What Happens During Invasive Fertility Testing - Part 2
Preliminary Fertility Testing - Third Day Blood Tests
When fertility testing is necessary to root out the cause of infertility, there are several tests done that are called preliminary fertility tests. Three are conducted on the third day of the menstrual cycle and they include the FSH test that evaluates the level of follicle stimulating hormone. FSH is the hormone that stimulates the follicles located in the ovaries. This test is run together with an estradiol test that assesses egg quality and quantity. The luteinizing hormone (LH) helps to maintain egg development. LH surges during ovulation causing a release of the egg. The LH test checks the level of LH released during the surge. The prolactin test is done to determine the level of this stress hormone that can inhibit the release of both LH and FSH. Unbalanced levels of any of these hormones can spell difficulties in conception.
21 Day Blood Test for Progesterone
Additionally, on the 21st day of a woman's menstrual cycle a progesterone blood test will indicate that ovulation has taken place because the levels of this hormone increase after an egg is released. Other fertility tests that are considered to be preliminary tests include a thyroid test and possible ultrasound scanning. All of these tests are non-invasive and, apart from the ultrasound, are done through blood work.
Beyond Blood Tests
However, when there fails to be an answer to infertility through these preliminary tests, advanced diagnostic testing is done. Often this type of testing is invasive and causes more physical stress on a woman's body. In a previous article we examined the endometrial biopsy, a procedure used to further check the levels of progesterone released during the luteal phase of menses. We also investigated the HSG (hysterosalpingogram), which allows the doctor to see if the fallopian tubes are blocked in any way.
The Hysteroscopy
The hysteroscopy is performed under general or local anesthetic as an outpatient procedure. It is done when a closer look at the uterus is necessary. If it is done as a diagnostic procedure it may be to determine what is causing unexplained bleeding, to examine the uterus, or to check on a growth. A hysteroscopy can also be done for operative reasons such as treating endometriosis or removing fibroid tumors. This procedure can be performed on its own or in conjunction with a laparoscopy or endometrial biopsy.
During a hysteroscopy the cervix is dilated and a hysteroscope (a small scope) is inserted into the uterus to allow for a close look at what is going on. Usually carbon dioxide gas is used to help improve the viewing. It is common to have some bleeding and pain when the procedure is completed, sometimes for a few days. Although recovery can take only a day, many women need a few days to feel normal again. Shoulder pain and bloating from the gas is a normal occurrence. Over-the-counter pain medications usually take care of the discomfort of this procedure. Since the procedure is done under anesthetic, the doctor will advise concerning eating and drinking before the hysteroscopy as well as how long to abstain from sex afterward.
The Laparoscopy
Usually performed on an outpatient basis, the laparoscopy is a hospital procedure that will require an abdominal incision. The laparoscopy is used to both diagnose and treat a number of conditions associated with infertility, such as endometriosis, ovarian cysts and blocked fallopian tubes.
Since it is an external invasion into the body, the surgery is done under general anesthetic. The surgeon makes two to four small incisions in the abdomen. One incision is through the navel and that is where the laparoscope is inserted. The other incisions are near the bikini line. Gas is administered to expand the abdomen making room for the laparoscope to be maneuvered while surgical instruments inserted through the bikini incisions are used to manipulate organs.
The laparoscopy differs from the other types of invasive diagnostic testing in that it is major surgery requiring general anesthetic. As with the other procedures, recovery varies with the woman as does the experience of pain and discomfort. Depending upon how physically demanding a woman's job is, she may return to work soon (if it is sedentary) or she may require more time to heal before returning. Women who are recovering from a laparoscopy are advised against heavy lifting and encouraged to get as much rest as possible.
