Menstrual cycles, birth control methods, previous births, miscarriages, traumas, diseases, family history, sexual behavior/preferences, are useful informations in determining possible root causes for infertility.
Ovarian reserve testing
Ovarian reserve testing is used to predict your ovarian response to ovarian stimulation. Commonly used measurements include AMH,AFC and FSH.
AMH (anti-Müllerian hormone) is a hormone produced by small follicles. AMH is a more reliable predictor of ovarian reserve compared to FSH, because AMH levels stay mainly consistent throughout the menstrual cycle and can be tested on any day. The higher the AMH, in theory the higher number of eggs you can produce after ovarian stimulation.
AFC (Antral-follicle count) is a measurement of 2-8mm follicles in ultrasound. It is best evaluated at the beginning of your menstrual cycle. More AFCs you have, more eggs can be retrieved.
FSH (follicle stimulating hormone) is a hormone produced by your brain to make your small follicles grow. Very high FSH indicates compromised ovarian reserve.
Obviously, ovulation (release of egg) is required for conceive. Regular menstrual cycles in most situations indicate ovulation. The easiest way to confirm ovulation is to check your urine starting on the second week of your menstrual cycle with an ovulation kit. If you see a positive result, it means you will ovulate within 24-36 hours. If the ovulation kit could not give you a clear answer, your doctor also can check your progesterone level by blood work one week before expected menses to confirm ovulation.
Pelvic ultrasound is a noninvasive diagnostic exam that produces images that are used to assess organs and structures within your pelvis. A pelvic ultrasound allows quick visualization of pelvic organs and structures including the uterus, cervix, vagina, fallopian tubes and ovaries. By performing ultrasound, your doctor can evaluate your ovarian and uterine basic status, also evaluate egg growth and uterine lining to determine if there are any issues contributing to the inability to conceive.
An x-ray of the fallopian tubes and uterus may be ordered if there is the possibility of tubal blockage that may be affecting conception.
Hysteroscopy is a procedure performed at the office to check the inner cavity of your uterus. It could be part of your infertility workup. It is a small procedure, well tolerated, no pain medication needed in most cases.