Infertility investigations for women Brooke Building Gynaecology Department 0161 206 5224 © G21031001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2021. Document for issue as handout. Unique Identifier: SURG08(21). Review date: May 2023. This booklet is aimed for women undergoing fertility LH (Luteinising Hormone) Progesterone investigations. Its’ aim is to Oligomenorrhoea - When the provide you with some useful periods are occurring three In women, luteinising hormone Progesterone is a female information regarding your or four times a year (LH) is linked to ovarian hormone produced by the hormone production and egg ovaries after ovulation. It investigations. Irregular cycle - Periods that maturation. LH is used to causes the endometrial lining vary in length We hope you !nd this booklet measure a woman’s ovarian of the uterus to get thicker, helpful. The following blood tests are reserve (egg supply). making it receptive for a used to investigate whether You will be advised to have some It causes the follicles to grow, fertilised egg. ovulation (production of an egg) or all of the following tests: mature and release the eggs Progesterone levels increase is occurring each month and also for fertilisation. It reaches its after ovulation, reaching a to help determine which fertility Hormone blood tests highest level (the LH surge) in maximum level seven days treatments to offer. Follicular bloods tests the middle of the menstrual before the start of the next cycle 48 hours prior to ovulation period. The progesterone test is These routine blood tests are FSH (Follicle Stimulating i.e. days 12-14 of a 28 day cycle. used to test whether a woman usually taken between days Hormone) is ovulating (releasing an egg). two and four of your menstrual In women, follicle stimulating cycle (Follicular Phase). Luteal blood tests In a regular 28 day cycle, the hormone (FSH) helps controls progesterone test is taken on Day one is the first day of your the menstrual cycle and the The luteal phase of the cycle is day 21 of a woman’s cycle. If period. They may also be taken production of eggs. from ovulation to the start of a woman’s cycle is longer or at any time if your periods are a woman’s period. The egg sac FSH stimulates the ovaries to shorter than 28 days the test either infrequent or completely becomes a structure called the produce follicles (fluid filled will be taken later or sooner. absent. corpus luteum after the egg has sacs) which grow, develop, and been released. Occasionally the test will be The tests are particularly useful release an egg. performed weekly if the time if you do not have a period The corpus luteum produces The FSH test is done on the of your period cannot be every month. Staff in the clinic progesterone for two weeks second to fourth day of the predicted. may use the following terms: then disappears. Blood test menstrual cycle. It can be used progesterone during the luteal Amenorrhoea - No periods to measure the egg supply in phase to test for ovulation. for six months or more the ovaries. © G21031001W. Design Services, Salford Royal NHS Foundation Trust, 1 All Rights Reserved 2021. Document for issue as handout. 2 Unique Identifier: SURG08(21). Review date: May 2023. Imaging tests Prolactin and thyroid function Ultrasound scans HSG (Hysterosalpingogram) Prolactin is a hormone The trans-vaginal (internal) A hysterosalpingogram or HSG is Further information will be produced by the pituitary ultrasound scan is one of a an x-ray procedure performed to given by the x-ray department if gland (in the base of the brain) number of investigations used determine whether the fallopian required. and may be requested if your when assessing your fertility. tubes are open and to see if the periods are infrequent or The scan can give extremely shape of the uterine cavity is HyCoSy (Hysterosalpingo- absent. Too much prolactin useful information about your normal. This is done by inserting Contrast Sonography) hormones can stop a woman uterus (womb) and ovaries that a speculum (similar to a smear) ovulating and having periods into the vagina and by inserting This test is an ultrasound will help make decisions about investigation carried out to regularly. Abnormalities of the your fertility management. a fine tube into the uterus. thyroid gland may also result in check whether your fallopian It is important that you have A fluid contrast (dye) is then tubes are open (clear) to allow a failure to ovulate regularly. injected through this tube. This an empty bladder for this the egg to pass through. At the This test will only be performed contrast then enters the tubes, investigation therefore it is same time it also allows us to in women who have other and spills out of the ends if they advisable to empty your bladder look at the uterus (womb) and symptoms of thyroid disease. are open. This procedure is an immediately before the scan. ovaries. outpatient procedure and takes Androgens The examination will take less than 30 minutes to perform. These are male hormones that Timing and preparation approximately 5-10 minutes and It is usually done following your are present in small quantities in Ideally the HyCoSy should be is similar to having a smear test. period but before ovulation women. The most well-known performed around day 5-12 of A probe is inserted into the to prevent any interference androgen is testosterone. The your menstrual cycle (a week vagina and images of the uterus with an early pregnancy. This level of testosterone and other (womb) and ovaries can be seen procedure is carried out in the following your period). This is androgens may be higher in on the scan monitor. x-ray department. before ovulation occurs to avoid women with Raised BMI and displacing an early pregnancy. Some women may experience lead to polycystic ovarian However a pregnancy test mild discomfort when the dye syndrome (PCOS). High levels will be performed before the is introduced and we would of testosterone can result in procedure. acne and abnormal hair growth recommend you take anti- (hirsutism). We test for high inflammatory painkillers such as androgen levels using a test ibuprofen at least 30 minutes called free androgen index (FAI). before the procedure. © G21031001W. Design Services, Salford Royal NHS Foundation Trust, 3 All Rights Reserved 2021. Document for issue as handout. 4 Unique Identifier: SURG08(21). Review date: May 2023. Other tests Contact information The procedure Risks Rubella (German Measles) Gynaecology Clinic M1 The doctor or nurse will explain There is a very small chance of antibody levels 0161 206 5224 the procedure to you prior to a pelvic infection following the It is important to look for the examination. You will be test. Occasionally the test may evidence of immunity, as rubella Erica Wilson (Sister) asked to sign a consent form. cause some light bleeding but infections in pregnancy can lead Initially a trans-vaginal this should settle after a couple to various abnormalities of the 0161 206 1480 (internal) scan would be of days. developing baby. If you are not 0161 206 0095 performed to assess your immune the vaccination should Bene!ts of HyCoSy and HSG uterus, tubes and ovaries. be arranged. Secretary to Dr Umapathy Following this a speculum is Some patients may feel slight passed into your vagina (similar discomfort or period type pain Chlamydia tests 0161 206 5312 to a smear) and a thin tube whilst the contrast is injected. It is important we screen for (catheter), is inserted through Any discomfort will only last for any cause of pelvic infections/ Notes your cervix (neck of the womb) a few minutes. Some women Chlamydia prior to undergoing into the uterus. may also experience sweating, HSG or HyCoSy. Vaginal swabs This may take a couple nausea, headaches and will be taken on your first visit of minutes and may be a dizziness. if they have not been taken little uncomfortable. Once If HyCoSy is required you will via the GP within the past 6 the catheter is in place the receive further written patient months. speculum can be removed. information. Please ask a member of staff if The ultrasound probe is then you have any questions about placed into the vagina and any of your investigations. the contrast (fluid) is injected very slowly into the catheter, allowing the doctor to observe flow into the fallopian tubes. The procedure will take approximately 10-20 minutes. © G21031001W. Design Services, Salford Royal NHS Foundation Trust, 5 All Rights Reserved 2021. Document for issue as handout. 6 Unique Identifier: SURG08(21). Review date: May 2023. © G21031001W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2021 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: SURG08(21) Review Date: May 2023 For further information on this leaflet, its references and sources used, please contact 0161 206 5224. Copies of this lea"et are available in other formats (for example, large print or easyread) upon request. Alternative formats may also be available via www.srft.nhs.uk/for-patients/patient-lea!ets/ In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities to access this service. Please contact the service/clinic you are attending by phone or email prior to your appointment to discuss your requirements. Interpreters are available for both verbal and non-verbal (e.g. British Sign Language) languages, on request. Please contact the service/clinic you are visiting to request this. 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