Female Fertility Diagnosis

Ovulation Conditions

Ovulation is the release of a mature egg into the fallopian tube.  Some conditions such as PCOS, Hypothalamic Anovulation, abnormal Prolactin hormone levels, etcetera may have an effect on ovulation.  It is the quality of the eggs being ovulated that is critical.  Young women that do not ovulate regularly can usually be induced to ovulate with either oral or injectable fertility medications.

The Impact of Age on Female Reproduction

The impact of aging on female reproduction is well known. Overall, a woman’s age is one of the best predictors as to whether or not she will conceive with her own eggs. After about age 35, fertility declines sharply, this is known as age-related subfertility. That is, there is no specific fertility problem other than as we get older, the egg being ovulated may be less capable of sustaining a pregnancyAfter about age 40, the odds of pregnancy is less than 10%.

Polycystic Ovarian Syndrome PCOS

Polycystic Ovarian Syndrome or “PCOS” is a hormone condition affecting 5-10% of women. Women with PCOS have a high level of androgens, hormones made by the ovaries and adrenal glands. Common signs or symptoms of PCOS include irregular periods, obesity, excessive hair on face, chest, abdomen, or upper thighs, severe acne or adult acne, darkened skin patches in groin area, or multiple “cysts” or follicles on ovaries. No single test or symptom may diagnose PCOS. A woman must have 2 of the 3 symptoms below to be diagnosed.

  1. Increased hormone levels
  2. Irregular menstrual cycles
  3. Increased Antral Follicle Counts on ultrasound of ovaries.

Treatment for PCOS varies from birth control pills to regulate your menstrual cycle to insulin sensitizing medications to reduce the amount of androgens produced. Often a small weight loss of 10% can improve ovulation rates. Ovulation induction medications such as Clomid or Femara are often prescribed in combination with Metformin to help with ovulation. If these fail, then injectable fertility medications or outpatient surgery (Ovarian Drilling) are options.

Hypothalamic Amenorrhea

Amenorrhea is the absence of your menstrual cycle. Hypothalamic Amenorrhea is amenorrhea caused by the hypothalamus. The hypothalamus is the part of the brain connecting the nervous system to the endocrine system. If the hypothalamus is not functioning properly, the amount of FSH and LH will be decreased and menstruation will stop. Common causes of hypothalamic amenorrhea are high stress levels, extreme exercising (more than 2 hours per day), poor nutrition, or extreme calorie restriction.

Treatment for hypothalamic amenorrhea is related to lifestyle changes such as but not limited to decrease stress levels, decrease exercise intensity and time, and weight gain. When indicated ovulation inductions medications are used to help with ovulation.


Prolactin is a hormone produced by the pituitary gland. When increased prolactin can block the body’s ability to produce the hormones needed to mature an egg and ovulate. This is tested by blood. If elevated medication may be prescribed to reduce the level or if indicated an MRI may be recommended to rule out any tumor of the pituitary gland.

Ovarian Reserve: What Are My Chances of Getting Pregnant

Through a woman’s ovarian reserve, we test the woman’s reproductive potential and the chances that she will be able to conceive a healthy, viable pregnancy with her own eggs. We test for ovarian reserve with blood tests, cycle day 2-3 Folic Stimulating Hormone (FSH) and Estradiol, as well as random Anti-Mullerian Hormone (AMH) along with an ultrasound to look at the ovaries.

Fallopian Tube Testing

Infection, post-surgical scarring or the disease endometriosis can cause fallopian tubes to be blocked, kinked, or distorted. This prevents eggs and sperm from getting together and can lead to tubal (ectopic) pregnancy.

Fallopian tube status is best evaluated by a Hysterosalpingogram or HSG. The HSG is commonly referred to as the dye test as radiopaque dye is placed in the uterus and under fluoroscopy the physician is able to watch the dye flow through the tubes and spill into the abdominal cavity. If free flow is not seen, it indicates a Hydrosalpinx.

Hydrosalpinx is the collection of fluid in the fallopian tube caused by a blockage. This can be caused by an old infection in the fallopian tube, previous surgery, endometriosis, ectera. A hydrosalpingx will prevent an egg from traveling to the uterus. It may be diagnosed by a Hysterosalpingogram (HSG) or by ultrasound. Hydrosalpinx may be treated by Laparoscopy.

Uterus and Endometrial Lining

The uterus and endometrial lining are very important in becoming pregnant. This is where the pregnancy will take place and the baby develops. Evaluation for any abnormalities is important they may cause infertility or miscarriage. Common problems within the uterus and endometrial lining include polyps, fibroids, scarring from previous surgeries, uterine anomaly, or septum of the endometrium.

To evaluate the uterus and endometrial lining a transvaginal ultrasound is performed. If a polyp is suspected in the lining, the physician may request a sonohysterogram. A sonohysterogram involves passing a small tube, catheter, into the uterus and place saline into the endometrium while performing an ultrasound. Sonohysterogram will also evaluate a uterine septum and the degree of the septum.

If any abnormalities are found during evaluation, the physician will review the appropriate treatment for you. This may include Hysteroscopy, Laparoscopy, or Mini Laparotomy.

Female Genetic Testing for Infertility

Some patients carry genetic diseases that can cause infertility, such as Fragile X syndrome. Some women (and men) can have rearrangements of their chromosomes, such that their eggs and sperm can have abnormal chromosomes and this can lead to repeated miscarriage or infertility. These problems are rare but do exist.

Endometriosis Diagnosis

Endometriosis is endometrial tissue that adheres to places outside the uterus such as the ovaries, fallopian tubes, or pelvic cavity. Some women will have no symptoms of endometriosis while others may experience dysmenorrhea (pelvic pain before or during menses) or painful intercourse.

Treatment options may vary from medication for pain control and hormone therapy to surgery. Surgery is the only way to make a definitive diagnosis. Surgery would consist of a Laparoscopy to evaluate the pelvic cavity and remove as much endometriosis as possible.


Fibroids are a growth of tissue that forms in the uterus. They are benign and non-cancerous growths. Fibroids can cause irregular bleeding, heavy bleeding with longer periods, anemia, pressure, pain, and miscarriage. Treatment of fibroids will depend on symptoms, size, and location of the fibroid. Treatment may include pain management, medication therapy, or surgical removal called myomectomy.

Uterine Polyps

Polyps are a growth inside the endometrium (lining of the uterus). Polyps may cause irregular periods, heavy menstrual periods, spotting after menopause, and infertility. Diagnosis of a polyp is done by a sonohysterogram. If a polyp is found, your physician will perform a Hysteroscopy surgery to remove the polyp.


Adhesions are scar tissue that forms. Adhesions can from on the ovaries, fallopian tubes, uterus, or anywhere in the pelvic cavity. They may form after an infection or previous surgery. Adhesions may be removed by performing a Laparoscopy.

Unexplained Infertility in Women

This is the diagnosis given when all the other tests come back normal. Many couples failing to conceive after 1-2 years of trying, with all the usual tests coming up normal. There may be other diagnoses or medical conditions that we have just not come to understand yet.

Repeat Pregnancy Loss

Two or more miscarriages is defined as Repeat Pregnancy Loss. A large number of miscarriages are unexplained while a number of miscarriages are due to a chromosome or genetic disorder, uterine abnormality, or medical condition.

Chromosome abnormality is more common as the woman is older at the time of conception. The embryo receives a copy of chromosomes from the egg and a copy from the sperm. When the embryo does not get the correct number of chromosomes this can lead to miscarriage. As a female ages, the egg quality declines with a higher number of eggs being abnormal. Technology advances in invitro fertilization now offers testing on embryos by performing a biopsy on the developing embryo and sending the biopsied cells for testing called Preimplantation Genetic Screening, PGS.

Abnormalities within the uterus may also cause miscarriages. This may include uterine septum, polyp, or fibroid. These conditions can be diagnosed by performing a sonohysterogram, hysterosalpingogram, or ultrasound. If an abnormality is present, surgery can be performed to remove the septum, polyp, or fibroid.

A medical condition known as Antiphosolipid Syndrome can lead to miscarriage as well. Antiphospholipid antibodies are present and affect blood clotting. APA is tested with blood tests. If APA is detected, blood thinner such as Lovenox, is prescribed with subsequent pregnancies to thin the blood and reduce the risk of miscarriage.

Other tests include screening for thyroid and celiac disease.

If you have experienced repeat pregnancy loss and would like to explore your circumstances or further options to conceive, please call our office to schedule a consultation.