As part of your initial consultation, your doctor will likely recommend some initial testing to help determine the cause of your fertility issues.
The Fertility Center’s on-site lab gives patients the advantage of timely results for testing and analysis of blood, urine, and semen samples taken in or transferred to the Chattanooga office. Some results are available the same day, and others may take up to 10 days. Specimens are occasionally sent to an outside lab for more in-depth analyses.
Fertility Testing for Women
Testing for female infertility can be in search for multiple signs of problems. We need to learn if the fallopian tubes are blocked, there are problems with egg development in the ovaries, if egg quality is diminishing, or if fibroids, polyps, or septums are hindering embryo implantation in the uterus. Below are a few different tests we can perform in-house or send to labs for further fertility testing and analysis.
- Hysterosalpingogram (HSG) – Used to determine if a woman’s fallopian tubes are blocked, an HSG involves injecting dye into the uterus by means of a tiny catheter inserted through the cervix. The dye is observed as it fills the uterus and fallopian tubes. If the tubes are clear, the dye will spill out. The HSG procedure is performed at a radiology surgery center near the Fertility Center and is optional for patients who will use in vitro fertilization, which bypasses the fallopian tubes.
- In-office, Ultrasound-guided HSG – The in-office, ultrasound-guided HSG is used to evaluate the condition of a woman’s fallopian tubes. A non-allergenic mixture of saline and air is introduced into the fallopian tubes and is observed under ultrasound. The test shows if the uterine cavity is normal and if the fallopian tubes are open. Fibroids, scar tissue or polyps in the uterus can also be identified.
- Saline-infused Ultrasound – A saline-infused ultrasound involves injecting saline solution into the uterus via a tiny catheter inserted through the cervix. The uterus is observed on ultrasound to identify any irregularities, such as fibroids, polyps, or septums, that could hinder embryo implantation or pregnancy. The SIUS procedure is performed at our office and is relatively painless, although some patients report mild cramping.
- Day 3 Labs – Day 3 labs are performed prior to participation in an IVF cycle to determine how responsive the ovaries may be to stimulation and the quality of the eggs that might be produced. This baseline blood work, which must be done on either day 2 or day 3 of a woman’s menstrual cycle, evaluates levels of three hormones: serum estradiol (E2), follicle stimulating hormone (FSH), and luteinizing hormone (LH). Note: The first day of menstrual cycle flow is considered day 1.
- Clomid Challenge Test – Women age 34 or older who have high follicle-stimulating hormone levels (14 or greater) may need to take a clomid challenge test to confirm if egg quality is diminishing. This test can also be used to confirm diminishing egg quality in younger women whose FSH levels are elevated in day 3 labs. Blood is drawn on day 3 of menstruation, 100mg of clomiphene citrate (Clomid) is taken orally on each of days 5 through 9, and blood is drawn again on day 10 to determine how the ovaries responded.
Fertility Testing for Men
Testing for male infertility generally focuses on analyzing sperm production. We also test and evaluate anatomical concerns as if there is a blockage limiting sperm production or dysfunctions with ejaculation. We've seen 40% of our male infertility cases come from sperm abnormalities. This leads to our typical test to focus on the quantity, quality, and motility of the man's sperm. We also can test the man's testosterone levels with a blood test. Low testosterone levels can lead to low sperm counts, which are a leading indicator of male infertility.
- Semen Analysis – The most common diagnostic fertility testing procedure for men, a semen analysis is a two-part test that helps determine the number and quality of sperm present. The first analysis reveals how many sperms are present, how many are moving, and how fast they are moving. The second portion of the test, called strict morphology, determines the percentage of sperm that are shaped normally. Additional tests may be ordered if results indicate male-factor fertility issues.
Sperm Extraction Procedures
For men who have had a vasectomy or whose semen analysis results reveal no living sperm, a testicular sperm extraction procedure may be recommended. These extraction procedures are performed under anesthesia and include percutaneous epididymal sperm aspiration (PESA) and testicular epididymal sperm aspiration (TESA). With the assistance of a urologist, our doctors can often collect viable sperm directly from the testes to be used in IVF cycles. Quantities retrieved during these procedures are often insufficient for intrauterine insemination.