OK, so you have been to your infertility doctor. You hear…..blah, blah, blah…… Then you met with the nurse who also said…….blah, blah, blah. What you missed in the blah’s was your pretesting work up. What is included in the work up and what do the results mean?
First off we want to make sure that you are "healthy" to proceed with infertility treatment. We want you to have a normal PAP smear within two year. You should also have had a physical exam within that same two year. We want to make sure that you are immune to rubella (German measles) and varicella (chicken pox). If you are not, we will ask that you either get immunized or sign a waiver stating that you understand the risks and complications that are associated with contracting those diseases while you are pregnant. We will also check a CBC (complete blood count) to make sure that you have nothing "brewing". Your doctor may have also ordered some pre-conceptional genetic tests (e.g. sickle cell, cystic fibrosis). These blood tests are relatively simple positive/negative tests. Now we get into the hormone testing.
We want to check your estradiol (E2) level, luteinizing hormone (LH), follicle stimulating hormone (FSH). Baseline is considered cycle day 2-4 (day 1 being the first day of full flow menses). Your E2 level should be less then 100 pg/mL. Your LH should be less than 11 mIU/mL. Your FSH should be less than 10 mIu/mL. We also check a hormone called AMH (anti mullerian hormone) and like to see that level over 1 ng/mL. We will check TSH (thyroid stimulating hormone) and want that to be less than 3.5 mIU/ml. If it is slightly over that we may start you on a medication called synthroid. Uncorrected thyroid disease can affect the egg quality adversely. Your prolactin level we like to see less than 26 ng/mL. Depending on what kind of (treatment) cycle you are going to be doing, we will do an ID panel (infectious disease). We have to check for gonorrhea, syphilis, Hepatitis B & C and HIV I & II because the CDC makes us. It is also for your protection.
Your husband isn’t left out of all this testing. We have a couple of things for him to do. He will need to produce a semen sample, (SA). We want to make sure that there is sperm to work with. For him, the numbers we look for are as follows; we want the count to be over 20 (million/ml), the motility to be over 50% and the morphology (normal shaped sperm) to be over 14% (strict criteria). This sample can be produced here in our office or at home as long as it can be in the office 30 minutes after production and be kept body temperature. We will also draw blood on him for his ID panel.
These are your work up numbers in a nut shell. I know…..blah, blah, blah.
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