The Female Fertility Check Up

Small ovarian follicles, spherical cyst-like structures that each contain an immature egg, can be directly visualized by ultrasound. The total number of these follicles, termed the antral follicle count, can be used to quantify your ovarian reserve.

Follicles in the ovary produces antimullerian hormone and its blood levels is used to quantify your ovarian reserve (the number of eggs that are remaining in the ovary). AMH is used primarily to evaluate quantity not quality You can have a “reassuring” AMH but still have poor egg quality.

Follicle-stimulating hormone (FSH) is a hormone produced by the pituitary gland. Elevated levels of FSH in the early follicular phase of the menstrual cycle typically indicate diminished ovarian reserve. This suggests a decline in the supply of a woman’s eggs, as the ovaries require higher levels of FSH to stimulate egg production.

While a history and physical exam can be highly suggestive of endometriosis, more definitive evaluation involves an endometrial biopsy which is a medical procedure in which a small sample of tissue from the lining of the uterus (endometrium) is collected for examination under a microscope. Endometriosis is associated with the expression of a biomarkers of inflammation called BCL6.

Indirect methods of detecting ovulation include cycle tracking (which can be accomplished with pen and paper or a variety of apps) to document menstrual cycle parameters (like bleeding days, basal body temperature or cervical mucus changes). Both at home urine hormone tests and conventional laboratory bloodwork provide more objective data by detecting luteinizing hormone (LH) surges or post ovulation progesterone or its metabolites.

Direct methods of detecting ultrasound include visualization of ovarian follicle development, the rupture of a mature follicle, and the formation of the corpus luteum.

Ultrasound can detect fertility issues of the uterus like fibroids or abnormal developmental shapes (“heart-shaped“ uterus). The use of saline water (saline infusion sonogram) provides the contrast needed to diagnose polyps and internal scar tissue (synechiae) that can impact fertility.

Despite the rapid and ongoing evolution of genetic testing technology, the chance of testing positive to a gene problem with clear links to your future fertility is still statistically low. However, some individuals may still choose to test “pre-emptively” just because the negative impact of the problem is so strong. Examples include FMR premutations (incidence up to 1 in 151 females), BRCA1 and BRCA2 gene mutations (incidence as high as 1 in 40 in some populations), and unrecognized abnormalities in karyotype such as a balanced translocation (1 in 500) or Turner or Turner mosaic syndrome (1 in 2000).

A HyFoSy (Hystero-Contrast-Salpingography) test is an imaging procedure used to evaluate the patency (openness) of the fallopian tubes and diagnose tubal damage. During the procedure, a contrast agent (usually a sterile saline solution mixed with a small amount of foam) is injected into the uterine cavity through a catheter inserted into the cervix. The contrast material then flows through the uterus and fallopian tubes. If the fallopian tubes are open and healthy, the contrast material should flow freely through them and spill out into the abdominal cavity. However, if there is any blockage or damage to the fallopian tubes, the contrast material will be unable to pass through, and the location and extent of the blockage can be identified.