16e. Fertility - Fertility Investigations

Question 1

Examples of orthodox fertility investigations

Answer 1

Ultrasound
Serum FSH/oestrogen/progesterone
Thyroid function
Glucose/insulin resistance
Anti-Mullerian hormone
Antral follicle count
Sperm sample

Question 2

Why is an ultrasound used to investigate fertility?

Answer 2

To rule out any structural abnormalities

Question 3

When would oestrogen be checked?

Answer 3

Day 1-5 of cycle

Question 4

Why would progesterone be checked?

Answer 4

Day 21 of cycle

Question 5

Why are glucose levels checked in fertility?

Answer 5

Elevated blood glucose/IR can affect ovulation/cycle length

Question 6

What is anti-Mullerian hormone?

Answer 6

Protein used as a marker for ovarian reserve

Question 7

How is anti-Mullerian hormone tested?

Answer 7

Blood

Question 8

What can increased anti-Mullerian hormone be a sign of?

Answer 8

PCOS

Question 9

What does antral follicle count investigate?

Answer 9

Follicle numbers in both ovaries

Question 10

How is antral follicle count investigated?

Answer 10

Ultrasound

Question 11

What markers does a sperm sample test for?

Answer 11

Motility
Morphology
Volume

Question 12

Examples of functional fertility investigations

Answer 12

Vaginal microbiome
Comprehensive hormone panels
Toxic metal profile
MTHFR/COMT genetic variations
Homocysteine
Adrenal stress profile
RBC minerals
Oxidative markers
Immune investigations
Serum/urine analysis of amino acids
Anti-Mullerian hormone
DNA fragmentation

Question 13

How can toxic metals be tested?

Answer 13

Hair
Urine

Question 14

Why would homocysteine levels be tested for fertility?

Answer 14

High homocysteine levels can indicate methylation issues

Question 15

Why would an adrenal stress test be used for fertility?

Answer 15

To assess the suppressive effects of cortisol

Question 16

Why would amino acids be tested for fertility?

Answer 16

Amino acids can affect sperm count

Question 17

Examples of comprehensive hormone panel testing

Answer 17

Genova Rhythm Plus
DUTCH test

Question 18

What does the Genova Rhythm Plus test for?

Answer 18

Salivary assessment of oestrogen, progesterone, testosterone
Spans 28 days
Also tests cortisol, DHEA, melatonin

Question 19

What does the DUTCH test for?

Answer 19

Sex hormones
Adrenal hormones
Their metabolites

Question 20

Examples of assisted reproductive technologies

Answer 20

IVF (In vitro fertilisation)
Intracytoplasmic sperm injection
Intrauterine insemination

Question 21

What does IVF involve?

Answer 21

Stimulation of ovaries
Egg retrieval
Egg fertilised in vitro with sperm
Fertilised embryos transferred into uterus

Question 22

What does intracytoplasmic sperm injection involve?

Answer 22

Sperm injected into egg in vitro
(used when sperm abnormalities)

Question 23

What does intrauterine insemination involve?

Answer 23

Sperm placed inside uterus around ovulation to facilitate fertilisation

Question 24

Risks of IVF

Answer 24

Multiple births
Premature delivery
Low birth weight
Ectopic pregnancy
Cancer
Ovarian hyperstimulation syndrome
Egg retrieval procedure complications

Question 25

What is ovarian hyperstimulation syndrome?

Answer 25

Swollen and painful ovaries due to injected fertility drugs

Question 26

Examples of egg retrieval procedure complications

Answer 26

Aspirating needle use could cause bleeding, infection or damage to bowel, bladder or blood vessel

Question 27

Why is the risk of cancer increased with IVF?

Answer 27

Egg growth stimulation drugs linked with development of specific ovarian tumour