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Whenever a couple commits themselves to medical treatment for infertility, they not only make a substantial financial investment, but also a large emotional investment. As conscientious health care providers, we would like to insure that any pregnancy resulting from this commitment has the very best chance possible for a positive outcome. For this reason we find it important to recommend certain preconception testing and precautions. This information is designed to help you understand the rationale for the basic testing in an infertility evaluation.
Rubella Titre and Vaccine
Rubella (German measles or 3 day Measles) is a communicable virus, which typically causes low-grade fever, upper respiratory symptoms and a diffuse red rash. In childhood this infection is usually mild. However, if contracted during pregnancy this disease can have severe effects on the developing fetus, including blindness, heart defects, hearing defects, musculoskeletal defects and mental retardation. If you have not been tested for Rubella immunity, we advise that this be done. If there is no immunity, we recommend that you be vaccinated for Rubella and then wait one month before trying to conceive.
HIV
HIV is the virus that causes AIDS. It is possible to have HIV for years and not know it or not feel sick. Many women who have been found to have HIV did not know they were at risk. To get early help for herself and to reduce the risk of infecting her baby, a woman who is attempting to conceive needs to know for sure. If she has HIV, even without symptoms, there is a 1 in 4 chance she could pass it to her baby. This risk can be greatly reduced with treatment. Your doctor can provide you with more information on HIV or refer you to other sources for education and counseling. Also, you may contact these sources for free, private information: American College of Obstetricians and Gynecologists (800-673-8444) or the Centers for Disease Control and Prevention (800-342-2437). If you choose not to be tested for HIV, please inform your physician. You will be given the same preconception and prenatal care as other women. However, if you have HIV and don't know it, your doctor won't know to give you special medication for HIV to protect you and your baby.
HSC 1644 - (HIV I & II / HEPATITIS B(HBsAg) / HEPATITIS C / SYPHILIS (RPR)
These are infectious diseases which can be potentially transmitted to other through blood, bodily fluids or childbirth. A simple blood test is available which allows the individual to be screened for the presence of any of these viruses. We require these tests as part of our workup. In order to do an Insemination (IUI) or IVF, State Law (HSC 1644) requires your partner to have these tests done. For certain diseases, treatment can proceed after a waiver is signed if the results are positive.
Blood Type, Rh and Antibody Screen
We should know your blood type and Rh status. If you already know this information, please get documentation of the results for your chart. Otherwise, we will perform the test for you.
Complete Blood Count and Metabolic Chemistry Screening
This is a comprehensive baseline screening to detect any underlying health conditions (i.e. anemia, diabetes, kidney or liver diseases, etc.) This is to be done fasting (no eating or drinking 12 hours prior to testing).
Thyroid Testing
The Thyroid gland controls metabolism. This blood testing is done to detect any thyroid dysfunction that may affect the menstrual cycle and / or your response to fertility treatment. This also may affect pregnancy.
Follicle Stimulation Hormone Test / Estradiol, Prolactin
These are done to rule out any hormonal imbalance(s) that can affect the menstrual cycle or that may indicate possible poor response to treatment.
Chlamydia Antibody Blood Test (ACAb)
Chlamydia is an organism which can cause infection in the male or the female genital tract. Different strains of Chlamydia can also cause infection of the eye or lung. When a person has a Chlamydia infection, the body reacts by making antibodies to fight off the infection. These antibodies can remain in a person's blood even after the infection has passed.
We test couples for ACAb that are going through intrauterine inseminations (IUI) or in Gamete Intra Fallopian Transfer. A positive test indicates a Chlamydia infection ocurred at some time in a person's life. If either you or your partner test positive, we will treat both of you with antibiotics to make sure the infection has been adequately treated.
Chlamydia/Myco/Ureaplasma Cultures
Chlamydia and Myco/Ureaplasma are organisms which can cause infection in the male or female genital tract. Chlamydia can cause tubal damage. Myco/Ureaplasma has been associated with infertility as well as habitual abortion. These cultures (Female) are obtained from the cervix during a pelvic exam. In order to test a male partner, a semen sample is collected. If either you or your partner test positive, we will treat both of you with antibiotics.
Semen Analysis
The Semen Analysis is the primary evaluation of a male. Parameters which will be evaluated are: volume, number of sperm present, viscosity or thickness, the motility of the sperm and the shapes of the sperm (morphology). This will help determine the best method of treatment for success.
Urine Luteinizing Hormone Test
Luteinizing hormone peaks (surges) in one's urine approximately 24-36 hours before ovulation. Home urine test kits such as Clear Blue Easy or OvuQuick help to predict when ovulation is about to occur. This is useful to determine the best time to have intercourse, or schedule an Intrauterine Insemination (IUI).
Hysterosalpingogram (HSG)
The HSG is an X-ray procedure which will demonstrate if the uterine cavity appears normal and will show if the Fallopian Tubes are open. Iodine dye is injected into the uterus through the cervical canal. HSG's are performed after menstrual bleeding has ended and prior to cycle day 12.
Sonohysterography (SHG)
The SHG is an Ultrasound procedure (done in the office) which will demonstrate if the uterine cavity appears normal for implantation. Saline is injected into the uterus through the cervical canal under ultrasound guidance. SHGs are performed after the menstrual bleeding has ended prior to cycle day 12.
Endometrial Biopsy
The extraction of a small piece of tissue from the endometrium ((lining of the uterus) for microscopic evaluation. The results indicate whether or not the endometrium is at the appropriate stage for successful implantation.
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