The first step when infertility is suspected should be to carry out a comprehensive diagnostic assessment. The single most important factor affecting a woman’s fertility is her age. As a woman ages, changes occur in her body that reduce her chances of conception. The number of ovarian follicles gradually decreases, and those that remain age; the rate of aneuploidy (chromosomal abnormalities) increases, resulting in a reduced chance of conception and an increased risk of miscarriage.
A woman’s fertility potential is determined by an assessment of her ovarian reserve. Every woman has a specific number of primordial follicles, some of which are used up during each cycle. The ovarian reserve depends on the number of primary follicles remaining in the ovary. It is these follicles that can develop into a mature egg.
AMH (Anti-Müllerian Hormone) is a hormone produced in both women and men. In women, AMH is produced in the follicles of the ovary by the cells surrounding the eggs that are ready to grow. AMH levels are not influenced by a woman’s menstrual cycle, so they can be tested on any day of the cycle. Levels decrease as a woman ages, making it a very good marker of declining fertility, including premature ovarian failure. In patients with PCOS (Polycystic Ovary Syndrome), AMH levels are significantly elevated.
INHIBIN B is used to assess ovarian reserve. Inhibin B is produced by the granulosa cells of early antral follicles. This substance is secreted primarily during the follicular phase of the menstrual cycle. Its concentration in the early follicular phase reflects the number and quality of ovarian follicles. There is a positive correlation between inhibin B concentrations and the number of antral follicles assessed by ultrasound in the early days of the menstrual cycle.
Another important test is the AFC (antral follicle count). In this case, an ultrasound scan provides additional information about ovarian reserve. Ultrasound can be used to assess the endometrium and ovarian structure, the number of antral follicles (follicles measuring 2–6 mm) and follicular growth in patients with ovulation disorders or those being considered for assisted reproductive technology.
Laboratory tests, when carried out and interpreted correctly, are an essential diagnostic tool. The basic diagnostic panel for women at INVICTA Clinics comprises 12 laboratory tests.
The tests included in the basic diagnostic panel must be carried out on an empty stomach. They are performed using a blood sample taken from the patient at all our centres. You should allow approximately 2 hours to complete all the tests and fill in the paperwork in preparation for your first consultation with a specialist.
It enables an assessment of ovarian reserve – that is, a woman’s reproductive potential – and thus helps to determine the likelihood of pregnancy and to estimate how the ovaries will respond to stimulation. The test provides important information about ovarian function and helps predict when the patient will enter the menopausal phase.
It regulates the menstrual cycle. Testing its levels enables an assessment of the quantity and quality of the eggs and helps predict the response to ovarian stimulation.
A protein that binds sex hormones (testosterone, oestradiol) and is involved in their transport in the blood. Abnormal levels are seen in hyperthyroidism or hypothyroidism, excess oestrogen or testosterone deficiency, in cases of suspected polycystic ovary syndrome, and in hirsutism.
It is a natural oestrogen. Among other things, this hormone is responsible for the development and functioning of the female reproductive organs; in particular, it influences the normal growth of the lining of the womb. A normal level indicates that ovulation is taking place correctly.
FSH stimulates the maturation of Graafian follicles and the production of oestrogens. Its levels are measured to rule out premature gonadal failure.
LH plays a key role in the ovulation process. It reaches its highest concentration in the blood during the follicular phase of the cycle and triggers the rupture of the Graffian follicle. In the subsequent stage, this hormone is responsible for the proper progression of the cycle, and thus for the possibility of the egg being fertilised.
The test helps to rule out any possible thyroid conditions, including Hashimoto’s disease.
DHEA, or dehydroepiandrosterone, is a natural steroid hormone with weak androgenic activity. Testing its levels is helpful in assessing the function of the adrenal cortex and the pituitary gland, as well as in evaluating whether sexual maturation is proceeding normally.
A DHEA test, together with an assessment of the levels of other hormones, is carried out, amongst other things, in cases of female infertility, primary and secondary amenorrhoea, suspected polycystic ovary syndrome, and premature puberty.
A TST test can be used to rule out, amongst other things, polycystic ovary syndrome and other disorders associated with excess male hormones that affect the menstrual cycle.
TSH, or thyroid-stimulating hormone, is produced by the pituitary gland. This hormone stimulates the metabolism of almost every tissue in the body and regulates the secretory function of the thyroid gland. A blood test to measure TSH is carried out to assess thyroid function and to rule out any possible hyperthyroidism or hypothyroidism. Sometimes, the doctor may also order tests for the thyroid hormones fT3 and/or fT4.
Prolactin, also known as lactotropin, is a hormone produced mainly in the pituitary gland. Prolactin performs over 300 functions in the body; amongst other things, it influences the proper functioning of the reproductive system, stimulates the mammary glands during pregnancy and breastfeeding to produce milk (lactation), regulates the immune system, and also influences behaviour and well-being. Elevated levels of this hormone in women can cause menstrual and ovulation disorders, which may lead to difficulties in conceiving a child.
