Before undergoing fertility treatment, your doctor may order a few tests. These tests can help rule out or discover anatomical reasons for infertility, like sperm abnormalities or uterine issues such as scarring, fibroids, or malformations. The results of these tests can help your doctor make the best and most helpful decisions for your treatment.
There are lots of hormone blood tests that your doctor will order for you before you get started. The main hormone tests that are drawn consist of AMH (Anti-Müllerian hormone), FSH (follicle stimulating hormone), E2 (Estrogen), P4 (progesterone), and LH (luteinizing hormone). You may have some or all of these labs drawn. Each hormone sheds light on different aspects of your fertility like AMH provides information about your ovarian reserve, LH can indicate when you are about to ovulate, and progesterone can confirm ovulation has occurred. Elevated estrogen levels can indicate a growing follicle in your ovaries and consistently elevated FSH levels early in your cycle can point towards menopause. Your doctor will be able to use these hormone results to help determine the possible cause of your infertility and also to help come up with the best plan for your treatment.
A hysterosalpingogram is a procedure where the uterus and fallopian tubes are filled with contrast dye and examined using X-ray. The dye allows the doctor to see the anatomy of the uterine wall and confirm that the fallopian tubes are free of any blockages.
A hysteroscopy is a procedure where the doctor enters through the cervix and into the uterine cavity using tiny instruments guided by a camera to see the interior of the uterus and cervix. Typically the procedure is done to remove a polyp, fibroid, or scarring from the cervix or uterine wall to prevent it from interfering with embryo implantation and pregnancy.
A saline sonogram is a procedure that uses a thin catheter threaded through the cervix to place a small volume of saline inside the uterus. The doctor then uses an ultrasound to examine the interior uterine wall for abnormalities, like fibroids or polyps, that can contribute to infertility.
A mock embryo transfer is when your doctor performs a dry run of an embryo transfer as a way to learn and document the characteristics and curvatures of your reproductive anatomy, prior to the actual embryo transfer procedure. That way, when it's time to actually transfer the embryo, the process is as easy as possible.
The MET procedure itself consists of inserting a speculum into the vagina to view the cervix. Then the doctor will thread a thin, flexible plastic catheter through your cervix and into your uterus, taking note of the angle and depth of the catheter. This is the exact same process that will happen on the day of the embryo transfer. The MET takes only a few minutes and isn’t painful.
A semen analysis is an evaluation of a semen sample and sperm within that sample. Some of the main categories of the analysis are volume, concentration, motility, morphology, and total motile count.
Some of the precycle tests must be performed on certain days of your menstrual cycle, while others can be performed at any time.
Some, but not all, hormone blood tests need to be drawn at certain times during your menstrual cycle. For instance, AMH can be drawn anytime, but estrogen and FSH drawn in the first few days of your menstrual cycle are expected to be low, but rise during the first half of the cycle before ovulation. Progesterone will become detectable after ovulation, in the later half of the menstrual cycle and LH surges about 24-36 hours before ovulation occurs during mid-cycle. Your clinic will give you specific instructions on when it is best to come in for blood work depending on which labs you need to have drawn.
Many of these tests should be done in the first half of your menstrual cycle, prior to ovulation. This timing allows for the best visualization of the uterus and fallopian tubes during the procedure and will not interfere with a possible implantation and pregnancy after ovulation in the second half of your cycle.
HSG, HSC, and Saline Sonograms are all performed in the first half of the menstrual cycle, most often between cycle days 6 and 10. During this time, your period has ended, but the new uterine lining has not had the chance to fully grow.
On the other hand, tests like mock embryo transfers can happen at different times. This test can be done alongside other tests like HSG or HSC, or it can be done on its own in the office. Your doctor will talk with you about how your clinic typically plans mock embryo transfers.
Another test that is not specifically timed is the semen analysis for the sperm provider. This testing can typically be scheduled at your convenience; however, it is recommended to have 2-5 days of abstinence before coming in for the appointment to get the best sample possible.
Depending on which tests your doctor orders for you, you may need one or a few months to complete all pre-cycle testing before being able to start your ovarian stimulation. It can be helpful to keep that in mind when planning your possible treatment timeline.