Disturbances in the production of an egg (also known as an oocyte or ovum) may lead to infertility.
The onset of ovulation in the middle of a woman’s menstrual cycle may be determined through home monitoring by measuring an increase in lutenizing hormone (LH) in her urine with an over-the-counter ovulation predictor kit and/or charting a significant rise in her basal body temperature (BBT). Although these monitoring techniques do not prove that ovulation has occurred, they provide useful information.
Medical tests may be ordered to help diagnose ovulation disturbances, to measure ovarian reserve, to confirm that ovulation has occurred, or to monitor the growth of ovarian follicles and the thickness of the uterine lining.
The following blood tests may be ordered to help identify a cause of ovulatory disturbances:
- TSH Levels: Levels of thyroid-stimulating hormone are measured to determine if the thyroid gland is under- or over-functioning, either of which can affect a woman’s ability to conceive and carry a pregnancy. TSH levels may be measured at any time during the woman’s cycle.
- Prolactin: Elevated prolactin levels may be associated with disturbances in the functioning of the ovaries and/or the corpus luteum. Prolactin levels may be measured at any day during the woman’s cycle, but preferably before 10 a.m. on the day of the test (before a natural rise in prolactin levels occurs).
The following blood tests may be ordered to measure ovarian reserve, a measure of how well the ovary will respond to ovulation induction medicines:
- FSH: Increased levels of follicle-stimulating hormone (FSH) may indicate a decline in ovarian function. The baseline FSH test is performed early in the menstrual cycle, usually on day 3.
- Estradiol (E2): Estrogen levels are monitored to assess ovarian function and follicle maturation. Baseline estrogen levels are measured along with FSH.
- Antral Follicle Count: An ultrasound typically performed cycle day 2-5 used to measure the number of follicles. Acts a marker of ovarian responsiveness and ultrasound also provides a baseline assesssment of the uterus, tubes and ovaries.
- AntiMullerian Hormone: A blood test performed at any time in one’s menstrual cycle that also assesses ovarian responsiveness, particularly to stimulation for in vitro fertilization.
The following tests may be ordered to confirm that ovulation has occurred:
- Progesterone: Increased levels of progesterone confirm that ovulation has occurred and that the corpus luteum (the ovarian follicle that released the egg) is preparing the lining of the uterus to implant a fertilized egg. Progesterone levels are measured approximately one week after ovulation has occurred.
Ovulatory problems may be treated with both oral and injectable medications (commonly referred to as fertility drugs). These medications stimulate the ovaries to produce and release eggs (also known as ovulation induction). While most patients will respond to oral agents that require minimal monitoring, some patients must be prescribed injectable medications that require close monitoring through ultrasounds and estradiol levels, which should be provided only by physicians with appropriate training and experience.
Ovulation induction may be accompanied by intrauterine insemination (IUI), using either the husband’s sperm or donor sperm. IUI is a form of artificial insemination in which specially prepared and concentrated sperm are inserted into the woman’s uterus via a small catheter at the time of ovulation. This sperm preparation is performed in our certified andrology laboratory by highly trained and experienced individuals.
See Treatment Options for more details on diagnosis and procedures.