- FSH (follicle-stimulating hormone) – FSH is the hormone that triggers your ovaries to prepare an egg to be released each month. High FSH levels indicate low ovarian reserve, or a diminishing egg supply, which typically means a lower chance of getting pregnant. An FSH level is typically checked around Cycle Day 3.
- AMH (Anti-Mullerian Hormone) - AMH is a protein hormone produced by cells within the ovary. You AMH level helps to assess your ovarian egg reserve. AMH levels on average, are lower in older women, and higher in those women with PCO or PCOS (Polycystic Ovarian Syndrome).
It’s important to rule out general physical problems, as well as evaluating the uterus and ovaries through a combined physical examination and an internal ultrasound. Depending on your situation, you may be asked to schedule this test for a certain time during your menstrual cycle (ex: ~CD#3 – or – between CD#6 to CD#15).
- Physical examination - This commonly involves listening to your heart and lungs, along with a brief pelvic examination.
- Pelvic Anatomy Ultrasound with BAFC - an ultrasound probe (or "wand") is placed into the vagina to view the patient’s pelvic organs. The ultrasonic sound waves allow for 2D and/or 3D imaging of the ovaries and uterus, allowing us to identify certain abnormalities, such as polyps, fibroids, or a septum. The BAFC (Basal Antral Follicle Count), provides information on the number of basal follicles a patient has on their ovaries at that time.
Hysterosalpingogram or an “HSG”
Hysterosalpingogram or an “HSG” - is an X-ray of the fallopian tubes. The X-ray is performed immediately following the injection of a liquid dye, through the vagina and into the tubes. An HSG allows us to view the patient’s fallopian tubes, looking for defects or blocked areas. It also allows the physician to determine if the patient has any abnormalities of the uterine cavity (see below pic). The test is typically performed between days 6 to 15 of a patients’ cycle (i.e. ~6 days after starting your menstrual cycle/period through the 15th day).
Abnormalities of the Uterus:
Hysteroscopy or HSC
Hysteroscopy or HSC – the physician uses a thin, flexible tube, with a camera on the end, and inserts it through the cervix and up into the uterine cavity. Tissue samples can be taken, and photographs of the inside of the uterine cavity allow us to view any defects present, such as: Endometrial Polyps, Adhesions, or Fibroids. Small defects, can typically be removed at the time of the procedure. Larger defects, such as fibroids, may require a more extensive surgical procedure to remove (at a later time).
Endometrial Biopsy – the procedure involves scraping and examining a small sample of tissue from the lining of the uterus (endometrium). It allows the physician to determine if ovulation has occurred, and whether the lining of the uterus has undergone the changes necessary for the implantation of a fertilized egg and the support of an early pregnancy. An endometrial biopsy can also detect an infection or inflammation of the endometrium (endometriosis).
ERA, or Endometrial Receptivity Analysis, is a test used to determine the receptivity of the endometrium.
ERA may increase the chance of pregnancy by predicting the ideal time for the implantation of the embryo during an IVF cycle.
A biopsy of endometrial tissue is taken and analyzed. Results will indicate whether the endometrium was receptive or non-receptive at the time the biopsy was taken.
A receptive result indicates the endometrium is likely to be receptive and the embryo is likely capable of implanting into the uterus relative to the day the biopsy was taken.
A non-receptive result indicates that the endometrium is either pre- or post-receptive relative to the day that the biopsy was taken. The embryo transfer would not be recommended.
A non-receptive result means the endometrium is either pre-receptive or post-receptive.
In this case, a new window of implantation will be suggested and a second biopsy and test are recommended to confirm the new personalized window of implantation.
ERA links to a major improvement of the global pregnancy rate, up to 85%* in those personalized transfers made according to the test results.
* SREI Prize Paper. O-115 Simón et al. on behalf of the ERA RCT Consortium. Prospective, randomized study of the Endometrial Receptivity Analysis (ERA) test in the infertility work-up to guide personalized embryo transfer versus fresh transfer or deferred embryo transfer.