Infertility Tests & Procedures       You may want to consider seeking the help of an OB if you've been trying to conceive naturally for 6 months to one year on your own and are under 30 years old. Most OB's specialize in taking care of the woman after she's become pregnant so if you've been trying for that amount of time with no luck, consider moving on to an RE. Seeking the help of a Reproductive Endocrinologist (RE) for treatment may be wise if you've been trying to conceive for over one year, are over 30 years old , have a history of PID, painful,abscent or irregular periods, miscarriage, or male problems such as low or abnormal sperm count. A general workup is usually performed at your initial consultation. Starting tests may include a physical exam,vaginal ultrasound,assessment of ovulation, PCT, S/A and b/w. Blood work may include tests for a day 3 follicle stimulating hormone (FSH),  lutenizing hormone (LH), prolactin levels, testosterone( T), estradiol ( E2) and progesterone( P4).   Vaginal UltraSound ( U/S) What is it?  Procedure to determine ovarian follicle sizes, thickness of the lining , help guide with egg retrival/transfer and to  dectect any abnormalities. How is it performed? Transvaginal ultrasounds are performed using a vaginal probe inserted into the vagina. When is it performed? Anytime of the monthly cycle depending on what is needed.  Baseline ultrasounds are performed on cycle day 3.  Generally, follicle checks can be done anywhere from cd 8-15. And then again before or after a procedue as needed. Post Coital Test ( PCT) What is it?  This test is to determine if active, motile sperm with good quality are present in cervical mucus and that the cervial mucus is not inhibiting sperm movement or hostile to sperm. It confirms intercourse is resulting in semen being deposited in cervix. How is it performed?  A sample of cervial mucus is taken from the cervical canal to be examined. When is it performed?  Mucus sample is obtained in the Dr's office within 4-10 hours after intercourse. Semen Analysis ( SA) What is it?  A semen analysis is an accurate measurement of the number of sperm, as well as the motility( movement) and morphology ( shape) of the sperm. How is it performed?  Semen specimen is obtained manually through masturbation.  Can be collected at home in a special container provided by the Dr and brought to the Dr's office within a half hour after collection or obtained at the Dr's office in a private room. When is it performed?  Usually this test is performed before starting any fertility treatments. Probably the single most imporant test for the male partner. Semen sample is collected 2-4 days after last sexual encounter. Endometrial Biopsy ( EMB) What is it?  This test is to evaluate the uterine lining development in relation to ovulation. How is it performed? A catheter is placed into the uterus and a small snip of lining tissue is obtained. When is it performed?  7-8 days after a postive LH surge. ( OPK) Very important not to try to concieve that cycle in case a possible pregnancy would be starting that could be ended with this procedure. Hysterosalpingogram (HSG)  What is it?   X-ray of the uterus and fallopian tubes.  Shows interior contour of the uterus and determines of the fallopian tubes are open. How is it performed?   This test is performed by the Dr by introducing dye into the uterus through the cervix.                                   When is it performed?  Within a few days after the last day of menstrual cycle. When the uterine lining ( endometrium) is thin, you're not likely to be ovulating or  newly pregnant when x-ray is exposed. Laparoscopy ( Lap) What is it?  This procedure is to view outside of the uterus, ovaries and fallopian tubes to look for, correct and/or remove endometriosis, adhesions or organ problems. How is it performed?   Operative test under general anesthesia. Scope is inserted through navel for viewing often with additional incisions near hairline. If defects are found, instruments are placed through those incisions to correct, repair or remove problem areas.  When is it performed?  After inital infertility testing or as needed based on individual problems. Hysteroscopy What is it?  This procedure is to view the inside of the uterus to determine whether there are any defects or abnormalities. How is it performed?  Operative: under general anesthesia, a scope is inserted into the vagina, past cervix into the uterus for viewing. CO2 is often used to expand the uterus for better viewing. When is it performed?  Performed alone this test is usually done at the beginning of the cycle or with laparoscopy, around ovulation. Sonohysterogram What is it?  This test is an ultra sound using saline to better view the uterus. A similar test to an HSG but without the dye or radiation to check for polyps, fibroids or uterine abnormalities. Also known as Hydrosonogram. How is it performed?  A catheter is inserted into the uterus where a saline solution is passed through while an ultra sound is being performed.  The saline distends the uterine cavity allowing a better view. When is it performed?   7-10 days after the 1st day of menstrual period.