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Assessment of Eggs and Ovulation
Several methods are used to assess ovulation and the quality of eggs, which is often referred to as "ovarian reserve." It has been clearly demonstrated that as women age, both the number and quality of eggs continues to decline. This decrease is termed "reduced ovarian reserve." The following diagnostic tests are available to assess the condition of eggs, ovulation, and the uterus and fallopian tubes.
Mid-Luteal Serum Progesterone:
Following ovulation, the ovary produces progesterone, a natural hormone that supports pregnancy in the event of conception. To document ovulation, a blood progesterone level can be drawn one week prior to the time of expected menstrual period. This is usually part of most infertility evaluations.
Day 3 Labs:
Studies originally performed at the Jones Institute for Reproductive Medicine of Eastern Virginia Medical School demonstrate that serum levels of hormones that stimulate egg development predict both the quality and quantity of eggs remaining in the ovary. These serum levels are commonly referred to as "Day 3 Labs," and consist of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol hormone level measurements typically performed on day 3 of the menstrual cycle. FSH and LH are produced by the pituitary gland after stimulation by the hypothalamus. The results of the Day 3 Labs can help predict a woman's chance of conceiving, determine the dose of FSH required for stimulation, and provide several other details.
Basal Body Temperature Charts (BBT Charts):
Since progesterone also increases the body's average temperature, measuring early morning basal body temperatures is a method patients can use to monitor ovulation. The woman's temperature is recorded every morning throughout the monthly cycle before leaving bed. An ovulatory pattern is one in which the temperature before ovulation (generally days 1-14 of the menstrual cycle) fluctuates below 98 degrees Fahrenheit and after ovulation (on or about day 15), the temperature rises as much as 1 degree Fahrenheit, thus fluctuating above 98 degrees Fahrenheit until the next period. It is this rise which suggests ovulation. A cycle without ovulation would not have persistently elevated temperatures in the last half of the cycle.
Measurement of Urinary LH:
Another method to monitor ovulation is an ovulation predictor kit, which measures the amount of luteinizing hormone (LH) in the urine prior to ovulation. Ovulation predictor tests are performed for 4 or 5 days during mid-cycle, beginning around cycle day 11. A change occurs in the color of the test when the concentration of luteinizing hormone increases in the urine. This test predicts in advance when ovulation will occur and is helpful in timing inseminations and intercourse to correspond to the most fertile time of the cycle.
Endometrial Biopsy:
An endometrial biopsy may also be performed late in the menstrual cycle to help detect how well the uterine lining has developed since ovulation. This test is performed in the doctor's office and generally takes 2-3 minutes. An endometrial biopsy is performed by placing a small straw-like instrument within the uterine cavity and removing a small amount of uterine lining. After the biopsy, patients should expect some vaginal spotting for the next 1-5 days. "Menstrual-like" cramping the day of the exam or the day after is sometimes experienced. Patients can take their usual medication for menstrual cramps (Advil, ibuprofen, Motrin) following the procedure and should drink plenty of fluids. Patients are also advised to abstain from intercourse and refrain from douching or using tampons for the next three days.
Hyperprolactinemia:
Abnormally high levels of the hormone, prolactin, can cause oligoovulation (irregular menstruation). Increased levels are often caused by a non-malignant tumor at the base of the pituitary gland. Symptoms of hyperprolactinemia can also include excess breast milk production, since prolactin stimulates this process during pregnancy. The drug, Parlodel, is often used with high success rates, or the tumor is surgically removed.
Hypothyroidism:
Hypothyroidism can be associated with ovulatory difficulties. A simple blood test can determine whether thyroid levels are too low. If this is the case, thyroid replacement therapy can be initiated.
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