What fertility tests should be carried out before fertility treatment?

What fertility tests should be carried out before fertility treatment?

A brief reminder of physiology

Every woman is born with hundreds of thousands of follicles in her ovaries. They are invisible to the naked eye and are called pre-antral follicles. Their number can be quantified by the level of AMH (anti-mullerian hormone).

On the first day of each menstrual cycle, a certain number of these small follicles will detach from the pool of ovarian follicles and appear on the surface of the ovary. They will then be visible on ultrasound. The number of follicles that detach is a reflection of the total ovarian reserve.

These follicles will increase in size as the days go by. One follicle will become larger than the others; this is the dominant follicle. Once it has reached the right size, it will ovulate, i.e. rupture and release the mature egg it contains, around day 14 of the menstrual cycle.

The egg is then expelled into the fallopian tube, into its terminal portion, the Pavilion. There it awaits a spermatozoon.

If intercourse takes place, the sperm cells then have to travel up from the vagina to the cervix, cross the uterus and descend into the fallopian tubes, where they meet and fertilise the egg.

The embryo formed in this way then travels up the fallopian tube and settles comfortably in the uterus around D5-D6, when it implants. The embryo is then a blastocyst that will implant in the inner wall of the uterus, the endometrium. The patency of the fallopian tubes is therefore an essential factor to check. In this case, hysterosalpingography is indicated.

The quality of the endometrium and the volume of the uterus are assessed by hysteroscopy. Finally, the number, speed and appearance of the sperm cells, as well as their ability to travel all the way and fertilise the oocyte, should be checked by a semen analysis.


When should a fertility test be carried out?

A fertility test is not binding. It's better to do it a little too early than too late. In the case of irregular menstrual cycles, very painful periods or intense pelvic pain during intercourse, a fertility test may be advisable from the outset. In all cases, it is best to consult a gynaecologist specialising in fertility.

If the patient has regular monthly menstrual cycles with nothing unusual, she should of course be given a few months' trial period.

If the patient is under 35, a 1-year try before undergoing a fertility test seems a reasonable period of time. On the other hand, if the patient is over 35, a fertility test should be carried out after 6 months without a pregnancy, in order to quickly diagnose infertility and initiate medically assisted reproduction if necessary.


What fertility tests should I have?

Fertility problems can affect both men and women. When a couple is unable to conceive a child within the recommended timeframe, a medical consultation is therefore recommended to investigate the causes of the drop in fertility and confirm potential infertility in one of the partners. 

Assessing fertility levels in women

A number of tests are carried out to investigate infertility in women : 

  • Assessment of ovarian reserve
    • Hormonal test to be carried out between the 2nd and 5th day of menstruation
    • Assessment of ovarian function: FSH, LH, estradiol, progesterone.
    • Assessment of pre-antral follicle stock: AMH
    • Rule out other causes of menstrual cycle disturbance: TSH, PRL, 17OHP
    • Pelvic ultrasound with count of antral follicles between days 2 and 5 of menses.
  • Tubal evaluation
  • Hysterosalpingography: carried out by a specialist radiologist. He inserts a catheter into the uterus and injects a radio-opaque iodine product. Radiographic images are then taken to assess tubal permeability according to the diffusion of the contrast product
  • Hyfosy ultrasound: this is an ultrasound in which a foaming product is injected into the uterine cavity and its passage through the fallopian tubes is observed. This examination is less common than hysterosalpingography. 
  • Assessment of the uterine cavity

Although hysterosalpingography provides some information about the uterine cavity, it is sometimes not enough. These examinations are particularly indicated when there have been endo uterine surgical procedures (aspiration-curettage, polyp or fibroid resection by hysteroscopy), infections (endometritis) or other elements that could damage the uterine cavity.

  • 3D ultrasound with hysterosonography: this is an endovaginal ultrasound in which a catheter is inserted into the uterus after passing through the cervix. Water is then injected into the uterus to loosen the two endometrial sheets and open up the uterine cavity. Polyps, fibroids and synechiae can then be seen, which may be responsible for infertility.
  • Hysteroscopy: this is a fairly objective examination, in which a camera is introduced into the uterus through the natural canal after opening the cavity by injecting water or gas. It can be carried out without anaesthetic or under general anaesthetic, depending on the fertility centre. 

Assessing fertility levels in men

Male infertility can be identified through a number of fertility tests:

  • Spermogram
  • Spermocytogram
  • Survival migration test
  • Depending on the context: sperm DNA fragmentation

Once this initial fertility test has been carried out, you should see your doctor again with all your tests. He may need to continue the investigations if necessary. Finally, he will decide on the technique best suited to your case to help you realise your pregnancy plans.

Fertility Fertility TestsUltrasoundHormonesFemale InfertilityMale InfertilitySpermogram

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