Solving the mystery of your fertility Issues Starts with
Scheduling a Routine Fertility Workup

The following is a listing of tests generally included in a routine fertility work-up. Please note that every reproductive endocrinologist (RE) has his or her own standard protocol, and the following is intended to be a basic guideline.

What to Expect At a Fertility Workup:

YOUR FIRST APPOINTMENT: Try to schedule your first appointment with your RE during the first week of your cycle. This will enable him/her to take baseline levels of FSH (follicle stimulating hormone) and LH (lutenizing hormone). Most REs also do routine screening of both partners---AIDS, hepatitis, etc. Medical histories for both partners will be taken. Try to keep track of the length of your menstrual cycles for several months beforehand. Charting Basal Body Temps (BBTs) for several months will also give your doctor some insights---as will using home Ovulation Predictor Kits and recording the results.

YOUR SECOND APPOINTMENT: This appointment should be scheduled on the day of LH surge---BEFORE ovulation. In most cases, you will be directed to use home ovulation test kits and call for an appointment on the day you detect a surge. Included in this exam will be:

CERVICAL MUCUS TESTS: including a post-coital test (PCT) to see that sperm can penetrate and survive in the cervical mucus, and a bacterial screening. It is important to note that the appropriate time to do PCTs is just before ovulation when mucus is the most "fertile." PCTs at other times may give false results.

ULTRASOUND EXAM(S): On the day of LH surge are used to assess the thickness of the endometrium (lining of the uterus), monitor follicle development and assess the condition of the uterus and ovaries. If the lining is thin, it indicates a hormonal problem. Fibroid tumors can often be detected via ultrasound, as well as abnormalities of the shape of the uterus and ovarian cysts. In some cases, endometriosis can also be detected. Many doctors order a second ultrasound two or three days after the first. This second ultrasound confirms that the follicle actually did release and can rule out lutenized unruptured follicle (LUF) syndrome---a situation in which eggs ripen but do not release from the follicle.

HORMONE TESTS: if the blood test at your first appointment indicated a high LH to FSH ratio, an indication of polycystic ovarian disease (PCOD), your doctor will order an "Androgen Panel" to check levels of free testosterone and dihydroeprandrostone (DHEAS). Other tests tests that should be conducted on the day of LH surge include LH, FSH, Estradiol and Progesterone. Tests which can be done at any time (and therefore done at the second appointment) include: Prolactin, Thyroid Stimulating Hormone (TSH), Free T3, Free Thyroxine (T4), Total Testosterone, Free Testosterone, DHEAS and Androstenedione.