Diagnose Your Condition

Saline Infusion Sonogram (SIS)

In conjunction with transvaginal ultrasound a special technique called Saline Infusion Sonogram can be performed as well. This specialized technique introduces fluid (saline) into the uterine cavity at the same time that the ultrasound is used. This technique is an excellent diagnostic tool for evaluating the uterine cavity (the inside of the uterus). This technique is often used to confirm various diagnoses such as fibroids, polyps, adhesions and uterine anomalies.

                          SIS: 3D Image of the uterus with an endometrial polyp visualized.

 

Semen Analysis

Semen Analysis Definition:

Semen analysis is a test that measures a man’s semen and sperm.  It measures the number, quality and motility of the sperm among other things.  A semen analysis is a critical test for couples that cannot conceive.  It is an easy test to perform, relatively easy to obtain and is not cost prohibitive.  A semen analysis can diagnose 15-25% of the causes of infertility.


The Test:

The Semen Analysis test is broken down to several components.  Each component gives us insight on the cause of infertility and whether it can be treated or not.

 

Volume:
This is a measure of the volume of the semen produced during one ejaculation
Sperm Count:
This is a measure of the amount of sperm present per mL (milliliter).
Sperm Motility:
This is a measure of the percent of sperm that are moving.  This portion of the test can be given grades based on how well the sperm are moving; typically a score of 0-4.  0 = Non-moving sperm.  4 = sperm that are moving fast and straight.
Sperm Morphology: This is a measure of the percent of sperm that have a normal shape (morphology)

 

What is Normal?

Normal Values differ from lab to lab, below are some of the measures that American Reproductive Centers uses to evaluate Semen Analysis results.

 

Volume:
1.5-6 mL per ejaculate is considered normal.
Sperm Count:
A count greater than 20 million sperm per mL.
Sperm Motility:
50% or more moving sperm (preferably forward moving, i.e. grade 3-4).
Sperm Morphology: 14% normal sperm or higher (Kruger’s criteria or strict criteria).

 

Fertility Potential - Women

Fertility Potential for women is best predicted by her ovarian function.  The evaluation of ovarian fuction is often very simple.  A careful medical history combined with simple tests can help predict a womans ability to conceive.

  1. AGE: age is perhaps one of the best predictors of fertility potential.  As women age pregnancy rates decline as well as miscarriage rates increase.  Although age decreases fertility potential for all women it is difficult to predict for each individual when a woman can no longer conceive.
  2. FSH: (Follicle Stimulating Hormone) is a hormone that the brain produces to stimulate the ovaries.  This stimulation creates an egg every month.  FSH is measured on the 3rd day of a woman's menstrual cycle.  This test is also measured in conjuction with Estradiol (estrogen).  Elevated FSH levels are predictors of low fertility potential.  Pregnancy with fertility treatment (IVF, Ovulation Induction, AI) is diminished in these patients.
  3. AMH: (Anti-Mullerian Hormone) is another hormone that can be tested to evaluate fertility potential in women.
  4. Ultrasound: Ultrasound evaluation of the ovary can also help predict fertility potential.  The specific Ultrasound test is call "antral follicle count".


The above evaluations as well as a thorough medical history can help predict a woman's fertility potential.

 

Ultrasound

There are two types of Ultrasound methodologies used for infertility evaluation and treatment.  The first is transvaginal ultrasound and is the most common method used.  The second is abdominal ultrasound.

Transvaginal Ultrasound:

This method of ultrasound is used to look at women's reproductive tract.  As the name suggests transvaginal means "across or through the vagina".

Your doctor will place a probe, also called a transvaginal transducer, into the vagina. The probe sends out sound waves.

These sound waves are safe and reflect the waves that bounce off the pelvic anatomy. 

The probe then collects the wave data and processes the data through a computer and translates that data into images that can be seen by your doctor.  Transvaginal ultrasounds are the preferred method because the probe is  close to the pelvic organs and the images seen are clearer and more accurate.

Ultrasound images are used to diagnose conditions of the reproductive tract.  The ultrasound images are capable of evaluating the uterus, ovaries, cervix, vagina and sometimes the fallopian tubes.

Your doctor will utilize the ultrasound to diagnose conditions like polycystic ovarian syndrome, ovarian cysts, uterine anomalies, fibroids, hydrosalpinx and many other conditions that can cause infertility.

 

 

Other Ultrasound Techniques:

Saline Infusion Sonogram:  In conjunction with transvaginal ultrasound a special technique called Saline Infusion Sonogram can be performed as well. This specialized technique introduces fluid (saline) into the uterine cavity at the same time that the ultrasound is used. This technique is an excellent diagnostic tool for evaluating the uterine cavity (the inside of the uterus).  This technique is often used to confirm various diagnoses such as fibroids, polyps, adhesions and uterine anomalies.

3D-4D Ultrasounds:  With todays technology ultrasounds can now be used to evaluate the pelvic anatomy in 3 and 4 dimensions.  Images can be seen in 3D and 4D (4D images are 3D images that can be rotated on different axises).  3D and 4D images are also used to evaluate the fetus during pregnancy.

 

                  3D Image of an ovary during stimulation for IVF

 

                              2D + 3D Image of large ovarian cyst 

 

             4D image of the uterus with polyp visualized in the cavity

 

HSG-Hysterosalpingogram

What is a Hysterosalpingogram-HSG?

An HSG is a specialized x-ray that evaluates the fallopian tubes and the uterus.  The x-ray(s) are obtained while contrast (dye) is injected through the cervix into the uterus and ultimately through the fallopian tubes.

How the test is performed:

The exam is performed typically in a radiology department.  You will lie on a table beneath the x-ray machine.  You will then be positioned to start the examination.  You will be positioned in stirrups (similar to a pelvic exam).  A speculum is placed into the vagina.  The cervix will be visualized and cleaned.

A thin catheter will then be placed in the cervix.  Contrast (dye) will then be pushed through the catheter.  Once dye begins to enter the uterus the radiologist will begin taking x-ray images.  He will continue this process until dye passes through both fallopian tubes.  The x-ray is an example of a normal HSG evaluation.

How to Prepare:

Preventing infection:  Your doctor will likely prescribe antibiotics.  If no antibiotics were prescribed ask your doctor or nurse.

Preventing cramping: Your doctor will likely prescribe pain medications or mild sedatives to make the procedure less uncomfortable.

Preventing complications: Your procedure should be done the week following your period to ensure that there is no pregnancy; alternately you may be placed on oral contraceptive pills prior to the procedure.

Benefits of the Test:

An HSG will help diagnose tubal blockages, uterine abnormalities, fibroids, polyps and other abnormalities that can prevent pregnancy from occurring.  This test is considered a high yield test as it will give your doctor a great deal of information regarding your reproductive anatomy.

An HSG is a diagnostic test but can often unblock fallopian tubes.  There has been some evidence that pregnancies can occur soon after this procedure is performed if tubal blockage was the cause.
How to schedule an HSG:

Talk to one of our doctors to have an HSG and a complete fertility evaluation performed.  If you are already an American Reproductive Centers patient then talk to your Nurse or Coordinator for Assistance.