Infertility Testing

When you first arrive at a fertility clinic, an initial set of tests will be offered.  They are more-or-less the same for every clinic.

Infectious Diseases

We screen the couple for HIV, Hepatitis B, Hepatitis C, and Syphilis.  These tests have to be updated every 6-12 months, depending on your clinic’s policies.  None of these conditions affect your fertility directly, but they do affect your overall health, and the results will impact how the clinic will handle your eggs and sperm.

Optional

We also like to confirm your immune system status to other conditions that may affect you once pregnant: Measles, Mumps, Rubella, Chicken Pox, Parvovirus, Toxoplasmosis, and CMV.

We also like to check blood types for the couple.

We also ask that women have their pap tests up-to-date, and that they get chlamydia or gonococcus screens if appropriate.

A special note for women considering donor sperm: Basic testing will include a blood test for CMV exposure.  CMV is a virus, like chickenpox.  If you have immunity, CMV should not be a concern.  But if you are CMV -ve, Health Canada recommends that you choose CMV -ve sperm.  For more information on medical screening for recipients, I like the ASRM patient education pamphlet on third party reproduction.

Female Hormones

TSH is a thyroid screen; your thyroid needs to be well balanced for a safe pregnancy.  Prolactin levels should be in the normal range to maximize chances for implantation.

Optional

DHEA can be elevated in women with PCOS.

Fasting blood tests to rule out elevated glucose (sugar) levels can be helpful in women who have an elevated BMI, have a history of PCOS, or a family history of diabetes.

Ovarian Reserve

Day 3 FSH is the standard test to help women confirm their ovarian reserve (how many eggs they may have).

Optional

We think that ovarian reserve testing is so important that, in addition to FSH, we like to measure antral follicle counts and AMH levels.  For a full post on ovarian reserve testing, go here.

Ovarian reserve is an important part of egg quality testing, but not the only part. Monitoring a complete cycle -including luteal phase progesterone levels- is also helpful.  More on egg quality.

Uterine Structure and Tubal Anatomy

A standard sonohysterogram should show uterine structure and fallopian tubal patency (proves that your tubes are open).

Optional

We prefer 3D sonohysterograms for uterine anatomy, and hysterosalpingograms for tubal structure.

However, the most accurate way to determine tubal strucure is through laparoscopy, and for uterine structure, a hysteroscopy.

A uterine biopsy can be done to rule out endometrial hyperplasia or other impediments to implantation

Semen Analysis

The basic semen analysis is a standard part of every fertility investigation.

Optional

There are many other tests for sperm that are not covered by provincial insurance programs.  For example, we often order DNA integrity testing.  We can do various sperm penetration assays, screen for antisperm antibodies, and complete sperm FISH analysis.

If men have low sperm counts, we may also offer ultrasound testing

More

Some tests that may not be offered unless you ask, or have special circumstances:

Women age >42y may wish to have a mammogram, and a consultation with a high-risk obsetrical team.

Your karyotype is your basic chromosomal count (you should have 23 pairs of chromosomes).  You may also wish to obtain other genetic screens, such as an Ashkenazi panel for some Jewish patients, a chloride sweat test for patients concerned about Cystic Fibrosis, FMR1 CGG repeats for women who may have Primary Ovarian Insufficiency, or Y microdeletions for men with very low sperm counts.

A coagulation screen is for women with recurrent pregnancy loss, or a strong family history of blood clotting disorders.

An autoimmune screen is also often offered to women with recurrent pregnancy loss.  These tests look for antiphospholipid antibodies, anti sperm antibodies, Natural Killer Cells, and other immune system peculiarities that may be associated with subfertility.

There are always more tests of course….too many to list in one place.  The ASRM patient sheets are a good place to go if you wish to continue your research.  But our collective challenge is that any and every health concern can have an impact on fertility.

At some point, the specific diagnosis may no longer impact management.  If you are negative for every test you have ever done, but still are having difficulty getting or staying pregnant, you may have Unexplained Infertility.  A frustrating “diagnosis” to be sure, but sometimes the best decision will be to simply move on to active treatment.

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