Dreams Fertility

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Male & Female Fertility Evaluation

The General Fertility Work Up

There is more than one approach to any fertility work up. For any given patient, the work-up may differ quite substantially, depending upon the history, past treatments and facts of the case. Different practitioners have different styles of practice and may approach the same problem in a different way. We refer to this as the ART rather as distinct from the science of medicine.

What follows is a brief summary of the approach that is used in most patients at DREAMS FERTILITY.

Preparatory Tests

  1. Initial Fertility Tests
    On the second or third day of menstruation, blood is drawn for the measurement of estradiol (E2) and follicle stimulating hormone (FSH). It is very helpful if a pelvic ultrasound can be done at this time too. This reading will provide a lot of information including ovarian size and volumes and Antral Follicle Count or AFC (the number of small follicles, destined to grow in the immediate future). We place significant importance on the AFC in management decisions.
  2. Drawing Blood
    Blood should also be drawn at any time of the cycle for the measurement of prolactin, thyroid stimulating hormone (TSH), anti-müllerian hormone (AMH).
  3. Perform HSG
    A hysterosalpingogram (HSG) should be performed within a week. This outpatient radiologic procedure involves injection of a radio-opaque dye, which outlines the fallopian tubes allowing the diagnosis of tubal blockage. It may also detect an unknown uterine malformation contributing to the problem. To a lesser degree, it permits the detection of surface lesions inside the uterine cavity.

For Women With Organic Pelvic Disease

For women who have evidence or symptoms pointing to underlying organic pelvic disease (e.g. endometriosis, chronic inflammation, pelvic adhesions, fibroids etc): A laparoscopy/hysteroscopy is another approach. This should be performed within a week of the cessation of menstruation. Laparoscopy is a procedure where a telescope-like instrument is introduced through the belly button into the abdominal/pelvic cavity, allowing diagnosis and treatment of ovarian cysts/endometriomas/benign tumors, uterine fibroids, tubal blockage, ectopic pregnancy, appendicitis, pelvic adhesions.

male female frtility
male female

The First In-Office Assessment

  1. History & Physical
    A thorough history is taken from both partners. This is very important to help assess potential causes of infertility. A physical exam is usually performed at all new-patient visits.
  2. Ultrasound Examination
    A vaginal ultrasound examination is performed to detect the position and relationship of the pelvic organs. This exam allows detection and evaluation of pathology, such as fibroids, endometriosis or blocked tubes with hydrosalpinges.

Intercurrent Testing (I.e. Any Time in the Cycle):

Tests On the Female Partner

  1. Immunologic Work-Up
    This may be required in certain cases of female infertility or with a past history of recurrent pregnancy loss. This includes measurement of several blood immunologic markers. These tests are performed in a laboratory that specializes in immunologic function.
  2. Routine Prenatal Lab Work
    This includes blood type, immune status to rubella and varicella, infectious disease testing (hepatitis B, hepatitis C, HIV, syphilis, gonorrhea, chlamydia and Covid 19). We also recommend preconception genetic screening, which tests for whether or not you carry several common genetic disorders (e.g. Cystic Fibrosis, Spinal Muscular Atrophy, Sickle Cell Disease, Tay-Sachs Disease, etc.).

Tests On The Male Partner

  1. Semen Analysis
    A semen analysis is required for accurate measurement of sperm motility and count. Sperm morphology ( shape) is assessed employing strict “Kruger criteria.”
  2. Genetic Screening
    We also recommend preconception genetic screening, which tests for whether or not you carry several common genetic disorders (e.g. Cystic Fibrosis, Spinal Muscular Atrophy, Sickle Cell Disease, Tay-Sachs Disease, etc.).
  3. Further Testing
    If indicated, the sperm may be further tested using the Sperm DNA Fragmentation Assay (SDFA) an Advanced Semen Report.

After the initial diagnostic testing has been completed, you will meet with your provider to review all results and discuss the treatment plan.