A detailed assessment is carried out on all female clients to identify a possible cause for infertility. This may include:
- Checking Ovulation
- Assessment of Ovarian Reserve (AMH testing)
- Assessment of the Fallopian Tubes and Uterus
The first step in investigating a woman’s fertility is to establish whether or not she is ovulating (producing an egg) every month. This can be verified with a simple blood test (at pre-determined days of the menstrual cycle) to measure the hormones responsible for ovulation – namely Follicle Stimulating Hormone (FSH), Lutenising Hormone (LH), Prolactin, thyroid function, testosterone and progesterone. This forms part of your initial assessment.
A transvaginal ultrasound scan may also be used to visualise the follicles within the ovary and by measuring their size, we can ascertain the stage of follicle development. Ultrasound scanning may also be used to check the condition of the endometrium (the lining of the womb) and to aid the diagnosis of polyps and fibroids.
Assessment of Ovarian Reserve (AMH testing)
Ovarian reserve is the term used to describe the number of good quality eggs left within a woman’s ovaries. A woman is born with approximately one million eggs and during her life the number of eggs will decline with increasing age. Approximately only 400 eggs are lost through the process of ovulation over a woman’s lifetime. The remaining eggs are lost through natural cell death. The rate at which eggs are lost naturally varies from woman to woman and this determines the onset of the menopause. However, it is estimated that at least 10 per cent of the population will have accelerated loss of eggs leading to a critical reduction of ovarian reserve by their mid-thirties.
Ovarian reserve is best assessed by a combination of blood tests to check hormones levels (FSH, Anti-Mullerian Hormone) and pelvic ultrasound (antral follicle count and ovarian volume). However, Anti-Mullerian Hormone (AMH) is the most sensitive test in this assessment.
What is Anti-Mullerian Hormone (AMH)?
AMH is a hormone which is naturally produced by special cells in the antral follicles of the ovaries. These follicles contain immature eggs that ‘wake up’ from their dormant state and develop into mature eggs. This is why AMH testing is a good indication of the number of eggs remaining. This is an important test the consultant can offer at your initial consultation and will help guide treatment and advice going forward.
Why is Ovarian Reserve assessment important?
Women with diminished ovarian reserve have diminished fertility and an increased risk of miscarriage. However assisted fertility treatment can improve the chance of success for such clients. The result assists the consultant in determining which treatment is best suited for you.
Assessment of the Fallopian Tubes and Uterus
As part of your assessment the consultant will determine if a more detailed assessment of the fallopian tubes, ovaries and uterus is needed.
This may be done by the following procedures:
A hysterosalpingogram (HSG) is commonly used to check tubal patency (a test to check the tubes are open). This is an x-ray procedure involving the injection of a dye through the cervix and into the uterus. The passage of the dye through the fallopian tubes will show if there is a blockage or spasm that may need further investigation.
A laparoscopy is a more invasive way of checking both the patency of the fallopian tubes and the condition of the uterus and ovaries. This procedure is usually undertaken as a day case in surgery, under general anaesthetic and involves inserting a small telescope through the abdominal wall so that the pelvic organs can be clearly seen. A dye may also be used to assess tubal patency. Endometriosis can be seen, if present and treated.
A hysteroscopy is an investigative procedure to assess the inside of the uterus, particularly in cases of infertility, recurrent miscarriage or abnormal bleeding. It is usually done at the same time as a laparoscopy and is helpful in diagnosing uterine abnormalities for example presence of fibroids, polyps.
The cervix is dilated to allow the hysteroscope (narrow telescope) to be passed through the cervix and into the lower end of the uterus to allow a view of the internal structure.
Galway Fertility Clinic has access to the above investigative tests through its consultants and other professional partners.