What a fertility evaluation actually contains
Three things. Everything beyond them needs a specific reason.
The evaluation checks three things. Whether you are ovulating. Whether the tubes are open and the shape of the uterus is normal. And what the man's semen analysis shows. Add a history and a physical examination and that is the whole evaluation.
Two tests are named for checking the tubes: HSG, which is an X-ray with dye, or SHG, which is an ultrasound with saline.
The man's tests are meant to happen at the same time as yours, not after yours have been exhausted. Here is the fertility society's own wording:
The infertility evaluation should include an evaluation of ovulatory status, the structure and patency of the female reproductive tract, and semen evaluation of the male partner. When applicable, parallel fertility evaluation of the male partner should occur. HSG or SHG are recommended tests to evaluate for tubal patency.
The same document also narrows several things that are still done routinely:
In women with regular menstrual cycles between 21 to 35 days, additional testing to confirm ovulation is not required
, unless there is hirsutism.- A single progesterone level
may be used to confirm ovulation, but not to assess the quality of the luteal phase
, because it can swing sevenfold within a few hours. - If your cycle history already suggests you ovulate, charting your temperature every morning adds nothing. It is not routinely recommended.
- Prolactin is not a routine test. Order it only if there is milk from the breast when you are not nursing, or if periods are infrequent or absent. Thyroid-stimulating hormone is kept.
Laparoscopy is not recommended as a routine method for assessing tubal patency.
- Inhibin B and the clomiphene challenge test
are not helpful tools to assess ovarian reserve and are not recommended.
One line matters for the next topic. Ovarian reserve testing, which includes AMH, is not a screening test. It should not be used on women who do not meet the definition of infertility. It is an addition to the evaluation of women who do. In the document's words: Ovarian reserve testing should not be used as a screening test for women who do not meet the criteria of infertility, but should serve as an adjunct to the evaluation of infertile women.