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Reasons to Consider Annual Fertility Screening

By David Kreiner MD

December 19th, 2014 at 8:01 pm

 

credit: akeeris/ freedigitalphotos.net


What Is Fertility Screening?

Fertility screening starts with a blood test to check the levels of FSH (follicle stimulating hormone), estradiol and AMH (antimullerian hormone). The FSH and estradiol must be measured on the second or third day of your period. The granulosa cells of the ovarian follicles produce estradiol and AMH. The fewer the follicles there are in the ovaries the lower the AMH level. It will also mean that less estradiol is produced as well as a protein called inhibin. Both inhibin and estradiol decrease FSH production. The lower the inhibin and estradiol the higher the FSH as is seen in diminished ovarian reserve. The higher the estradiol or inhibin levels are then the lower the FSH. Estradiol may be elevated especially in the presence of an ovarian cyst even with failing ovaries that are only able to produce minimal inhibin. However, the high estradiol reduces the FSH to deceptively normal appearing levels. If not for the cyst generating excess estradiol, the FSH would be high in failing ovaries due to low inhibin production. This is why it is important to get an estradiol level at the same time as the FSH and early in the cycle when it is likely that the estradiol level is low in order to get an accurate reading of FSH.

The next step is a vaginal ultrasound to count the number of antral follicles in both ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least a total of eight antral follicles for the two ovaries. Between nine and twelve might be considered a borderline antral follicle count.
As you start to screen annually for your fertility, what you and your doctor are looking for is a dramatic shift in values from one year to the next.

What Does the Screen Indicate?

A positive screen showing evidence of potentially diminishing fertility is an alarm that should produce a call to action. When a woman is aware that she may be running out of time to reproduce she can take the family-planning reins and make informed decisions. The goal of fertility screening is to help you and every woman of childbearing years make the choices that can help protect and optimize your fertility.

Although none of these tests is in and of themselves an absolute predictor of your ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a discussion with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out. It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as a history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order.

Regardless of the nature or severity of the problems, today, with Assisted Reproductive Technology and the latest Egg-freezing technology, there is a highly effective treatment available for you.

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Have you had a fertility screening yet? Did you find it helpful? Do you have any questions for Dr. Kreiner?

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Infertility Podcast Series: Journey to the Crib: Chapter 6 Have You Had A Fertility Workup?

By David Kreiner MD

March 18th, 2013 at 7:33 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Six: Have You Had a Fertility Workup? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=43

Have You Had A Fertility Workup?

A fertility specialist called a Reproductive Endocrinologist, who has performed a three year fellowship training in IVF and infertility after an Obstetrics and Gynecology residency, will initiate the fertility workup by conducting a history and physical examination.  The exam includes a pelvic ultrasound of a woman’s uterus and ovaries to determine if there are any abnormalities that may affect implantation or pregnancy, as well as assess ovarian activity and the presence of endometriosis.

Different causes of infertility will be tested.  The most common factor, that affecting the male, is easily tested with a semen analysis.  Tubal obstruction preventing a woman’s eggs from reaching the sperm can be ascertained by a hysterosalpingogram, a radiograph of the uterus and fallopian tubes performed after injecting radio-opaque contrast through the cervix.

Other tests to better delineate problems in the uterine cavity may be performed such as a hydrosonogram, where water is injected through the cervix and the cavity inspected by vaginal sonography or with hysteroscopy, where a scope is placed through the cervix to directly inspect the uterine cavity.

Blood tests may be performed to assess ovarian activity, in particular day 3 FSH and estradiol levels and AntiMullerian Hormone.  Prolactin and TSH levels are checked to rule out other hormonal disorders that may affect ovulation and fertility.

Treatment can be directed at the cause of infertility, such as ovulation induction for women with ovulatory disorders or surgery to remove uterine polyps or it may be independent of the cause such as with ovarian stimulation and intrauterine insemination or IVF which will improve success rates regardless of the cause of infertility with some exceptions.  IUI will have limited success for tubal factor, male factor infertility and endometriosis.  IVF will have limited success in women who have diminished ovarian reserve or abnormal eggs unless they use eggs donated by young fertile women.  Today, there is a highly successful treatment available for all.

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Was this helpful in answering your questions about what to expect from a fertility workup?

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