Investigations for the woman

There are many reasons why a woman may have difficulty getting pregnant naturally. A variety of investigations may be required in order to determine the reason for her fertility difficulties.

This section provides information on the various tests used to diagnose female subfertility at Waterstone Clinic.

The following tests will be recommended to you when you book your appointment with Waterstone Clinic.

It is not essential that these are carried out prior to your consultation and if you prefer we can carry out these tests for you at the clinic.

  1. Blood tests for hormone levels will need to be taken on day 2, 3, or 4 of the menstrual cycle. These bloods will test levels of:
    • FSH
    • LH
    • Prolactin
    • Oestradiol
    • T4 & TSH
  2. Anti-Mullerian Hormone level (AMH) taken on any day of the menstrual cycle to measure ovarian reserve (number of remaining eggs)
  3. A blood test for progesterone in the mid-luteal stage of the menstrual cycle (7 days before your next period, i.e. day 21 of a 28 day cycle)
  4. Rubella immunity
  5. An up-to-date cervical smear test result.

A transvaginal ultrasound scan has a central role in fertility investigations and treatment. It is an internal scan performed using a slim ultrasound probe that is inserted into the vagina, allowing a clear view of the uterus and ovaries. It is used to detect abnormalities such as ovarian cysts and uterine fibroids. During fertility treatments a transvaginal ultrasound scan is used to monitor the growth of follicles on the ovaries and the thickness of the uterine lining (endometrium).

Laparoscopy and dye is a minor surgical procedure performed under general anaesthetic. A thin camera is inserted through a 1cm incision in the belly button which allows the doctor to inspect the health of the pelvis- in particular the presence of endometriosis, adhesions or ovarian cysts. During the procedure a dye is passed through the uterus to check for blockages in the Fallopian tubes.

A hysterosalpingogram (HSG) is used to assess the uterus and Fallopian tubes, in particular whether the Fallopian tubes are open. While a dye is injected through the cervix an Xray is taken as it passes through the uterus and Fallopian tubes. The X-ray may detect abnormalities of the uterine cavity or a blockage in the Fallopian tubes.

Blood tests are needed to investigate if the levels of certain hormones in your body are within normal ranges. These have to be taken on specific days of your menstrual cycle.

Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) are released by the pituitary gland in the brain at various stages throughout the menstrual cycle.

FSH stimulates follicular (egg) development in the Ovary. High FSH levels may indicate that the number of eggs within your ovaries is decreasing.

LH is responsible for triggering the release of the developed egg from the ovary. High LH levels may be an indication of Polycystic Ovary Syndrome (PCOS).

Blood tests for FSH and LH should only be taken on days 2, 3, or 4 of the menstrual cycle.

What is AMH?

Anti Mullerian Hormone (AMH) is a blood test for quantifying ovarian reserve. Blood levels of AMH can indicate the number of immature follicles in the ovary. Low levels of AMH in the blood can suggest poor ovarian reserve and declining fertility. AMH is produced by granulosa (follicular) cells in the ovary. These cells play a role in the development of follicles and the maturation of eggs, during a woman’s reproductive years.

The blood test for AMH can be carried out on any day of the cycle (as opposed to FSH which must be measured on cycle day 3). Levels do not fluctuate from one cycle to another, making AMH a more reliable measure of ovarian reserve than FSH.

Where can patients avail of the test?

AMH testing is available at our clinics in Cork, Dublin, Limerick and Waterford.

When are the results available?

Results are available within seven working days.

What is the cost?

Patients can avail of the test at our clinics at a cost of €120. Alternatively, patients can purchase the AMH kit from our clinic by contacting a patient liaison coordinator and the kits will be posted directly to them. The cost is €100.

Progesterone levels usually increase after an egg has been released by the ovary. Blood tests for progesterone levels need to be taken on day 21 of the menstrual cycle (one week before your next period is due). Satisfactory progesterone levels indicate normal ovulation.

High levels of prolactin can cause infertility by preventing the release of FSH and LH.

T4 and TSH levels should also be checked as suboptimal thyroid function can impact on ability to conceive.

Prior to appointments patients must be screened for:

  • Rubella and chicken pox
  • Hepatitis B surface antigen
  • Hepatitis B core antibodies
  • Hepatitis C
  • HIV
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