An egg is thrown from the ovary into the tube each month, so called ovulation. Without ovulation, there is
no conception. Regular monthly menstrual cycles equate with ovulation. Polycystic Ovarian Syndrome,
Hypothalamic Anovulation, Luteal Phase Insufficiency and problems with other hormones such as thyroid
hormone or Prolactin may interfere with ovulation. Most women will ovulate well into their 40's and even 50's but
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 medications.
This is the concept of what is a woman's reproductive potential and what are the chances that a woman will be able to conceive a
healthy, viable pregnancy with her own eggs? We test for ovarian reserve with blood tests (cycle day 3 FSH and AMH levels and vaginal
ultrasound to check ovarian reserve). There are some other tests such as thyroid, prolactin and androgens to assess the hormonal status of
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.
The dye test HSG (hysterosalpingogram) is the only non-surgical way to evaluate the patency of the fallopian tubes
that is to determine whether or not the tubes are open.
Uterus and Endometrial Lining
Fibroids, polyps, intrauterine scarring from prior surgery are some of the things that can cause the uterus
and its lining to be abnormal and to cause an embryo to fail to implant. Vaginal ultrasonography performed
just prior to ovulation can often be sufficient to diagnose any problem.
Some patients carry genetic diseases or abnormal chromosoms that can cause infertility or repeated
miscarriage. These problems are rare but need to be evaluated before the treatment.
This is one example of a disease of the female reproductive years that is strongly associated with infertility.
Surgery is the only way to make a definitive diagnosis. Surgery may be helpful in improving the chance
Hormonal Blood Tests
FSH and LH: This blood test should be done during day 2 to day 5 of your cycle. FSH, LH levels are
important to know your ovarian function. Day 1 is first full day of your period. Blood levels after 5th
day can give us wrong information.
TSH: To know your thyroid hormonal levels. Thyroid hormone can sometimes disturb the menstrual cycle and thereby affect fertility.
Prolactin: High levels of prolactin is known to be associated with problems with ovulation.
HIV I & II: For the benefit of patients, staff and other people these tests are compulsory if you are undergoing Assisted
HBsAg: This test is to know that you are not carrying hepatitis B virus.
Anti HCV: This test is to know your status for hepatitis C virus.
VDRL: Routine test for syphillis.
If you need further information about these viruses please speak to the nurse.
Rubella IgG: This is an important test to perform before you conceive. If this test is negative, it means that you
are susceptible to get a rubella infection during pregnancy, which can harm your baby. In that case Rubella vaccine is
Usually gynae sonographies are performed through internal (vaginal) probe. It is best to keep your bladder
empty during the procedure as it gives best pictures of organs. During vaginal sonography (TVS) we can normally
see the shape and size of uterus, location, volume and appearance of ovaries.
Please note that normal tubes are not seen during the sonography.
Saline Infused Sonography (SIS)
This is a special form of sonography performed to see the cavity of the uterus and patency
of the fallopian tubes. You are required to start the first day of antibiotic (i.e. Doxyycline
and Flagyl) before the procedure. Please take the second dose of both the tablets after going
home on the same day. Continue taking both the tablets twice a day for another 4 days. This
precaution is taken to avoid any vaginal infection to spread into the pelvis.
For SIS it is best to have your bladder slightly full. This makes it easier to introduce the
plastic cannula into the womb to infuse saline during the procedure. Most of the patients do
not need any pain killers after the procedure. Rarely if you experience pain simple painkillers
like crocin or combiflam can be taken.
SIS is advisable to perform after stopping your periods and before your day of ovulation
(i.e. Day 5-14).