BASIC TESTS for women
For women the basic tests to find out why you are not getting pregnant are:
- blood tests – to check whether you are releasing your eggs (ovulating), check the levels of hormones that control the menstrual cycle and assess your egg numbers. These tests are often FSH, LH, Prolactin, Oestradiol, Rubella immunity and AMH levels.
- an ultrasound scan of the pelvis to rule out abnormalities in the womb and ovaries
- an X-ray of the fallopian tubes – called a hysterosalpingogram (HSG) – to assess whether the tubes are open or blocked
Once you have done these tests you will need to see a fertility doctor. A fertility doctor is usually an obstetrician and gynaecologist who has gone through extra medical training over many years to become a reproductive medicine expert (fertility doctor).
Other tests that may be recommended for women are
- other blood tests to look for causes of infertility
- a pregnancy test to check you are not already pregnant
- vaginal and cervical swabs to check for infection
- a saline scan of the pelvis where fluid is passed into the womb to outline the inside cavity and look for abnormal areas that might affect an embryo being able to implant and grow
- a laparoscopy – where a small camera is passed through a ‘keyhole’ into your abdomen to check for cysts, endometriosis or blockages.
TESTS – IN MORE DEPTH
If you’re not having periods it might be because you are already pregnant. A urine pregnancy test looks for the pregnancy hormone (HCG) and is a very accurate test whether done at home or in a clinic. Pregnancy hormone can also be measured in the blood by a simple blood test (beta HCG) and this gives a more detailed level of the amount of pregnancy hormone that is present. Blood tests are usually done after fertility treatment.
A blood test will show whether a woman is immune to the virus Rubella. If a woman is not immune she can catch the Rubella virus. Rubella is the German measles virus, and if caught during pregnancy there is a serious risk of the baby being infected and damaged. If the blood test shows that a woman is not immune to the Rubella virus, then the MMR vaccine should be given. This is available in all our clinics and also at health centres throughout Trinidad and Tobago.
Once the vaccine has been given it is essential that 28 days is allowed to elapse before pregnancy occurs, because rubella is a live vaccine, which can damage an unborn child.
There are a variety of tests to try and work out if a woman is releasing eggs (ovulating). Unfortunately there is not one test that can tell for sure if ovulation will or has happened.
- Ultrasound scan of the ovaries. This type of scan is called a follicle-tracking scan because it measures the bubble of fluid called the follicle in which the egg grows. Human eggs are microscopic and cannot be seen with the human eye. If a follicle is seen to be growing in size from one scan to the next, then it is likely to contain an egg. Once this follicle reaches 18-25mm in diameter then it usually will contain a mature egg. A scan in the next 24-48 hours will show that the follicle has ruptured and changed in appearance if ovulation has happened.
- Urine testing for ovulation hormone (LH). Once a mature egg is ready to ovulate the body usually releases a “surge” or large amount of LH hormone to cause ovulation to occur. This LH hormone can be easily detected in the urine using a commercially available urine ovulation kit.
- Basal body temperature monitoring. Once ovulation has happened the body temperature rises by 0.5 degrees Farenheit. Often a small dip in temperature is seen just before this rise. Both of these slight temperature changes can be detected with a sensitive thermometer, used to measure your morning resting temperature before you get out of bed (basal body temperature).
- Progesterone blood test. When ovulation takes place, levels of the hormone progesterone rise. The amount of hormone present can be detected in the blood. This rise can be found on a blood test that is done seven days before your period starts. If you have a 28-day menstrual cycle the test is performed on day 21. If your cycle is longer or shorter the day of the test will be altered. The doctor will calculate which is the correct day for you according to your menstrual cycle.
Most fertility clinics now advise ultrasound scanning or LH urine testing, as they have the advantage of picking up signs before the egg releases, at a time when sexual intercourse is recommended to maximise the chance of pregnancy. Both progesterone blood testing and basal body temperature testing only show signs after ovulation has already happened, at a time when sexual intercourse is less likely to result in a pregnancy.
Maximum pregnancy rates are actually seen when sexual intercourse takes place in the 24 hours before the egg releases. This ensures that sperm are ready and waiting for the egg inside the fallopian tube. The sperms are capable of living for several days inside the womb & tubes, however the egg probably lasts 12 hours at most. This is why the most up-to-date advice for timing sexual intercourse is to be sexually active in the 24 hours before ovulation.
Blood hormone testing. (AMH, LH, FSH, Oestradiol & Prolactin)
All the female hormones involved in egg growth and release can be measured. The time of the menstrual cycle is important when measuring FSH, LH and Oestradiol.
- AMH (anti-mullerian homone) is the most accurate test to estimate how many eggs a woman has in her ovaries. It can be done at any point in the menstrual cycle and is also not affected by hormone or drug medications.
- FSH, LH and Oestradiol levels are performed between days two and five of your menstrual cycle. This test is an estimate of the number of eggs in the ovary and also the balance between the hormones. It can pick up a variety of medical conditions, such as low FSH and LH (hypogonadotrophic hypogonadism), PCOS and premature ovarian failure. Because the levels of these hormones fluctuate during the menstrual cycle, this test is not very helpful when done after day five of the menstrual cycle.
- Prolactin hormone is usually produced in large amounts during breast-feeding. It can become high in other situations and may then cause problems for egg release. It can be measured at any point during the menstrual cycle.
Ruling out medical conditions that can affect fertility
- Thyroid disease (TSH levels). Tests might be undertaken to check whether these hormones, which affect the menstrual cycle, are present at normal levels.
- Diabetes screening. Blood testing to screen for diabetes may be suggested. Women with un-diagnosed diabetes are less likely to get pregnant, and are also at increased risk for miscarriage and abnormal babies.
Vaginal and cervical swabs
These might be taken to check for infection. These swabs are taken during a speculum examination, which is similar to a smear test. Having the swabs taken should not hurt, and you will probably find it easier than a smear test.
Pelvic ultrasound scan
This is usually performed in the clinic by one of our doctors and helps to rule out any abnormalities in the womb, ovaries and other pelvic organs. A scan may show the presence of ovarian cysts, endometriomas (ovarian cysts caused by endometriosis), fibroids, swollen fallopian tubes, polyps, abnormal location of the ovaries, and PCOS. Ultrasound scans are usually done through the vagina, as this is more accurate in assessing the pelvic organs.
Saline contrast scan.
This is a specialised vaginal ultrasound scan that gives more detail of the inside lining of the womb (endometrium). It is commonly used to diagnose uterine polyps and fibroids inside the womb. The procedure is performed while you are awake, and is safe and painless. A small volume of saline fluid is injected through the neck of the womb while the ultrasound scan is being done.
This is a test to assess whether the fallopian tubes are open or blocked. It also assesses the inside cavity of the womb. During this procedure a radio opaque dye (a dye which can be seen on an X-ray) is injected through the neck of the womb (cervix). The dye will pass up through the womb and if the tubes are open, will pass through the tubes into the pelvis. This will be seen on the X-ray.
For this test you will need to visit a specialised x-ray centre. Our staff can advise you on recommended units for this test in Trinidad and Tobago. This procedure is performed while you are awake. It is quite safe but a small number of people may be allergic to the dye. A doctor is present in case of this. Some patients complain of discomfort during the procedure, so it is advisable to take some simple painkillers such as Paracetamol beforehand.
This is another type of test to assess if the fallopian tubes are open. Some units offer this rather than HSG. A HyCoSy is similar to a HSG except that ultrasound, instead of X-ray is used to look at the tubes. The contrast medium contains galactose particles and is injected through the cervix as with the HSG. Again you are awake for this procedure.
Laparoscopy and dye test
This may be done instead of the HSG. It requires a short-lasting anaesthetic, which means that you will be put to sleep. It is a form of keyhole surgery. A small camera is placed into your abdomen through the belly button, giving a good view inside the pelvis. Any cysts, adhesions or endometriosis can then be identified and treated (if mild or moderate in severity).
A dye is injected through the cervix. If the tubes are open the dye is seen passing through the tubes and into the pelvis. If the tubes are blocked, the extent of the blockage may be identified. Other abnormalities of the tubes can also be identified and sometimes treated.