Female Infertility Evaluation

Female issues are the cause in approximately 1/3 of couples who are unable to get pregnant. When evaluating the causes of female infertility, The Fertility Center of Charleston focuses on three separate factors: The ability to make eggs (ovarian reserve), the uterine condition, and the condition of the fallopian tubes.

Ovarian reserve is the term used to describe the ability to make eggs. The ovarian reserve can be assessed through evaluation of the patient’s age, ultrasound of the ovaries and blood tests to determine hormone levels. Age is the most important factor affecting the ovarian reserve. No eggs are created after a woman is born and unfortunately the number of eggs within the ovaries decreases with age. The quality of the eggs within the ovary also decreases with age meaning that those eggs that are present are less capable of creating a pregnancy as the woman ages. Therefore, as a woman ages she has fewer quality eggs available with which to make a baby.

Ultrasound can be used to visualize the size of the ovaries and the number of fluid filled pockets within the ovaries (follicles) capable of creating eggs. This evaluation is referred to as an antral follicle count. A reassuring ultrasound will reveal an ovary that is robust in size and holds multiple capable follicles.
Finally, blood can be drawn to assess hormone levels predictive of egg making ability. Two of the most important hormone predictors of ovarian reserve are follicle stimulating hormone (FSH) and antimullerian hormone (AMH). Follicle stimulating hormone is created by the brain to stimulate follicle development to create eggs. Antimullerian hormone is created by the cells that make up the follicles where the eggs are created. These hormone levels help to predict a woman’s ability to create eggs and therefore her ability to get pregnant.

At The Fertility Center of Charleston, our team will assist you in coordinating the testing necessary to determine your ovarian reserve.

The uterus is important with regard to the ability of the embryo to implant and continue to grow. It is evaluated through ultrasound and hysterosalpingogram (HSG) studies. The ultrasound allows for visualization of the uterine wall and the basic lining of the cavity which will support implantation. Abnormalities such as fibroid tumors can be seen on ultrasound examination. The hysterosalpingogram study (HSG) is a fluoroscopic x-ray that allows for the cavity to be filled with a contrast fluid so that we can determine the normal shape of the uterine cavity. In some cases, further evaluation of the uterine cavity is recommended using a saline sonohysterogram (HSSG). This test is a transvaginal ultrasound during which salt water is placed into the uterine cavity to allow for better and more sensitive evaluation of the uterine cavity as needed.

In most cases a basic ultrasound will be conducted for visualization of the uterus at your initial visit to The Fertility Center of Charleston. Your nurse will assist you in scheduling an HSG or HSSG, as needed, on days 6 -9 of your menstrual cycle.

Finally, the fallopian tubes are the route by which the sperm and the egg come together to create your baby. To conceive naturally or through the use of intrauterine insemination, the fallopian tubes must be open. The fallopian tubes are also evaluated with the hysterosalpingogram (HSG) procedure. The contrast which is placed into the uterine cavity will hopefully enter, travel through and exit each tube proving that the fallopian tubes are open and capable of allowing for fertilization of the egg by the sperm. Again, your nurse at The Fertility Center of Charleston, will assist you in scheduling an HSG, as needed, on days 6-9 of your menstrual cycle.