FERTILITY FOR WOMEN Testing for Ovarian reserve (egg reserve) As women advance in age, their ability to get pregnant reduces and the risk of miscarriage increases because the quantity and quality of the eggs in the ovaries decrease with age. Egg quantity and quality begin to decline when a woman is in her early 30s and the rate of decline becomes more rapid and unpredictable during the late 30s and early 40s. The ovarian reserve test tries to measure the reproductive potential by measuring the egg quantity. The tests we use to assess ovarian reserve include: Basal (menstrual cycle days 2-5) Follicle stimulating hormone (FSH), luteinizing hormone (LH) and oestradiol: FSH and LH are hormones secreted in the pituitary gland, a small gland located at the base of the brain. FSH and LH control for the development and maturation of eggs in the ovary. As women grow older, their ovaries begin to respond less and less to FSH stimulus and the brain in turn increases the production of FSH to boost the response of the ovaries to it. Oestradiol is secreted and released into the blood stream during the development of the eggs in the ovaries. High blood level of oestrogen in the early phase of the menstrual cycle –between days 2 and 5 – shows low ovarian reserve and hastens egg development. The main importance of checking serum oestradiol early in the cycle is to allow for the proper interpretation of early FSH values because high oestradiol can suppress the blood level of FSH and give an apparently normal value. Elevated basal levels of FSH and oestradiol signifies reduced ovarian reserve. Chances of conception is low in this situation and such women require more drugs during IVF treatment. Antimullerian Hormone Test (AMH): AMH is a hormone secreted by the very young follicles in the ovaries. These young follicles are the ones that may eventually be recruited into egg production. The larger their pool the higher the level of AMH in the blood. Therefore, as the number of follicles decease with age, the level of AMH reduces in the blood, hence AMH levels are thought to reflect the level of egg reserves in the ovaries. Between and during menstrual cycles, AMH in the blood is stable and this offers the benefit that the test can be performed at any time during the menstrual cycle. Antra follicular count: This is the number of follicles that measure between 2-10mm seen in the ovaries on a transvaginal ultrasound scan performed in the early part of the menstrual cycle – between days 2 and 5. The number correlates well with the ovarian reserve and response to stimulation in an IVF cycle. Other hormone tests: We test for other organs whose functions may affect the ability to get pregnant and have a baby. They include the thyroid, adrenal, and the pituitary glands assessing the prolactin secreting cells. Transvaginal ultrasound scan: We use the transvaginal ultrasound scan to evaluate the uterus and in addition to ovarian reserve testing, the ovaries. Depending on the needs of the individual, we may request for other tests such as: Saline infusion sonogram A procedure whereby a small amount of saline fluid is passed into the uterus through the cervix to allow a more detailed visualization of the endometrial cavity while performing an ultrasound scan. Hysterosalpingogram (HSG) This is a special X-ray of the uterine cavity (womb) and the fallopian tubes. It helps to diagnose the disease of the fallopian tube such as blocked tubes and uterine condition. This is performed by injecting a dye, that is capable of showing on x-ray film, through the cervix into the uterus and then the tubes. Hysteroscopy This is the examination of the uterine cavity (womb) with a slender telescope to enable the doctor to see the lining and the conditions inside the uterine cavity. The procedure also allows for the treatment of some uterine cavity diseases such as adhesion, polyps and some fibroids. Infection screening tests: Screening for transmissible infections such as Hepatitis B and C viruses, HIV 1 & 2 and immunity to the rubella virus is very important. The human immunodeficiency virus (HIV), hepatitis B and hepatitis C, are well known infections that are known to be harmful to health. However, during reproduction they can be transmitted both to your partner and your offspring and jeopardize their health. We screen couples with their consent, carrying out various tests to verify the presence or absence of these infectious diseases. The presence of one or more of these chronic infections significantly adds to the complexity of treatments.

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