Infertility testing, AMH and FSH meaning for IVF

Male infertility assessment begins with a sperm analysis. A sperm analysis indicates many parameters of the sperm sample that relate to sperm viability and the capacity of sperm to fertilize the eggs. While a semen analysis is the most important starting point of male testing, it should be known that a semen analysis cannot possibly reveal everything about the possible causes of male infertility. Sometimes, advanced male testing will be necessary to understand the underlying causes of male infertility. Nevertheless, semen analysis is still a very good starting point. Before having your sperm sample tested, it will be important to have abstinence of 3 to 5 days so that the sperm sample is in its optimal condition. Shorter or longer abstinence periods can negatively affect sperm motility and count, respectively. A sperm analysis shows important parameters regarding sperm quality such as:

Sperm volume: The total volume of the ejaculate in mililiter.

Sperm count / concentration: The number of sperm cells in the ejaculate per mililiter.

Sperm motility: The percentage of sperm cells that are motile/mobile.

Sperm morphology: The percentage of sperm cells that have normal/expected sperm morphology

pH level: Measures acidity/alkalinity of the sperm sample

Round cell count: Elevated round cell count may indicate an active infection. 

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These parameters provide us with important information regarding the viability of sperm during 

First of all, before any treatment can be planned or any recommendations can be made, we will be asking you to undergo the female and male infertility testing described above. Female infertility tests are the basic method of screening which will help us make an assessment of your ovarian function and predict your expected response to the medication which we will use during your IVF treatment. Male semen testing gives us a very good idea about the viability of the sperm sample for fertilization. 

During a normal menstrual cycle, the blood flow marks the beginning of follicle (egg) development. During this stage, the follicles are still very small, and they require Follicle Stimulating Hormone (FSH) in order to grow. This FSH hormone is released by the pituitary gland in your brain. In a natural menstrual cycle, there is only enough FSH release to recruit one follicle for ovulation. During an IVF cycle, we hope to obtain more than one egg so that we can offer you a higher chance of success. Therefore, we prescribe FSH medication externally in greater amounts so that more follicles are recruited for ovulation. This is the reason behind using medication during an IVF cycle. We simply mimic what your body does in a natural cycle, but we do it in a slightly higher doses so that we can multiple eggs, and therefore, multiple embryos.

The precise dosage of medication and the precise protocol will depend on your test results, because these test results will indicate to us what the naturally occuring level of hormones are. Based on these hormone levels, we will be able to design your treatment protocol. 

Female Infertility Testing

fertility treatments. If sperm analysis indicates a value below reference values, then the parameter in question is further investigated and if problem is not too severe, ICSI or microchip sperm selection methods are usually very effective in resolving the problem. If the male patient is diagnosed with azoospermia, then surgical sperm extraction methods can be employed to surgically search for sperm cells. For more information about male related infertility problems, please visit our "Male Infertility" section.

  • Hormone testing on day 2 or day 3 of the menstrual period for ovarian and reproductive assessment. These tests include FSH, LH, Estradiol, Prolactin, TSH and AMH hormone tests.
  • A baseline ultrasound scan, again, on day 2 or day 3 of menstrual period. An investigation into the uterus, cervix and the ovaries will be necessary to make sure that there are no visible problems that can interfere with a successful pregnancy.
  • If the patient has had previous IVF failures, then further investigations will be needed such as certain transferrable disease tests, infections, genetic testing and more advanced screening techniques.
  • If the patient has had recurrent miscarriages, then further genetic testing as well as thrombophilia testing will need to be administered for starter.

Why Do I need to get tested before an IVF Treatment?

Infertility: Causes and Investigation

Repeated IVF Failures

One of the most disappointing and frustrating experiences a couple can go through is an IVF failure. An IVF treatment is both an emotional and a financial investment and when it fails, it is not only hard on finances, but it takes a toll on emotions. Even though it is an undesirable outcome, it is something that does happen. However, on the positive side, a negative IVF outcome can possibly give us much more information about a couple's infertility problems. Standard test results mentioned above will give us a fairly good idea, but observing actual fertilization process in the lab and observing embryo development will give us a lot of insights which won't be possible to see via standard testing. In a way, we see a failed IVF cycle as a "lesson learned" in terms of how the patient responds to medication, how the eggs fertilize, how the embryos develop and many more parameters.

Patients who have had a number of failed IVF cycles will be asked to undergo additional testing such as "karyotype analysis" so that we can find out about any possible chromosomal problems which might be causing the IVF failures. Chromosome translocations are such problems often observed. A reciprocal translocation between two chromosomes may not exhibit any phenotypical problems on the patient, but may affect his/her reproductive capacity. Besides chromosome analysis, "thrombophilia testing" will also be important. When the female patient has a thrombophilic defect, she experiences blood clotting, which can possibly lead to implantation failures and/or miscarriages.

In some cases, the problem is neither the genetics, nor the embryos- It is the uterine conditions. With some patients, the endometrial thickness does not offer optimal conditions for an embryo transfer. The lining might be too thin or it might not have the right structure. In such cases, Assoc. Prof. Dr. Savas Ozyigit offers a number of solutions including protocols with viagra, neupogen wash and neupogen injections as well as intralipid infusion. 

Neupogen is a synthetically derived form of G-CSF (granulocyte colony stimulating factor) which is a chemical messenger which normally exists in the body in certain amounts. and neupogen (filgrastim) is a synthetic (recombinant) form of G-CSF. Healthy and viable embryos have shown to express higher levels of G-CSF compared to poor quality embryos and the same has been found in healthy placenta. This finding has lead researchers and clinicians to conclude that since higher levels of G-CSF is associated with higher quality embryos, higher embryo survival and better pregnancy rates, supplementation of this chemical during pregnancy can influence success rates with patients who have a history of failed IVF cycles.

Several clinical studies with neupogen have shown that supplementatin of neupogen as an endometrial cavity wash and a sub-Q injection has improved endometrial lining thickness during IVF cycles. Similar studies have shown that it was not only the endometrial lining which improved during neupogen use, but also patients with repeated IVF failures have been observed to have a dramatically higher rates of success while on neupogen.

Our own experience with neupogen has also been similar over the past few months that we have started using it, therefore, we do recommend and use it with patients in older age brackets or patients with unexplained IVF failures.

A failed IVF cycle is as important as your test results and previous screening. It tells a lot about what may have gone wrong. Therefore, even though it is a disappointing experience, it could be turned into an advantage by drawing lessons from it. Based on your assessment, our clinical team will offer you modifications on your IVF protocol and will consider the use of some out of the box "Innovations in IVF Treatments". 

Infertility refers to inability to conceive or maintain a pregnancy even when couples have regular unprotected sexual intercourse. The usual agreed upon definition of infertility uses one year as a reference. Therefore, if a couple has regular intercourse without using any protection for a year and is unable to achieve a pregnancy, then it will be a good idea to see a fertility specialist and undergo a few tests for fertility assessment. For patients older than 35, the waiting period is usually shorter. Rather than waiting for one year, a couple where the female partner is older than 35, fertility testing will be in order if they cannot achieve a pregnancy within six months of trying. The reason is, patients older than 35 years of age are more likely to have reduced levels of fertility. Therefore, the longer they wait, the more difficult it might become to parent a biological child. 

Both male and the female patients need to undergo investigation in order to understand what the underlying problem might be. In some cases, none of the partners may seem to have an obvious problem but they may still need the help of assisted reproductive technologies as conception via natural methods does not occur.  Depending on the ages of patients and their test results, our team will identify the right method of treatment and prepare a customized treatment protocol for each couple. 

Below you will find information about the initial tests and screening we ask our patients to have when they have not been through any infertility testing and/or fertility treatments. If a couple has already been through infertility testing and/or fertility treatments, then based on previous test results and previous treatment outcomes, further investigation will be performed. However, advanced investigation will be diferent for different people. For instance, a patient who has had 4 IVF failures and a patient who has had 4 positive outcomes but experienced miscarriages will be subjected to different tests and screening. Please do not forget that one prescription does not fit all and we are only trying to give you some general ideas about infertility and testing. 

Male infertility testing and treatment for azoospermia

Male Infertility Testing

Our “Female Infertility” section discusses in length the possible causes of female infertility. Briefly, these are ovarian factors, uterine factors, tubal factors and cervical factors of infertility. Ovarian factors refer to inability of producing viable egg cells for natural conception while tubal factors form a barrier between the egg and the sperm. Uterine and cervical factors have to do with implantation and maintenance of pregnancy. Each of these factors should be evaluated before making an informed decision as to how to proceed with treatment. The first round of testing for female patients include the following:

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