Testing & Diagnosis
Infertility affects 6.1 million Americans. This means that at some point, one out of every six couples will experience an issue with infertility. Nevertheless, advances in assisted reproductive technology (ART) have made it possible for the great majority of couples who have been diagnosed with infertility to realize their dreams of having a family.
At Fertility Specialists of Texas, we perform a comprehensive evaluation to establish the cause of the infertility and then begin treatment in a stepped approach. In most cases, simple tests performed by our physicians can ascertain the cause of infertility within a couple of weeks. Based on the outcome of these tests, treatment can be as straightforward as utilizing medication to induce ovulation, or more advanced treatments such as artificial insemination (AI) or in vitro fertilization (IVF).
As a premier fertility clinic in North Texas, we offer a full scope of services designed to deal with each couple’s unique needs. Our services incorporate all of the latest technologies intended for correcting hormonal imbalances, surgical treatments, optimizing male infertility and in vitro fertilization (IVF) with blastocyst transfer.
Additionally, we perform semen analysis and donor insemination from various sperm banks that are FDA Approved and Certified. Some procedures, such as blood testing, are fairly simple; others, such as a hysterosalpingogram or even surgery, can be more invasive. The following tests are usually recommended in a basic work up.
- Day 3 Follicle Stimulating Hormone (FSH) and Estradiol Measuring the FSH on day 3 of the menstrual cycle is a good way to evaluate egg quality. Estradiol measurements confirm the accuracy of the test. FSH should be less than 12. This hormone is necessary for the maturation of an egg each month, and elevated levels may indicate diminished ovarian reserve.
- Estradiol on day 3 of the cycle should be greater than 10 but less than 68. An elevated estradiol may indicate the presence of an ovarian cyst or other fertility-related concerns. Very low levels may indicate that the ovaries are suppressed and may not respond to stimulation.
- Anti-mullerian Hormone (AMH) is a substance produced by granulosa cells in ovarian follicles. With increasing female age, the size of the pool of remaining follicles decreases and the AMH levels and the number of ovarian antral follicles also decrease on ultrasound. Research shows that the size of the pool of growing follicles is strongly influenced by the size of the pool of remaining primordial follicles which are “resting”. AMH blood levels are thought to be a marker of the size of the remaining egg supply – or ovarian reserve.
An HSG is an x-ray that shows the interior contour of the uterus and fallopian tubes. This test is important because it can detect irregularities inside the uterus that could interfere with fertility. It also lets us know if the tubes are open so that the sperm and egg can meet. The HSG is performed by injecting a special dye through the cervix and observing the flow of the dye through the uterus and tubes on x-ray. This procedure is performed at both our Frisco location and Grapevine location by a reproductive endocrinologist. An HSG must be done between menstrual cycle day 6 and 10. To schedule the procedure, please call our nurse on day 1 or 2 of your period and she will assist you. You will be given an antibiotic to take for 5 days beginning 2 days before the HSG to reduce the risk of any infection. We also recommend that you take 2-3 ibuprofen tablets one hour before your appointment because some women experience mild to moderate cramping during the procedure. Patients are usually able to drive themselves home, but you may wish to have someone accompany you.
Evaluation of the male partner’s sperm is an essential part of a fertility work-up. To obtain the most accurate results, the test should be performed in a lab that specializes in semen analysis. These specialty labs use a very specific method of analyzing the shape of the sperm (Kruger morphology), the number of sperm present and the motility (ability to swim). We will provide you with a specimen cup and instructions provided by our office. Please schedule an appointment for a semen analysis by calling 214-618-2044. Click here to download a Semen Analysis form. Semen analysis are performed between 8:30 am- 4:00 p.m. Monday through Friday. If you live more than one hour away from our office, we ask that you collect the sample on-site. Our laboratory has private collection rooms available in a comfortable environment. The male should abstain from any sexual activity for at least 2 days, but no more than 5 days, prior to the day of semen collection and evaluation. If collected at home, keep the sample at body temperature while bringing to the facility. For patients with insurance coverage for infertility treatment, please note that the Andrology Laboratory is a separate entity and does not contract with insurance companies. Fees will be required at the time of service.
A pelvic ultrasound is very useful when done at the appropriate time in the cycle. Done a few days prior to ovulation, ultrasound can evaluate impending ovulation and assess the thickness and pattern of the endometrial lining, where the fertilized egg would implant. Polyps, fibroids and ovarian cysts can also be identified on ultrasound. This procedure is usually performed in the office.
Saline Infusion Sonohysterogram (SIS or SHG)
This test may be performed to evaluate the uterine cavity specifically. This test involves injecting a saline solution through the cervix into the uterus while imaging the uterus with a sonogram. This test may also be performed in the office. This allows the physician to visualize any irregularities that might interfere with fertility. It does not evaluate the tubes and does not take the place of an HSG. Sonohysterography fills the uterine cavity with saline, outlining the polyp which could not be discretely seen with routine ultrasound.
Genetic testing is not often necessary, but is important in women with premature menopause or multiple miscarriages. It is also valuable in men with very low sperm counts. The American College of Obstetricians and Gynecologists recommends that genetic testing for cystic fibrosis be offered to all couples attempting conception. If your family tree does hold a genetic problem or birth defect, you’ll probably want to have genetic testing done. If you are a known carrier of a disease such as Tay-Sachs, cystic fibrosis or sickle cell anemia, you will want to have your partner tested as well. These are recessive diseases, and therefore only if both partners are carriers are you at risk of having an affected child. If a couple are both carriers for cystic fibrosis, preimplantation genetic diagnosis (PGD), can be performed on embryos from an IVF cycle. Unaffected embryos can be transferred to the uterus or frozen for future transfer.