it's Autoimmune (the male has them) then the sperm are healthy looking, but they clump together and make knots that don't make satisfactory progression in great looking mucus. If it is alloimmune (the woman has them) then they are usually healthy looking but mostly dead on arrival or all of the live ones are incredibly slow. It's at IUI time that most of us get sent for the full range of tests, but many of us are treated without testing (testing cost is high, treatment cost is low). Treatment is usually prednisone for the party doing the antibodies. Dose is dependent on severity. Prednisone is very inexpensive.

Alloimmune tests:

Leukocyte Antibody Detection (LAD or HLA sharing)
Natural Killer Cells (CD56+)
Full Reproductive Immunophenotype (include NK cells)
Embryo Toxicity Factor (ETF)

More information on immune testing can be found on the ICIID (pronounced inside) web site, http://www.inciid.org/immune.html, and on Dr. Beer's web site at http://repro-med.net/index.html.

MRI or CT scan: One of these might be done if elevated prolactin is found. This is to look for a pituitary tumor.