Your TTC Strategy 1: Prepare to Be Pregnant
What you should know up to 12 months before you start trying to get pregnant
Not all couples seeking fertility assessment are ready to conceive immediately. Some just want to know for their own peace of mind that there are no obstacles to conceiving. Others, who have delayed childbearing, want to know if they still have enough eggs and sperm. While no method of testing is 100 percent accurate, there are many approaches from low tech to high tech that provide valuable information.
For both men and women it is important to assess risk factors that may interfere with conception. Potential problems for women include a history of cancer treatment, endometriosis, sexually transmitted infections, age, polycystic ovarian syndrome, smoking, early menopause, and prior abdominal or pelvic surgery. Men should be concerned about age, chemical exposure, heat exposure, prior cancer treatment, certain prescription medications, sexually transmitted infections, surgery on reproductive organs, varicocele, and smoking.
A woman’s menstrual patterns provide an indication of fertility potential. If periods occur regularly every 28 to 32 days, if ovulation predictor kits indicate ovulation, if there are some premenstrual symptoms, and if she experiences mild to moderate cramps it is quite likely that she is ovulating and producing an egg each month. The absence of these signs and shortening or lengthening of menstrual cycles may indicate a problem.
Over-the-counter fertility testing has recently become available. The male fertility test assesses the protein content of a semen sample to determine whether the sperm density is satisfactory. Other tests assess the sperm motility. For women, a test is available to measure follicle stimulating hormone (FSH), which gives an indication of the number of eggs in the ovary (ovarian reserve). The accuracy of the results from these tests are only as good as ability of the person to read directions and perform the tests properly.
These tests are performed by a health care provider and have a much better ability to predict fertility. Many of these tests are used to assess infertility, but they can just as easily be used by those contemplating pregnancy.
Semen analysis Semen analysis is probably the first test that is performed in men. This test determines the number of sperm and the proportion that are motile. If there are an inadequate number of sperm, additional testing may consist of an examination by an urologist, blood tests to measure hormones, chromosomal analysis, testicular biopsy, and tests to see if there are any blockages to sperm transport.
If the sperm are not moving well, you may be tested for the presence of anti-sperm antibodies, varicocele, or prostatitis. No single sperm feature can accurately predict fertilization or pregnancy potential so tests to predict whether the sperm are able to fertilize an egg are sometimes used and include a computer-assisted semen analysis, induced-acrosome reaction testing, sperm penetration assay using hamster eggs, and sperm-zona pellucida binding assays. The clinical usefulness of specialized sperm testing remains controversial.
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The most pressing issue in women is whether they have a sufficient number and quality of eggs in the ovary (ovarian reserve) to become pregnant. This is particularly important in women over 35, when fertility begins to decrease dramatically. Diminished ovarian reserve is usually age related and occurs due to the natural loss of eggs and decrease in the average quality of the eggs that remain. However, young women may have reduced ovarian reserve due to smoking, family history of premature menopause, prior ovarian surgery, or even if they have no known risk factors. Several tests are used to determine ovarian reserve.
FSH and estradiol testing Day three estradiol and FSH blood testing is the most common and easiest test to perform. The basis for the test is that as you approach menopause, your ovaries begin to respond poorly to FSH and LH. As a result, your body produces more of these hormones in an attempt to “jump start” egg development in your ovaries. High levels of FSH and/or estradiol indicate that your ovarian reserve is low, and that your chances of conception are poor, but still possible. However, normal levels of FSH do not guarantee conception. Although FSH and/or estradiol can fluctuate monthly, a single elevation is predictive of poor ovarian function.
Clomiphene citrate challenge test A variation of the day three FSH test is the clomiphene citrate challenge test (CCCT), which assesses a woman’s response to clomiphene citrate given on cycle days five through nine. Blood levels of FSH are obtained on days three and 10. Abnormally elevated blood levels of FSH on either cycle day three or cycle day 10 are associated with reduced spontaneous pregnancy rates.
Inhibin B Inhibin B is a relatively new blood test that may be more predictive of ovarian reserve. Because inhibin B is produced directly by ovarian follicles, the amount of inhibin B in your blood directly correlates to the number of eggs that you have in your ovaries, though standardized levels are still being determined. Low levels of inhibin B are associated with impaired ovulation, lower spontaneous pregnancy rates, increased risk of miscarriage, and decreased success with IVF. Women who would benefit from the test are over the age of 35, have unexplained infertility, have shown a poor response to fertility drugs, or have had a positive CCCT.
Ultrasound Transvaginal ultrasound may be performed in the early part of the menstrual cycle to count the number of small (2mm-10mm) follicles (cysts) in the ovary. The number of these follicles reflects the egg supply and chance of conceiving. A low ovarian volume and/or a low follicle count indicate a reduced chance of conceiving.
Unfortunately, even with a normal ovarian reserve test, older women may have difficulty achieving a pregnancy. Moreover, the results may vary from cycle to cycle. Any single abnormal test, however, generally indicates that fertility potential has diminished.
These tests only indicate fertility potential. Those with abnormal tests do get pregnant and those with normal tests may have difficulty conceiving. The true test of fertility potential is conceiving!
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