FSH / LH / Estradiol: This combination of FSH (follicle stimulating hormone), LH (luteinizing hormone) and estradiol drawn on day 2, 3 or 4 of the cycle is a reflection of the female partner's ovarian reserve, or how well we expect her ovaries to respond to stimulation. This is done because women may have "normal" cycles, but not be able to become pregnant for about 6 years before menopause (average age 50-51). We will generally test all women regardless of age because of the wide range of variation in the onset of menopause and of ovarian function in infertility patients. These tests will help us determine which procedures and protocols are most appropriate.
Infectious Screen (chlamydia, hepatitis, syphilis, HIV, mycoplasma, gonorrhea): Having one of these organisms could adversely affect the outcome of your treatment or your pregnancy should you become pregnant. All of these infections (except gonorrhea) have one thing in common: you may be infected, but not have symptoms for long periods of time. Thus, it is imperative that these be completed prior to initiation of therapy
Pre-Pregnancy Screen: (Blood type and Rh Factor, Rubella titer, complete blood count). Determining blood type can be helpful if there are problems with a pregnancy. Rubella is an infection that can cause serious birth defects if it occurs while you are pregnant. Most of us have been immunized against it. However, some people have not been immunized or their immunization is no longer working. This test determines if immunization is needed. A complete blood count screens for anemia and other blood disorders, as well as tip us off about certain inherited disorders.
Prolactin, TSH: These hormonal tests screen for subtle abnormalities that could effect your treatment or your pregnancy. Both hormones are made by the pituitary gland in the brain. Prolactin is a hormone that helps to stimulate milk production during breast-feeding. Some women will secrete too much prolactin when not breast-feeding. TSH (thyroid-stimulating hormone) is the most sensitive test of thyroid function. It can detect either over activity or under activity of the thyroid gland.
Other: if you're medical history, family history or testing suggests that you may be at risk for genetic or autoimmune diseases, or other medical problems, appropriate tests will be ordered prior to initiating the cycle.
2. Uterine Testing
Radiologic:
A hysterosalpingogram (HSG) or sonohysterography (saline sonography) will be done to evaluate the inside of the uterine cavity. The HSG can also provide information regarding the fallopian tubes.
Baseline ultrasound: this is done at the initial visit. It allows us to look at the muscle of the uterus and assess the ovaries.
Mammogram: a screening test for breast cancer. The baseline mammogram for most women should be done at age 35, with a follow-up mammogram at 40. Current recommendations suggest screening every 1-2 years after that until age 50, then yearly mammograms after that.
Trial Transfer: a special catheter is inserted into your uterus to determine the direction and length of the uterine cavity. This measurement may also be done by ultrasound. This is done so that when an insemination is done or the actual embryo transfer is done at IVF, it will occur in the smoothest possible fashion.
Pap smear: a screen for cervical cancer and human papilloma virus infections. Currently, screening for most women is to be done on a yearly basis
Note: Some women may require more frequent mammogram and pap smear testing, depending upon their medical and family histories.
3. Complete Physical Examination and Pelvic Ultrasound
