Fertility Testing

Lee Bladon 10:54 am

Fertility Testing

Fertility Hormones, Tests & Diagnostics

Fertility Testing

Fertility testing involves a series of diagnostic tests and assessments to determine an individual’s or couple’s reproductive health and ability to conceive. The tests provide insights into various factors that may impact fertility, and help to identify any underlying issues that could be addressed to improve the chances of pregnancy. Fertility testing may include the following: Blood Hormone Tests, Semen Analysis, Sperm DNA Testing, Ovulation Monitoring, Pelvic Ultrasound, Hysterosalpingography (HSG), Endometrial Biopsy, Ovarian Reserve Testing, Genetic Testing and Infectious Disease Testing.

The specific tests depend on individual circumstances, such as age, medical history, and the duration of attempts to conceive. The results of fertility testing help doctors to develop treatment plans to address the identified issues and optimise the chances of successful conception.

Female Fertility Testing

Blood Hormone Tests for Women

Blood hormone tests play a crucial role in assessing female fertility and understanding reproductive health. Here is an overview of common tests and their significance in assessing female fertility:

Oestradiol (E2): Egg Maturation, Menstruation, Libido, Mood, Skin & Hair
Oestradiol is the primary type of oestrogen produced by the ovaries, and is the main female reproductive hormone, so measuring it gives a good indication of how well your ovaries and menstrual cycle are working. As follicles grow and develop within the ovaries, the surrounding cells secrete oestradiol, which influences various reproductive processes, including thickening the lining of the uterus, and triggering the LH surge that leads to ovulation. An oestradiol imbalance can cause vaginal dryness, hot flushes and dry skin/hair. Oestradiol levels are measured in conjunction with Day-3 FSH to check the ovarian reserve in women aged 35 and older.

Progesterone: Ovulation, Menstruation
After an egg is released from a follicle in the ovaries, that follicle becomes a corpus luteum, which secretes large amounts of progesterone and small amounts of oestrogen. The progesterone prepares the lining of the uterus for implantation. If you become pregnant, progesterone levels increase to 10 times higher than usual to support the pregnancy. If you don’t become pregnant, your progesterone levels will fall, the lining of your uterus will become thinner, and your period will begin. So, testing progesterone levels seven days after ovulation confirms normal ovulation. Women with ovulatory dysfunction or undergoing fertility treatments benefit from regular progesterone testing. Progesterone testing can also help to diagnose adrenal glands issues.

Follicle-Stimulating Hormone (FSH): Menstruation, Egg Maturation, Menopause
FSH is produced by the pituitary gland in the brain. It stimulates an ovarian follicle to grow, and a batch of eggs to mature, so that one can be released at ovulation. The lower your ovarian reserve (egg count), the more FSH needs to be produced to compensate, so FSH testing can help to diagnose low ovarian reserve (LOR), premature ovarian failure (POF) and menopause.

Luteinising Hormone (LH): Menstruation, Ovulation
LH is produced by the pituitary gland in the brain. It surges mid cycle, which triggers ovulation, and it stimulates the corpus luteum to produce progesterone after ovulation. LH production at the wrong time of the cycle can interfere with ovulation, and low levels may not be sufficient to trigger ovulation. LH testing is typically used to detect ovulation, so that sexual intercourse or IUI can be appropriately timed. However, it can also be used to assess fertility issues like anovulation, ovarian failure and PCOS.

Anti-Müllerian Hormone (AMH): Egg Quantity, Polycystic Ovaries
AMH is produced by the follicles – the little sacs within the ovaries where eggs mature before one is released at ovulation. Since the number of eggs decreases with age, so does AMH, which is why AMH testing is used to assess a woman’s ovarian reserve (egg count). Higher AMH levels generally indicate a higher ovarian reserve, and lower levels can indicate a lower ovarian reserve, which can be associated with reduced fertility. AMH levels tend to decline with age, and they are also affected by PCOS and some cancer treatments. AMH testing is commonly used in fertility assessments, and prior to IVF and other assisted reproductive technologies.

Prolactin (PRL): Menstruation, Ovulation, Breast Health
Prolactin is produced by the pituitary gland in the brain, and its primary role is stimulating milk production during breastfeeding. However, it also plays a central role in regulating the menstrual cycle. Too much prolactin (hyperprolactinemia) reduces the production of oestrogen, FSH, LH and testosterone, which can affect fertility and interfere with ovulation. Prolactin testing is used to investigate ovulatory dysfunction, irregular or absent periods, or milky breast discharge.

Testosterone: Ovulation, Muscles, Metabolism, Libido, Mood, Skin
Testosterone is produced by various different tissues in the female body, including the ovaries, and has a role in maintaining your levels of E2, as well as the growth and maintenance of various tissues. Monitoring our testosterone levels can help to identify the causes of symptoms such as oily skin and acne, excessive body hair, and irregular periods. High testosterone levels are useful for signposting PCOS, which is commonly associated with these symptoms.

Sex Hormone-Binding Globulin (SHBG): Hormone Regulation
SHBG is a protein, produced mostly in the liver, that helps to regulate testosterone and oestrogen levels. SHBG helps to control the amount of sex hormones that are actively working in your body. When SHBG binds to these sex hormones, your tissues can’t use them – they can only use sex hormones that are free (unbound). An SHBG test is usually done if you have signs or symptoms of having too much or too little testosterone.

Dehydroepiandrosterone Sulphate (DHEAS): Hormone Regulation, Metabolism, Libido, Mood, Skin
Dehydroepiandrosterone sulphate (DHEAS) is a different form of the steroid hormone dehydroepiandrosterone (DHEA). It’s created in the adrenal glands and helps make other hormones, such as oestrogen and testosterone. We test DHEAS to investigate the causes of symptoms such as excess facial and body hair (hirsutism), acne, hair loss, irregular periods, and fertility problems.

Thyroid-Stimulating Hormone (TSH): Metabolism, Weight, Fatigue, Mood, Skin & Hair, Ovulation
TSH is produced by the pituitary gland in the brain, and it stimulates the thyroid gland in the neck to produce T4 thyroxin. High TSH suggests hypothyroidism (underactive thyroid), which can cause irregular cycles, weight gain, fatigue and feeling cold. Low TSH suggests hyperthyroidism (overactive thyroid), which can cause irregular cycles, weight loss, rapid heartbeat, anxiety and feeling hot. Thyroid testing typically includes TSH, T3 and T4 hormones.

Thyroxine (T4): Metabolism, Weight, Fatigue, Mood, Skin & Hair, Ovulation
T4 thyroxine is produced by the thyroid gland, and eventually gets converted to T3 thyroxine, which is used in various parts of the body. T4 testing helps to check for an overactive or underactive thyroid, which can impact body weight, fatigue levels, mood, periods and ovulation.

HCG (Human Chorionic Gonadotropin) testing is commonly known as a pregnancy test. HCG levels are used to confirm pregnancy, and monitor the health of a pregnancy for the first 10-12 weeks. Declining HCG levels, during this time, may indicate a failing pregnancy or miscarriage. HCG levels are also monitored after a miscarriage or ectopic procedure.

PCOS Testing: Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels. Insulin resistance is when the body becomes less responsive to insulin, which leads to elevated blood sugar levels. Women with PCOS often have insulin resistance, which means their bodies require higher levels of insulin to regulate their blood sugar. High insulin levels stimulate the ovaries to produce more androgens (male hormones), which leads to irregular or absent ovulation and periods. Weight gain, acne, thinning hair, and excessive hair growth on the face and body are common symptoms of PCOS. Identifying and managing insulin resistance is crucial for addressing fertility issues related to PCOS, so a fasting insulin level is conducted if PCOS is suspected.

Lupus Anticoagulant isn’t a hormone, but a protein that causes blood to clot abnormally. It increases the likelihood of blood clots forming in the placenta, which raises the risk of complications, including miscarriage. Women who experience recurrent miscarriages or have an autoimmune disease (like lupus or HIV/AIDS) may be tested, and about 15% have this protein in their blood.

Blood Hormone Tests for Men

Blood hormone tests play an important role in assessing male fertility and understanding reproductive health. Here is an overview of common tests and their significance in assessing male fertility:

Testosterone: Sperm Production, Libido, Irritability, Fatigue, Weight
Testosterone is the primary male sex hormone crucial for the development of male reproductive tissues and the production of sperm. Optimal testosterone levels are vital for spermatogenesis and maintaining reproductive function. Low testosterone levels may suggest issues with sperm production or broader reproductive health problems.

Follicle-Stimulating Hormone (FSH): Sperm Production, Hormone Regulation
FSH is a key hormone for male fertility as it stimulates the Sertoli cells in the testes, promoting the production and maturation of sperm (spermatogenesis). Elevated or decreased FSH levels can indicate issues with sperm production and may be assessed through diagnostic tests.

Luteinising Hormone (LH): Hormone Regulation
LH works in tandem with FSH to regulate testosterone production in the Leydig cells of the testes. Adequate LH levels are essential for maintaining testosterone levels, influencing sperm production and overall reproductive health. Abnormal LH levels can be indicative of testosterone-related concerns. High levels of LH in men can indicate testicular failure from illness (adult mumps), injury or radiation therapy.

Prolactin: Hormone Regulation, Sperm Production
While primarily associated with lactation in females, elevated levels of Prolactin in males can impact testosterone production and consequently affect sperm function. Abnormal prolactin levels may be associated with fertility issues and can be diagnosed through hormonal testing.

Inhibin B: Sperm Production, Testicular Function
Inhibin B is produced by the testes and provides feedback to regulate FSH secretion. It plays a crucial role in modulating spermatogenesis and provides insights into testicular function. Measuring Inhibin B levels helps assess the testes’ ability to produce sperm and can aid in diagnosing fertility issues.

Oestradiol (E2) Libido, Sperm Production
While predominantly a female sex hormone, small amounts of oestradiol are also produced in males. It contributes to modulating libido and supporting sperm production. Abnormal oestradiol levels may be associated with fertility concerns, and testing can provide valuable diagnostic information.

Fertility Tests for Women

Female fertility assessment can be multifacted and involve a range of diagnostic tests aimed at understanding the various aspects of reproductive health, including the hormones, ovaries, fallopian tubes, uterus and immune system.

Pelvic Ultrasound

  • Objective: To visualise pelvic organs, including the ovaries and uterus, for abnormalities.
  • Procedure: Sound waves create images of the pelvic region.

Cervical Mucus Analysis

  • Objective: To assess the quality and quantity of cervical mucus, crucial for sperm transport.
  • Procedure: Collection and analysis of cervical mucus samples during the menstrual cycle.

Hysterosalpingography (HSG)

  • Objective: To evaluate the shape of the uterus and check for blockages or abnormalities in the fallopian tubes.
  • Procedure: A contrast dye is injected into the uterus, and X-rays are taken to visualise the reproductive organs.

Sonohysterography (SIS)

  • Objective: To assess the uterine cavity for abnormalities, such as polyps or fibroids.
  • Procedure: Saline solution is injected into the uterus during an ultrasound to provide detailed images of the uterine lining.

Hysteroscopy

  • Objective: To directly visualise the inside of the uterus for detecting and treating abnormalities.
  • Procedure: A thin, lighted tube (hysteroscope) is inserted through the cervix into the uterus.

Ovarian Reserve Testing

  • Objective: To assess the quantity and quality of a woman’s remaining eggs.
  • Tests: Anti-Mullerian Hormone (AMH), Antral Follicle Count (AFC), and Follicle-Stimulating Hormone (FSH) on specific cycle days.

Endometrial Biopsy

  • Objective: To assess the uterine lining for abnormalities and determine the timing of the menstrual cycle.
  • Procedure: A small sample of the uterine lining is collected for examination.

Immunological Testing

  • Objective: To evaluate the immune system’s role in fertility and recurrent pregnancy loss.
  • Tests: Antiphospholipid antibody testing, natural killer cell activity.

Fertility Tests for Men

Male fertility assessment can involve a range of diagnostic tests aimed at understanding the various aspects of reproductive health, such as sperm quantity, quality, hormone balance, and structural abnormalities.

Semen Analysis

  • Objective: To evaluate the quantity, quality, and motility of sperm.
  • Procedure: Collection of a semen sample for laboratory analysis.

Sperm DNA Fragmentation Testing

  • Objective: To evaluate the quality of the DNA within the sperm.
  • Procedure: Collection of a semen sample for laboratory analysis.

Sperm Oxidative Stress Testing

  • Objective: To evaluate the quantity, quality, and motility of sperm.
  • Procedure: Collection of a semen sample for laboratory analysis.

Testicular Ultrasound

  • Objective: To assess the testicles and surrounding structures for abnormalities.
  • Procedure: High-frequency sound waves create images of the testicles and scrotum.

Additional Fertility Tests

These additional tests provide a more comprehensive understanding of the factors influencing fertility and help healthcare professionals tailor treatment plans to address specific fertility issues. The choice of tests depends on individual circumstances and the nature of fertility concerns. A fertility specialist can guide individuals or couples through the diagnostic process and recommend appropriate interventions.

  • Genetic Testing: To Identify genetic factors that may impact fertility or the health of a potential pregnancy. Tests include: Carrier screening, chromosomal analysis, and preimplantation genetic testing (PGT).
  • Postcoital Test (PCT): To assess the interaction between sperm and cervical mucus during the fertile window. A sample of cervical mucus is collected after intercourse to evaluate sperm movement and survival.
  • Karyotype Testing: The number and structure of chromosomes are analysed to identify chromosomal abnormalities that may affect fertility.
Additional Fertility Tests

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