Diagnosis of Female Infertility
Where to Begin
Any evaluation for infertility should be done in a focused and cost-effective way to find all relevant factors. The least invasive methods that can detect the most common causes of infertility should be done first.
The speed and extent of evaluation should take into account the couple’s preferences, the woman’s age, the duration of infertility, and unique features of the medical history and physical examination.
Fertility Testing for Females
Ovarian Reserve Testing: The most common test to evaluate ovarian reserve is a blood test for:
- Follicle stimulating hormone (FSH) drawn on cycle day 3.
- Anti-Mullerian hormone (AMH) is another test of ovarian reserve. It is made in the follicle and is related to the number of eggs produced. AMH levels can be drawn at any time during the menstrual cycle.
- Antral follicle: A transvaginal ultrasound may be done in the early part of the menstrual cycle to count the number of small (2mm-9mm) follicles in the ovary. These are called antral follicles and are where eggs develop. The number of antral follicles can tell us about the quantity of eggs available and the response to gonadotropin medicines.
Ovarian reserve testing is more important for women who have a higher risk of reduced ovarian reserve such as women who:
- are over age 35 years
- have a family history of early menopause
- have a single ovary
- have a history of previous ovarian surgery, chemotherapy, or pelvic radiation therapy
- have unexplained infertility
- have shown poor response to gonadotropin ovarian stimulation