Page modified at: 26/06/2010
MANDATORY INVESTIGATIONS ON ALL COUPLES
Ultrasound Tubal Patency Test (Hycosy, Ex-Em Foam, Hysteronography)
This test is carried out in our clinic and is a screening test to check if the tubes are blocked.
A speculum is passed, as during a smear test, and a small amount of sterile foam is injected through the cervix. A series of scan images are taken, which show the outline of the uterus and, if the tubes are open, the salt water will be seen flowing through them. Phone 0845 2303386 on first working day after a period starts to book a Hycosy Tubal Patency Test between day 1-day10.
DAY 1-10
Hysterosonogram showing a normal uterine cavity and patent Fallopian Tubes
FSH and LH Blood Test
This is a blood test that checks whether there is a good reserve of eggs in the ovary and that the hormonal system leading to their release is intact. It is taken on the second day of the cycle (day 1 is the first day of a period). FSH and LH are hormones that stimulate egg development and release. High levels of LH are also found in polycystic ovary syndrome, which is a common cause of anovulatory infertility.
Day 2-6
Progesterone Blood Test
This will check if ovulation has taken place. It should be taken 7 days before a period, so for a 28-day cycle it is done on day 21. If a period doesn't come 6-8 days after the test, then it will need to be repeated. A level of 30 nmol/l or more suggests ovulation has occurred.
DAY 21
Semen Analysis
A sample of semen is needed to check the total count, whether the sperms look normal, and if they are motile. It is important to abstain from sex for a few days before the test and to ensure that the sample is transported to the lab without delay when produced. If the first test is low or borderline a second sample is requested to see if this was a one-off result - was this the best or worst? More details about abnormalities of the semen analysis will be discussed in another section.
Rubella Antibody Levels
These are checked to see that immunity is present, as this is a good time to repeat the immunisation if not rather than risk infection during pregnancy, which can cause fetal defects.
ANY TIME IN CYCLE
OTHER INVESTIGATIONS IN SPECIAL CIRCUMSTANCES
Pelvic Ultrasound Scan
We would advise this as part of the initial investigation to check that the uterus appears normal and whether the ovaries have a polycystic appearance. An internal or transvaginal scan is most accurate.
Diagnostic Laparoscopy and Dye Test
If there is a significant degree of pain with intercourse or painful periods then a laparoscopy might be suggested instead of an Ultrasound Guided Tubal Patency Test or HSG.
This involves a general anaesthetic and small telescope look through the umbilicus into the pelvis to see if there is anything causing the pain (eg. endometriosis).
At the same time some dye is injected to check the patency of the tubes. This is also done if a Tubal Patency Test or HSG suggests that there might be a problem with the tubes, as a Tubal Patency Test alone can't give all the information and the 'blockage' may just be due to spasm of the tube or inadequate pressure when injecting the dye when you are awake.
Post-coital Test
This test involves an examination of the mucus around the cervix shortly after intercourse has taken place. It is like having a smear test, and under the microscope interactions between the sperms and cervical mucus are analysed.
It is only rarely used now in the UK, as studies have found it to be poor at predicting infertility, it often gives inaccurate results and adds little to the information obtained by the above tests.
Hysteroscopy
If the Tubal Patency Test suggests that there is an abnormality of the inside of the womb, a hysteroscopy can be done for a closer look.
A fine telescope is passed through the cervix and the uterine cavity visualised. Hysteroscopy can detect fibroids or congenital variations such as a double-womb, bicornuate (heart-shaped) uterus or a uterine septum.
Thyroid function tests and Prolactin
If a woman has irregular or infrequent menstrual cycles, or shows other signs of thyroid disease then it is important to exclude this. Prolactin is a hormone that is normally involved in production of breast milk and is released from a gland in the brain called the pituitary. An overactive pituitary gland can cause abnormally high levels of prolactin (hyperprolactinaemia) which prevents ovulation. A blood test for prolactin levels should be done if cycles are infrequent or there is an unusual discharge from the breast.
ANY TIME IN CYCLE