Trinidad IVF Services

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.

We provide expert ultrasound practitioners within all our clinics. This test for women is a vital way of assessing your fertility problem and also an essential way of monitoring all treatments in the clinic.

What is ultrasound?

An ultrasound test uses high frequency sound waves to look at various organs and soft tissues within the body. Ultrasound can be used to look at the internal organs within the abdomen (lower tummy area) and pelvis (at the lower end of the spine), to look for fluid within the chest or to look at soft tissues in any part of the body, including the eye and muscles within the limbs. It is also used to look at an unborn baby in the womb. Ultrasound scans are used widely in fertility medicine to evaluate your womb, ovaries and pelvic area. Every fertility treatment will generally require at least one ultrasound scan to monitor your egg production or the growth in the lining of your womb as your body prepares for pregnancy.

How is it done?

Ultrasound is a painless procedure. When looking at the organs in a woman’s pelvis by ultrasound, often the ultrasound probe is placed in the vagina (a trans-vaginal ultrasound scan). The reason for this is that the probe can get closer to the womb and ovaries giving much more information and detail. This is the way most early pregnancy ultrasounds are done. The ultrasound probe transmits and collects the sound waves which make up the ultrasound picture. The doctor will see the picture (which is black and white) at the same time on a TV screen.

Why are ultrasounds done?

Ultrasound is used as part of the investigation into the cause of a your fertility problem, to show if you have any problems that might reduce your chance of a pregnancy or increase the chance of a miscarriage. It can be used to view the body’s internal structures to see if they are structurally normal. It is also used to monitor the growth of egg-containing follicles in the ovary and the increase in thickness of the lining of the womb during fertility treatments such as IUI and IVF. Abnormalities such as fibroids, cysts, swollen tubes, uterine polyps, excess fluid and abnormal growths can be seen using this technique. It is also used to confirm a healthy pregnancy and analyses the development of unborn babies to check for normal growth and any abnormalities.

Benefits and risks

Benefits

Ultrasound is a very safe procedure and does not involve any radiation. It is also easy to perform and is painless.

Risks

There are no serious risks associated with the ultrasound.

Do I have other choices?

There are alternative diagnostic tests that you might have instead. These include:

• X-rays.
• CT scans – this method looks at the structures of the body using computer-generated images (computed tomography). It is a painless procedure and the person is conscious, but must lie quite still while they rest inside the scanning device, so that accurate images of the brain can be taken (rather like having a photograph taken). The technique is 100 times more sensitive than conventional radiography.
• MRI scans – this is a special imaging technique used to see internal parts of the body, particularly the soft tissues. These scans may be used for detecting some cancers and other diseases or for following their progress.

The possible alternative tests depend on the person’s symptoms. Doctors differ in whether or not they perform the procedure – some will use ultrasound first as it is painless and easy to perform. Others will use another diagnostic test – which will depend on the problem.

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.

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.

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.

(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.

1. 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.
2.  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.
3. 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). This screening thyroid test is done 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.

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.

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.

What tests can tell me how many eggs I have?

There are a variety of tests that help your doctor work out how many eggs might be left in your ovaries. However there is still not one test that will tell you for certain. The tests currently available are:

1. AMH blood test (done at anytime in your cycle)
2. FSH and LH blood test (done in the first three days of your period)
3. Oestradiol test (done in the first three days of your period)
4. Inhibin B blood test (done at any time in your cycle)
5. Ultrasound scan to measure the volume of your ovaries
6. Ultrasound scan to count the antral follicles in your ovaries

What we do know is that a woman is born with all the eggs she will ever have, and slowly loses them, as she gets older.The number of eggs starts dropping from before birth. When there are no eggs left then the periods stop completely and this is called the menopause. Men are very different and are capable of growing new sperm most of the time.

What is the best test to tell me how many eggs I have?

From research around the world it seems like the AMH blood test is most accurate test to measure the number of eggs left in the ovaries.

AMH levels tell us whether a woman is likely to have more or less eggs than her age alone suggests. It is a good measure of a woman’s fertility potential. The blood AMH levels remain relatively stable (20–25 pmol/L) from 18 to 29 years of age. By 30 years of age, AMH levels start to drop rapidly, reaching an average of only 10 pmol/L by 37 years.

Other blood tests are less accurate at picking up this drop in egg levels, for example the older blood test FSH. Despite the 50% fall in AMH levels between 29 and 37 years of age, minimal changes in FSH levels will be picked up on testing.

What is AMH?

AMH (anti-mullerian hormone or Mullerian inhibiting substance (MIS)) is a hormone produced by special cells that surround the eggs in the ovaries – the granulosa cells.

We introduced AMH into clinical practice in 2010, and have seen very accurate results, with AMH levels consistently predicting women with low egg levels and lower chances of pregnancy – often despite a young age and normal FSH levels. AMH can be done at any point in the menstrual cycle and is also not affected by hormone or drug medications.

How can I get an AMH blood test done?

All new patients are offered an AMH blood test in our fertility clinic. It is a simple blood test that does not require any special preparation (such as fasting or a certain time in your menstrual cycle). The results are available within a week.