Fertility and Pregnancy - Fertility Investigations Flashcards
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Ultrasound scans
• To rule out any structural abnormalities.
• Day 1–5 oestrogen test.
• Day 21 progesterone test (to evaluate progesterone adequacy)
Thyroid function
• To check thyroid function. Usually check for TSH only. Best to have a full thyroid panel (TSH, T3,T4, thyroid antibodies, possibly rT3).
Glucose levels and insulin resistance
• Elevated blood sugar levels and insulin resistance can affect ovulation / cycle length.
AMH (anti-Mullerian hormone) combined with AFC (antral follicle count)
• AMH is a protein that is used as a marker of ovarian reserve. It is tested using blood and is produced by granulosa cells of immature ovarian follicles.
• ↑ AMH could be PCO. ↓ AMH / reserve is likely to respond poorly to IVF drugs.
• AFC is done via ultrasound scan to check numbers of follicles in both ovaries.
Sperm sample
• To check for sperm motility and morphology, as well as semen volume
Other
• Testing for infections such as STIs, UTIs etc.
Toxic metals profile
• Hair / urine mineral analysis to identify levels of toxic metals in body.
MTHFR and COMT genetic variations
• DNA testing; MTHFR (as discussed). COMT polymorphisms can disturb oestrogen balance, e.g., COMT Val / Met polymorphism increases the risk of premature ovarian insufficiency.
Homocysteine
• ↑ homocysteine levels can indicate methylation issues.
Adrenal stress profile
• Can highlight a need for support due to the suppressive effects of cortisol on fertility.
RBC minerals
• Tests intracellular levels of minerals (zinc, magnesium) instead of blood levels.
Oxidative markers (e.g. Genova Oxidative Stress test or DUTCH)
• Blood sample (e.g., Genova) ― evaluates the oxidative stress status and antioxidant reserve.
• The oxidative stress marker ‘8-OHdG’ is measured via panels such as DUTCH (urine).
Immune investigations
• NK cells, HLA, antiphospholipid antibodies.
Serum or urine analysis of amino acids (male)
• Amino acids can affect sperm count (carnitine / arginine). E.g., Genova amino acid panels.
Vaginal ecology
• Evaluate the VMB ― look for evidence of BV etc.
Comprehensive hormone panels
• Genova Rhythm Plus (saliva ― female): Comprehensive salivary assessment of oestrogen, progesterone and testosterone that spans a full 28 days. Also tests cortisol, DHEA, melatonin and testosterone.
• DUTCH test: Comprehensive assessment of sex and adrenal hormones + their metabolites. Includes 8-OHdG.
AMH (female) — Medichecks / Biolab
• Normally already tested if undergoing ART.
DNA Fragmentation (sperm) ― TDL
• Measures the DNA of the sperm liable to fragmentation, with the potential to impair / damage normal embryonic development.
