I have a logical mind. When I encounter a problem, I seek verification. What is the root of the problem? Why? What can I do to solve this problem?
Unfortunately in the world of infertility, there seems to be no definite answer in anything which frustrates me until my hair falls out. A long standing battle with infertility and puzzling results had me asking tons of questions, how do I know where our real reason behind poor embryo quality lies? Sperm or egg?
I found myself offered a lot of tests and I had no idea what it all meant or what I should expect. So I've put together this page of all the tests/procedures I've done, what my test results mean, and what to expect when getting the test done.
AFC (Antral Follicle Count)
How:
This test is done by transvaginal ultrasound on your CD3. Great site explaining everything about AFC: http://www.advancedfertility.com/antralfollicles.htm
My AFC: 8
With this number, OFC had me categorized as a low responder, which later after getting my AMH tested, found out this is not so. Plus, I had responded well to stim during IVF 1 and 2.
AMH (Anti-Mullarian Hormone)
How:
This test is a simple blood test.
What:
This is an important one, I think! I did not have this done until after my second failed IVF. I was originally at OFC and this was not offered to me, only the AFC test was. Basically, AMH is a test that tells you your ovarian reserve. This is not indicative of the quality of your eggs, only how much left.
This can be done any day of your cycle, gives you information when ultrasounds can sometimes be unclear. However, it is not covered by provincial insurance in Canada. Cost me about $75. It also took like a month for the results to come back!
- AMH is can be measured with two different units of measurements, so know which your results are listed as! They are: pmol/L and ng/mL.
- To convert from ng/L to pmol/L, multiply ng/mL by 7.14 to get pmol/L
There are many versions of what is good/acceptable/low by different clinics. Talk to your RE about it. Here's a link that has a chart of what's good/low: http://www.drmalpani.com/amh.htm
Yet, here is another link showing AMH>1 ng/mL to be acceptable: http://www.fertileheart.com/does-a-low-amh-level-indicate-infertility/
My AMH:
May 2012 - 14.67 pmol/L (2.05 ng/mL)
July 2012 - 16.42 (2.3ng/mL)
I had it done twice, once at Mount Sinai, once at Hannam Fertility. I was told that with this AMH level, I did not need such high doses of stim as I had in IVF 1 and 2.
Sonohysterogram(Salin Infusion)
Not to be confused with HSG (hysterosalpingogram)
How:
Done with ultrasound and saline solution that goes into your uterus. Basically, the first part is like a pap. A speculum is inserted, then something called a ballon (this caused me some cramping), then the catheter is inserted, and the ultrasound stick! It's all pretty fast, about 5-10 mins. Was told to take 2 Advils an hour before, and prescribed antibiotics just in case. Was it painful? I wouldn't say PAINFUL, but uncomfortable and definitely very crampy.
What:
A procedure to test to see if your tubes are open and to asses your uterus (shape, polyps, etc...)
Never had an HSG but was told that the sono is much less painful! I was told that this is less accurate compared to the HSG to test if tubes are open. Yes it is uncomfortable/very crampy.
My results:
Had it done twice with the same results, showed both tubes blocked, no abnormalities in the uterus.
Not surprised at my results although after my lap for the cysts, I was told that one tube is open. However, it's not uncommon for adhesions and scar tissues to set in after surgeries. One thing I've heard about Sonos or HSGs is that it's not 100% accurate, and sometimes people get pregnant after they've had one done! So if you've just had one, go have some sex... NOW! You never know!
Sperm DNA Fragmentation (For the boys, duh)
How:
This test is just like a regular semen analysis but results may take a lot longer to get back to your doctor. It took us about a month.
What:
We were offered this test after our second epic failure with no fertilization. We were told that if sperm have a high percentage of fragmentation, fertilization/normal embryo growth will be difficult. There are a variety of reasons for high fragmentation, varicocele, infection, smoking, age... This is a good general info about sperm DNA fragmentation: here.
- Below 15%: Excellent fertility potential
- Between 15%-30%: Good fertility potential
- Above 30%: Fair to poor fertility potential
DH's results:
22%
I was not sure what to do with this number. It's an inbetween number, kind of towards the high side of normal, but not bad. We were hoping to find something here that we could fix and move on to a great cycle because now we've pin pointed the issue. But of course, life is an ass.
Other tests/procedures I've done that I have not written about yet: (but will in the future)
- Laparoscopy
- Karotyping
- Endometrial biopsy
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