Infertility Testing and Diagnosis
Our examination frequently starts with an evaluation of the hormone levels at the start of the woman’s cycle:
- What follicle-stimulating hormone (FSH) level do we have when the cycle is starting?
- What anti-müllerian hormone (AMH) level do we see?
At mid-cycle, we can use a sonogram to examine the pelvic anatomy and location of the ovaries, including their follicular development.
The appearance of the uterine epithelium and the thickness of the endometrium should also be assessed. At that time, a post-coital test is usually performed.
On day 21 in a 28-day cycle, progesterone and estrogen values are examined. Our long clinical experience tells us that levels of progesterone over 20 ng/ml are more consistent with good fertility. Lower levels indicate ovulation but reduced chances for a pregnancy. Now is also the proper time to perform a semen exam.
If all these exams are normal, we conduct an evaluation of the fallopian tubes. This should be done after the woman’s period has ended but before ovulation has begun. The simplest way to do this is with a sonohysterosalpingogram (sono HSG). This is performed as an office procedure with an injection of saline and bubbles into the uterine cavity. The sono-HSG reveals the inside of the uterine cavity and the outline of the fallopian tubes to help us ensure they aren’t obstructed. A regular x-ray HSG is an alternative diagnostic option that may even increase the chances of a pregnancy.
After the initial evaluation, it is time to sit down and think about what we found and begin discussing the best approach for treatment.
So, what happens next? It varies.
At Friberg Fertility, we do not believe in a one-size-fits-all treatment approach like many larger fertility clinics tend to do. We believe in personalized medicine and will discuss the best options for your unique situation, taking into account your economic and insurance coverage situation.