There are a variety of diagnostic tests done specifically on women to try to determine the cause for low fertility or infertility. One of the first things that we do is check what we call an ovarian reserve number. What ovarian reserve is, is a description of a woman's chances of conceiving with her current egg supply. Women lose eggs as they get older, and the quality of those eggs tends to diminish as well. As a result, we do certain blood tests and ultrasound examinations to assess a woman's ovarian reserve. That is essentially look at the quantity and quality of her eggs.
We do certain tests, including a follicle stimulating hormone level in the early part of the cycle. We also look at another hormone called anti-Mullerian hormone or AMH. It also gives us an indication of egg quality and number.
We also can do what is called a antral follicle count where we actually use an ultrasound to determine the number of follicles in a woman's ovaries. Women with lots of follicles tend to have a much higher chance of conceiving successfully than those who have a very low number of follicles. Follicle numbers decrease as women age.
In addition to these tests, we also will check a woman's Fallopian tubes. We do a test called a hysterosalpingogram, also known as a HSG. It's an x-ray test in which dye is placed through the cervix into the uterine cavity and is then seen by x-ray moving up the Fallopian tubes towards the end of the tubes. Women with open tubes will have what's called free spill. The dye will spill from the ends of the Fallopian tubes showing open or patent Fallopian tubes. Blockages or stoppage of the dye can be seen by x-ray as well, indicating an occlusion of one or both Fallopian tubes.
In addition, we do ovulation testing either by blood tests or by ultrasound, and we can therefore time and also ascertain whether a woman is in fact ovulating. We also will do a test of the uterine cavity to determine if there is any abnormalities. To do that we often do what is called saline hysterosonogram, and in that test saline solution is placed through the cervix into the uterine cavity. By ultrasound we can then determine if there are polyps or fibroids or any other abnormalities of the uterus.
There are additional tests done as well, but they are far less common and far less useful. There are multiple diagnostic tests that are required. It's very difficult sometimes to get these tests done in a very short time span because some of them are cycle related. For example, the blood tests have to be done early in the cycle and other tests at later times in the cycle.
These are some of the fertility tests that are being done on women. Speak to your reproductive endocrinologist about which tests are right for you.