You finally did it. You took a deep breath and scheduled a visit with a fertility specialist. You are ready to go! And suddenly, you have a laundry list of tests to do and some of these don’t even diagnose fertility problems! What the heck??
Fertility problems affect the whole body. In fact, 2 bodies are affected, yours and your partner’s. A healthy body is more likely to have a healthy pregnancy, so your fertility specialist will want to be sure everything is as good as we can make it. So, what are these precycle tests and why do we ask for them?
We will need to be sure your uterus, tubes, and ovaries are in top condition, and that we address any problems that can impact your fertility.
Ultrasound: A vaginal ultrasound can tell us a LOT, and is one of the most important tests that we do. With it, we can check for fibroids, polyps, fluid in the tubes, egg counts, cysts, and the length of your cervix.
HSG or Femvue: These tests are very similar and are used to check the interior of the uterine cavity where your pregnancy will implant, and also to check if your tubes are open. They involve placing a speculum in the vagina, just like for a pap, and then inserting a thin tube inside the uterus. Liquid is then instilled into the uterus and imaging is done to see if the tubes are open. This test can also check for scar tissue or polyps (benign fleshy growths) inside the uterine cavity. The differences between these tests are really the liquid and the imaging type. HSG uses dye and Xrays. Femvue uses water, bubbles, and ultrasound. These tests also need to be done when there is no chance of pregnancy, so they will be timed to your cycle appropriately.
Pap: If your last pap was normal, you don’t need to repeat it for another 3 years. If it has been longer than 3 years, or your last pap was abnormal, we may need to have you update that before we proceed with fertility treatments. This is because if your pap is abnormal, it is more difficult to assess and treat it if you are pregnant.
STD testing: These tests are done with blood, urine, or cultures. They test for any STDs that can cause diseases of a baby or even birth defects. If possible, all STDs should be completely treated before getting pregnant or starting fertility treatments. If you are freezing and storing tissue, STD testing also helps us to know where to store your tissue. Fertility labs store like with like, meaning that a person who has a positive test for Hepatitis C will be stored with other samples that are Hep C positive, to minimize the risk of contamination.
Basic Health Screening
Mammogram: We recommend a mammogram yearly after age 40, and earlier if there is a family history of early breast cancer.
Cancer genetic screening: We don’t require this testing, but because fertility doctors are already talking about genetics, it’s reasonable to offer a screening to our patients. This is a blood test and usually involves genetic counseling about your individual risk of cancer.
Maternal fetal medicine consultation: We recommend this if a patient has risk factors that could impact her chances of having a healthy pregnancy. The purpose of an MFM consult is to pre-plan your pregnancy and troubleshoot it as much as possible, so that once you are pregnant, we can prevent as many problems as possible.
Other Fertility Tests
Semen analysis: Semen analysis is done on the male partner. 50% of all couples with fertility problems have a male component. About 30% have problems with both the male and female partner. So even if you have a sense that we know what one of the issues is, we still recommend this simple and inexpensive test.
AMH: Anti-Muellerian Hormone is a blood test that gives us a sense of your general ovarian reserve; low, medium or high. In our lab, a normal AMH is 1-6. A low AMH suggests that we would not want to delay fertility treatments or egg freezing any longer than necessary. An elevated AMH suggests that while there are plenty of eggs, there may be other hormonal problems that need to be addressed. This would be done with additional blood tests to check for metabolic problems, thyroid disease, and abnormalities of the adrenal glands or milk hormone (prolactin).
Genetic carrier screening: This is blood work that tests to see if you are a silent carrier of hundreds of genetic diseases. Silent carriers are called autosomal recessive, and they have no symptoms and possibly no family history of disease. However, if two carriers of the same disease conceive a pregnancy together, there is a high risk of having a baby with that disease. At Kindbody, we recommend testing both partners, so that you can be appropriately counseled about your options if you are both carriers of the same thing.
These are not all the tests that may be recommended for you and you may not need to do all these tests. However, any testing that we order has one goal in mind: to help you get pregnant, stay pregnant, and have a healthy baby!