Category Archives: Female Infertility

Luteinizing Hormone and LH Testing

The source of luteinizing hormone is pituitary gland. The purpose of a luteinizing hormone test is to measure the quantity of luteinizing hormone (LH) that is available in a sample of blood or urine. The functions of women’s LH are to help the menstrual cycle’s and egg production’s (ovulation’s regulation. The LH found in a womans body can vary according to the menstrual cycle’s phase. Before ovulation the quantity of LH increases suddenly, it may happen on the 14th day of a 28-day cycle. This process is called a LH increase. During the monthly menstrual cycle luteinizing hormone and follicle-stimulating hormone levels become higher or lower. The purpose of men’s LH is the stimulation of the testosterone’s production. Testosterone is responsible for sperm production.

The purpose of a luteinizing hormone (LH) test is:
1) To find out why a couple is unable to get pregnant (the medical term is infertility). During this testing a womans egg quantity (ovarian reserve) and a mans sperm availability are examined.
2) To evaluate menstrual problems, such as irregular or absent menstrual periods (amenorrhea).  It is done to find out whether the woman has had menopause.
3) To find out whether a child is now at the process of early puberty or precocious puberty. Puberty is considered to be early when it begins in girls at the age younger than 9 and in boys at the age younger than 10.
4) To find out why there is no proper development of sexual features or organs. The medical term for it is delayed puberty.
5) To find out using a urine sample the time of a woman’s ovulation. Home urine tests for ovulation can also be held.
6) To monitor a womans reaction to medicines which have been taken inside for ovulation’s stimulation.

It is recommended to follow the next recommendations before LH testing:
1) You should stop consuming medicines that have estrogen or progesterone in its content (among such medicines there are birth control pills) within 4 weeks before having a luteinizing hormone (LH) test.
Many medicines, among them there are cimetidine, clomiphene, digitalis, and levodopa have an ability to influence the test’s results. You should supply your doctor with information about all medicines, herbs and natural substances being taken by you.
2) Inform your doctor about a test conducted with a radioactive substance (tracer) you have been passed though within the last 7 days. If you have passed a thyroid scan or bone scan tests with a radioactive tracer recently, these tests can influence LH test results.
3) Inform your doctor about the first day of your last menstrual period. If you observe that your bleeding pattern is light or starts with spotting, the first day is considered to be the day of heaviest bleeding.
4) Ask your doctor about everything you are interested in: the necessity of the test, its risks, its procedure and possible results.
The purpose of a luteinizing hormone test is to measure the quantity of luteinizing hormone (LH) that is available in a sample of blood or urine.

The factors that influence LH levels are a persons age, sexual development’s stage and the phase of her menstrual cycle. The purpose of urine test is to define whether a woman is ovulating and to observe the presence (positive result) or absence (negative result) of LH.

Pelvic Examination

A complete physical examination of a woman’s pelvic organs by a health professional is called Pelvic Examination. This kind of analysis helps the doctors to evaluate the size and the location of the vagina, cervix, uterus, ovaries and fallopian tubes. This kind of examination is conducted in order to help detect some certain cancers in their early stages, infections, sexually transmitted diseases and other problems of the reproductive system of a woman. Pelvic examination is considered to be an important part of preventive health care for every adult woman.

Why Pelvic Examination is Conducted
A pelvic exam may be necessary to conduct in the following cases:
–  It may be a part of a woman’s regular physical checkup. It is also possible to conduct a Pap smear during the pelvic examination;
–  It may also be conducted in order to detect different kinds of vaginal infections, such as bacterial vaginosis or yeast infection;
– This kind of examination helps to detect the majority of sexually transmitted disease;
– It also helps to determine the reason of abdominal uterine bleeding;
– Such abnormalities of pelvic organs, like uterine fibroids, ovarian cysts, uterine prolapse, etc. may be diagnosed with the help of a pelvic examination;
– The reason of abdominal or pelvic pain may also be determined with the help of this test;

How to Prepare to Pelvic Examination
Before a pelvic examination is conducted, you should:
– Schedule the examination when you are not having your menstrual period, because blood can interfere with the receiving the results of a Pap smear. Anyway, in case if you have a new vaginal discharge or new increasing pelvic pain, this kind of examination may be necessary to conduct during the menstrual period.
– You may not use douches, vaginal medications, tampons or vaginal sprays and / or powders for at least a day before your pelvic examination;
– In case if you have an abnormal discharge, you may not have sexual contacts for 24 hours before your pelvic examination, as any amount of semen in your vagina may interfere with the results of the examination.
 
As soon as you came into your doctor’s office, you are to inform him if:
– You have any reproductive or urinary tract symptoms, like redness, sores, itching, swelling or some unusual odor or increased vaginal discharge. In case if you have  been performing pelvic examination in a regular manner, you should discuss the least changes, you notice, with your doctor;
– You are or you might be pregnant;
– This pelvic examination is the first one in your life;
– This day is the first day of your last menstrual period;
– If you have undergone a surgery of any other procedure, like radiation therapy, etc. to the vagina, cervix and / or uterus.

Progesterone

Progesterone is a female hormone produced by the ovaries during release of a mature egg from an ovary (ovulation). The purpose of a progesterone test is to measure the quantity of the hormone progesterone in a blood sample. The purpose of such hormone as progesterone is to fertilize egg implant. It prepares the lining of the uterus (endometrium) to receive the egg as soon as it gets fertilized by a sperm. If the egg is not fertilized, progesterone levels decrease and menstrual bleeding starts.
During pregnancy, it is observed that the placenta also produces high levels of progesterone. Progesterone begins its production at the end of the first trimester and lasts to the delivery of the baby. Levels of progesterone in a pregnant woman are observed to be about 10 times higher than in an impregnate woman. The possible causes for abnormal progesterone levels in men and women are certain types of cancer.

The purpose of a progesterone test is:
1) To find out why infertility occurs.
2) To control the effectiveness of medications taken for infertility or the effectiveness of treatment where progesterone is used.
3) To find out the cause of ovulation.
4) To find out if there is any possibility of miscarriage.
5) To control the function of the ovaries and placenta during pregnancy.
6) To diagnose problems connected with the adrenal glands and some types of cancer.

Before having a progesterone test you should do the following things:
1) You should give up consuming medications (among them there are birth control pills) that contain estrogen or progesterone for a period to 4 weeks before having a progesterone test.
2) Inform your doctor if you have had a test conducted with a radioactive substance (tracer) within the last 7 days. If you have recently passed tests such as a thyroid scan or bone scan conducted with a radioactive tracer, they can influence with the test results.
3) Inform your doctor about the first day of your last menstrual period.
If you observe that your bleeding pattern is light or starts with spotting, the first day is considered to be the day of heaviest bleeding.
4) You should consult your doctor if you have any concerns about the necessity of the test, its possible risks, its procedure and possible results. You are recommended to fill out the medical test.

The procedure of a progesterone test is conducted in such an order:
1) The first thing you should do is to wrap an elastic band around your upper arm to prevent the further flow of blood.
2) Wrapping an arm leads to the liger size of the veins below the band, that’s why it is better to insert a needle into the vein.
3) Disinfect the sharp side of needle with alcohol.
4) Insert the needle into the vein. It is recommended to have more than one needle stick. Then you should put a tube to the needle to fill it with blood.
5) As soon as the process of blood collection is over, you should take away the band from your arm.
6) As soon as you take away the needle, put a gauze pad or cotton ball over the needle site.
7) Then you should use pressure to the site and then a bandage. 8) Women with problems with her menstrual cycle and those who are unable to get pregnant, it is recommended to have more than one blood sample for progesterone testing that are necessary for the identification of the problem. It is advised to take a sample every day during some days.

When the doctor insert a needle, it can be hardly noticeable or you may feel a brief sting or pinch at the moment of the needle’s pinching the skin. A stinging pain at the moment of the needle being in the vein can be available among some people. No pain or little discomfort is the most common things when the needle is inserted in the vein.

Prolactin Testing

The purpose of prolactin is to define the cause of infertility in women. The purpose of prolactin test is to measure the level of the hormone prolactin, that is produced by the pituitary gland in your blood.
High levels of prolactin are observed among pregnant women, who prepare their breasts for the production of milk. During pregnancy, prolactin levels can vary and become higher by 10 to 20 times. After the delivery, prolactin maintains the mothers milk production (lactation). Women, who do not breast-feed their babies, observe that their prolactin levels become normal after the delivery of a child. Breast-feeding leads to the higher level of prolactin. Prolactin levels may become again normal some months of breast-feeding afterwards and be the same as normal nonpregnant or non–breast-feeding levels.

Prolactin is produced by the pituitary glands of men and a woman who is not pregnant, its function is not clear. Prolactin levels can change within the day. They are the highest while people sleep and soon after their sleep. Its levels can become higher while people are under physical or emotional stress and while they are sleeping. Some medications lead to higher level of prolactin. Tumors of the pituitary gland are also able to more intensive prolactin production. It should be kept in mind, that a damaged pituitary gland losses its ability to produce required quantity of prolactin.

The purpose of prolactin test is:
1) To get to know why an abnormal nipple discharge and such problem as infertility in a woman appears, why  menstrual periods is not observed (the medical term is amenorrhea),
2) When a pituitary gland problem in a man appears.
3) For the evaluation of a mans sexual desire or why he is unable to have an erection (erectile dysfunction), especially it should be done if his testosterone levels are very low.
4) To find out whether a big quantity of of prolactin is produced by a tumor in the pituitary gland (the medical term is a prolactinoma).

Before having a prolactin test the following recommendations are given: 
You should not eat or drink a few hours according to the advice of your doctor before having a prolactin test. A blood prolactin test should be done about 3 hours after your sleep; the recommended time is between 8 a.m. and 10 a.m.
Elevated prolactin levels can be observed after the influence of emotional stress or strenuous exercise. Before the test it is recommended to rest during the period to 30 minutes. Prolactin levels can become higher when you stimulate the nipples. It is forbidden to stimulate the nipples during a period of 24 hours just before the test. Women, who observe abnormal nipple discharge, should avoid eliciting the discharge just before the test.

The procedure of prolactin blood test should be done in such order:
1) The first thing you should do is to wrap an elastic band around your upper arm to prevent the further flow of blood.
) Wrapping an arm leads to the liger size of the veins below the band, that’s why it is better to insert a needle into the vein.
3) Disinfect the sharp side of needle with alcohol.
4) Insert the needle into the vein. It is recommended to have more than one needle stick. Then you should put a tube to the needle to fill it with blood.
5) As soon as the process of blood collection is over, you should take away the band from your arm.
6) As soon as you take away the needle, put a gauze pad or cotton ball over the needle site.
7) Then you should use pressure to the site and then a bandage.

When the doctor insert a needle, it can be hardly noticeable or you may feel a brief sting or pinch at the moment of the needle’s pinching the skin. A stinging pain at the moment of the needle being in the vein can be available among some people. No pain or little discomfort is the most common things when the needle is inserted in the vein. If your doctor is skilled and experienced, you feel little or no pain. Other factors that influence the reaction to pain are the condition of your veins and your sensitivity to pain.

Rectovaginal Examination

In order to conduct this kind of examination, your doctor will have to insert one finger into your rectum and the other one – into your vagina. This will let him evaluate your ovaries, fallopian tubes and uterus shape, size and location. This kind of examination is not always conducted as part of a pelvic […]

Ultrasound for Infertility

Ultrasound is applied when there is a necessity of a nonsurgical observation of a womans pelvic organs conducted during various infertility tests and procedures. During ultrasound observation high-frequency sound waves observe body organs and tissues at different speeds. Then the reflected waves return to a detector where they are transformed into pictures. To evaluate the condition and to prescribe necessary treatment the probe (transducer) is used. The place of the probe’s location is within the vagina (it is known in the medicine as transvaginal).

The evaluation of the inner side of uterus is performed through the hysterosonogram (it is also known as endometrial cavity) by filling the uterus with fluid during a test conducted with a transvaginal ultrasound. This procedure is called a sonohysterogram.

Ovarian follicle development is observed with ultrasound. The procedure is used for information concerning the number, size of developing follicles and the reaction of the uterine lining (endometrium) to follicle growth. Transvaginal ultrasound has more advantages comparing with transabdominal ultrasound because it can monitor follicle growth, count the follicles’ amount and evaluate the thickness and the uterine lining’s growth.
Ultrasound is a quick, vaginally invasive procedure that causes no pain and demands no special dietary preparations. An outpatient basis is necessary for the conduction of ultrasound procedure. The results should be interpreted by a radiologist or a gynecologist. During a test that longs 20 minutes you should empty your bladder.

The transvaginal ultrasound is used to:
1) Evaluate the state of the external structures of the uterus, fallopian tubes, and ovaries.
2) Monitor the development of follicles in the ovary that leads to ovulation.
3) Evaluate the condition of the uterus and uterine lining.
4) Insert a needle for the removal of eggs used in reproductive techniques.
5) Count how many egg follicles are available in the ovaries. The treatment’s effectiveness is influenced with egg follicles’ quantity in the ovaries, the patient’s age and blood tests.
Ultrasound and reproductive techniques can find out how ultrasound and laparoscopy differ from each other.

The results of ultrasound may be either normal or abnormal.
The results of ultrasound are considered to be normal when the size and shape of uterus, fallopian tubes, and ovaries are in a normal condition. They are also normal when no growths, scar tissue or injury site (known as abnormal attachments to the wall of the abdomen) are observed. The amount of follicles and their development are also normal results.

The results of ultrasound are considered to be abnormal when such problems are observed as:
1) Extremely thick or deformed uterine lining.
2) Defects in the structure or enlarged uterus.
3) Uterine fibroids or ovarian cysts available in the organs.
4) The fallopian tubes are not in a normal condition, it is known as hydrosalpinx.
5) There are some available egg follicles in the ovaries.
Ultrasound cannot monitor small tumors, scars and internal structures, such as a dividing tissue growth (septum) within the uterus.

Urine Test

There are certain recommendations for urine collection:
1) You should begin the urine collection in the morning. When you get up, you should not collect your first urine. You should only write down the time of your urination to fix the collection period that will start during 24 hours.
2) The next day you should save all your urine. To the purpose you will be given a large container that is able to contain about 1 gal and some small preservatives. You should at first urinate into a smaller, clean container and then pour the urine into the large container. You are forbidden to touch the inner sides of the container with your fingers.
3) You should put the large container in the refrigerator while you have been collecting urine.
4) Before the end of the 24-hour period’s collection you should save your urine for the final time. Pour the urine you have collected for the last time in the large container and fix the time.
5) The urine sample should not contain toilet paper, pubic hair, stool (feces), menstrual blood or other foreign things.

Urine Test for Ovulation
A sample of your first urine of the morning is required to find out if you are ovulating. You should follow the next recommendations if you are conducting home ovulation testing on a urine sample.
1) You should collect about 4 Tbsp of urine’s stream into the collection container.
2) You are forbidden to put the rim of the container to your genital area, and you should avoid toilet paper, pubic hair, stool (feces), menstrual blood, or other foreign things getting in the urine sample.
3) The procedure of urination should be held in the toilet.
4) You may be provided with a plastic test strip to hold in the urine stream. The test strip contains a color indicator that can signalize about the availability of luteinizing hormone (LH).

The procedure of urine collection does not lead to any discomfort. There are no complications connected with urine tests. It is quite safe.

Treatment Overview

• Fertility medication which stimulates the ovaries to "ripen" and release eggs (e.g. clomifene citrate, which stimulates ovulation)
• Surgery to restore patency of obstructed fallopian tubes (tuboplasty)
• Donor insemination which involves the woman being artificially inseminated with donor sperm.
• In vitro fertilization (IVF) in which eggs are removed from the woman, fertilized and then placed in the womans uterus, bypassing the fallopian tubes. Differences of IVF include: 
   – Use of donor eggs and/or sperm in IVF. It happens when a couples eggs and/or sperm are unusable, or to avoid passing on a genetic disease.
   – Intracytoplasmic sperm injection (ICSI) in which a single sperm is injected directly into an egg; the fertilized egg is then placed in the womans uterus as in IVF.
   – Zygote intrafallopian transfer (ZIFT) in which eggs are removed from the woman, fertilized and then placed in the womans fallopian tubes rather than the uterus.
   – Gamete intrafallopian transfer (GIFT) in which eggs are removed from the woman, and placed in one of the fallopian tubes, along with the mans sperm. It allows fertilization to take place inside the womans body.
• Other assisted reproductive technology (ART): 
   – Assisted hatching
   – Fertility preservation
   – Freezing (cryopreservation) of sperm, eggs, & reproductive tissue
   – Frozen embryo transfer (FET)
• Alternative and complimentary treatments 
   – Acupuncture Recent controlled trials published in Fertility and Sterility has shown acupuncture to increase the success rate of IVF by as much as 60%. Acupuncture was also proven to be effective in the treatment of female an ovular infertility, World Health Organization, Acupuncture: Review and Analysis of Reports on Controlled Trials (2002).
   – Diet and supplements
   – Healthy lifestyle

Clomiphene citrate (CC)
CC is a drug that induces ovulation and is used as a frontline fertility treatment for both anovulatory and ovulatory women. It can be harmful to the cervical mucus, however, and should be combined with intrauterine insemination (IUI) so as to maximize the chances for conception.
The usual initial dose is 50 mg per day from days 3-5 through days 7-9 of the womans menstrual cycle. All patients should use an LH kit and time their intercourse to make best use of the chances of conception. This kit augurs when ovulation will occur based on the level of LH in the womans urine.
If ovulation occurs as a result of CC treatment, the 50 mg/day regimen should be maintained for 3 to 4 cycles.
If ovulation doesnt occur, the dose can be increased by 50 mg increments.
If even as much as 150 mg per day doesnt induce ovulation, then a transvaginal ultrasound should be performed to allow the physician to get a close-up view of the development of the follicle (the follicle is a cluster of cells in the ovary that change in color and shape during the different phases of the menstrual cycle).