What Do Fertility Tests Involve? By Blair Nelson

Blair Nelson, of Fab Fertility in the USA, gives us her personal fertility report card. A simple explanation of how fertility tests work, as well as Blair and her husbands’ test results, and the reasoning behind them. Blair is a big voice in the TTC (trying to conceive community) and we’re delighted that after years of fertility treatments, tests and failed IVF cycles, they finally has a BFP (big fat positive).

Read on to find out more about how fertility tests work, how expensive fertility tests are and why your fertility specialist might request you have them.

Over to Blair

fabfertility.com | @fabfertility

When to do a Fertility Test

A little over two years ago, the only ‘lady’ tests I was familiar with was the annual pap smear & HPV panel. Oh what I would give to go back to those sweet, sweet days of ignorant bliss. Since then, I have gone from a naïve, unstudied, shy-in-a-gown thirty year old to an open, well-educated infertility veteran with an unofficial master’s degree in reproduction and the female body.

I have been through three IVF cycles, undergone SO many fertility tests and taken so many meds over the course of two years it makes my f***ing head spin. Whether you’re at the beginning of your TTC (trying to conceive) journey or wading through the thick of it, I thought I would do you a solid summary and give you an explanation of the many tests I have had done, what the fertility tests involved and the reason behind why I did them, to prevent your head from spinning exorcist style if you’re confronted with these tests.

Let’s start at the beginning of my story. About eight months into trying to conceive, we found out my husband had a balanced translocation and that IVF was our path to parenthood. Talk about the shock of a lifetime. No honeymoon stage baby-making for us! We met with a fertility specialist at a fertility clinic and were off to the races. In the USA, once it is determined IVF is your path, it is standard operating procedure to do these four tests to set the scene:

1. STD Screening – Your fertility specialist wants to make sure there isn’t any underlying infection that needs to be treated and/or could impact results. This is a simple blood test of just a couple of tubes. My report: good news, my husband and I were clear here!

2. Genetic Carrier Screening – This is a basic screening to see if you and your partner are carriers for any genetic conditions that could impact/challenge the IVF process. As an example, if you and your partner were both carriers of the same potentially harmful condition, this could be a challenge and would require further testing down the road once you made embryos. Don’t worry, I will get there. My report: My husband and I did not have any challenges here other than his translocation. I did find out I was a recessive carrier of Usher’s syndrome though… WHO KNEW?!

3. AMH (Anti-Mullerian Hormone) – This test is one of the most accurate tests to assess a woman’s ovarian reserve. It is a simple blood test that tests the AMH protein that can be done at any time during the cycle. As a guide, a healthy AMH for a fertile woman is between 1.0 – 4.0. This used to be the be all and end all, and in my experience, fertility specialists are not relying as heavily on this anymore. My report: I have had readings from 0.8 – 2.6 within a period of 12 months so take it with a grain of salt.

4. Thyroid Panel – Thyroid function is crucial for achieving and maintaining a pregnancy. Your OB/GYN and/or fertility specialist will want to know what your levels are prior to starting any fertility treatment in case intervention is needed to stabilize levels. Treatment for this is easy if a problem is found, so not to worry! I tend to have high readings which actually means my thyroid function is slightly low. I am on a synthroid medication to stabilize my levels.

Related Article – IVF Blog: Pregnancy after IVF

What do Fertility Tests Involve?

Phew… that is a lot just to start fertility treatment, right?! Don’t worry… it only gets more confusing from here 😉

Some doctors like to perform other tests/procedures before or in between IVF cycles, either for exploratory/diagnostic reasons or to resolve issues you might have had in the past, or come across during the course of treatment. This really does all depend on your unique journey. These tests include:

1. Saline Sonogram – This is a simple test that can be done at your fertility clinic, that involves sticking a catheter up lady-land, past the cervix and into the uterus where saline solution is shot up into your reproductive parts so your doctor can get a good look at your anatomy on a regular ultrasound machine. Here they are looking for the shape and position of the uterus and for anything out of the ordinary. Pain level is minimal. I had this done prior to my second frozen embryo transfer and mine was all normal and all clear!

2. HSG – This is a more intense version of the saline sonogram. This test involves the same steps of inserting a catheter into the hooha but instead of shooting saline through your lady parts, a dye is shot through them. The dye is an agent that more or less allows a physician or tech to take an x-ray of your reproductive system. The main function of this test is to see the shape of your uterus and to determine if your Fallopian tubes are blocked or not (if one or both is indeed blocked you likely have what is called a hydrosalpinx and will have to have that addressed). This test is usually done at an imaging center and not your RE’s office. Pain level is moderate to severe depending on whether or not you have blockage; take some extra strength Tylenol before you go. I had this done after my second round of IVF and all was clear! Pro-tip: push for this test before starting fertility treatment – I am mad to this day that this wasn’t done earlier.

   Related Article – Fertility Blog – Pregnancy After Fallopian Tube Removal

3. Hysteroscopy – A hysteroscopy is a procedure where a camera is inserted into your reproductive system vaginally (never did I ever think I would type that word for an article) to investigate symptoms or problems such as heavy periods, unusual vaginal bleeding, pelvic pain, repeated miscarriages or difficulty getting pregnant. This procedure can diagnose conditions such as cysts, fibroids, polyps or any scar tissue that may remain in your uterus from previous miscarriage(s) or cysts. You will go under anesthesia for this procedure and recovery is just a few days. I had this done after my second transfer resulted in miscarriage, at the same time I had my ERA test done (read more about ERA below). The purpose of this for me was to make sure there wasn’t any scar tissue from my miscarriage that could hinder implantation of another embryo and also to get a better look at my anatomy to ensure we weren’t dealing with any other issues like fibroids, etc. My report was all clear!

4. RPL Panel – This is a Repeat Pregnancy Loss panel which looks at several different blood clotting disorders. If you test positive for any of these, you may be put on blood thinning medication prior to any embryo transfer to help with implantation and reduce risk of miscarriage. You would have this test done only if you had experienced several miscarriages in the past or strictly as a precaution. This is a blood test with A LOT of tubes. Eat a snack, take water and brace yourself. My report after my first failed transfer: all normal!

   Related Article – Fertility Help – Everything You Need to Know About Immunology and Fertility by IVF Spain

5. Laparoscopy – This procedure allows a doctor to see inside the body by making a handful of small incisions and inserting cameras into them. For fertility purposes, your doctor is looking at everything… the ovaries, Fallopian tubes and uterus. Laparoscopy can be used to remove scar tissue, a fibroid, or endometrial deposits that are causing pain. Your doctor removes anything found either through incising or cauterization. This procedure is very common for those who suffer from endometriosis or for those who think they may have it. You go under anesthesia for this one and the recovery is 3-7 days. My report: some scar tissue in my abdomen was removed but all my reproductive organs looked great! Push for this if you are experiencing unexplained infertility. I have talked to so many women who say this was their saving grace.

6. ERA (Endometrial Receptivity Analysis or Array) – The ERA test is for women who are undergoing IVF and want to narrow in as much as possible on their body’s ideal implantation window. Based on the results, your RE will push back or move up your transfer time and day. This test can be done under anesthesia or not – it depends on your doctor. A small biopsy is taken from your uterus on the day your RE would normally transfer an embryo and it is sent off to a lab. The lab is able to tell whether or not, on that specific day, you had the ideal amount of progesterone receptors in your uterus. The results will tell you if you were pre-receptive, post-receptive or receptive that day. Using me as an example, I was 24 hours pre-receptive the day of my test, meaning I needed 24 more hours of progesterone for ideal implantation.  I had this done at the same time as my hysteroscopy which was a blessing because I was knocked out. I have heard from others that it is very painful if you aren’t under. Pro tip: ask to couple this procedure with one where you’ll be under OR be prepared with pain meds.

Related Article – How to Choose a Fertility Clinic: 9 Top Tips

Testing Embryos

Ok, let’s say you made an embryo…. YAY! Now you get to decide whether or not you want to run tests on that little guy. If you’re like me, you may not have a choice. Because of my husband’s translocation, we have to test our embryos. If we were to put an embryo inside that had his translocation, we risk miscarriage, a high risk pregnancy or a child that may not be viable for life. Very scary stuff. You may have no known genetic factors but simply don’t want to risk transferring an abnormal embryo – completely understandable given what you’ve gone through to get to that point.  Either way, there are three kinds of testing:

1. PGT-A is an analysis of embryo cells to determine if there is the normal amount of chromosomes. An unequal division of either sperm or egg cells can result in an embryo having too few or too many chromosomes.

2. PGT-M analyzes for specific gene mutations that one (or both) of the parents is known to carry like cystic fibrosis or sickle cell anemia.

3. PGT-SR analyzes embryos of patients known to have a chromosomal structural rearrangement, such as an inversion or translocation. This is the testing we have to do.

Related Article – IVF – What is PGT and is it Necessary? Clinica Tambre Answer your Questions

Now how exactly does the lab do this? The first step is an embryo biopsy. The second step is analysis of the biopsy by a laboratory to conduct genetic testing on DNA. The biopsy is done at the blastocyst stage of development (day 5, 6 or 7). The blastocyst consists of two cell types, the type that allows the placenta to develop and the inner cell mass that later develops into the baby. The biopsy removes 3-10 cells from the placenta piece for laboratory testing for genetic disorders. The cells that will eventually make a baby are not disturbed. The blast(s) are frozen right after they are biopsied to wait for the results of the testing which usually takes one to two weeks.

This is the most excruciating part – you’ve gone through so much to get these little embryos. Now you have to wait even longer! Our results have been so wild… round one we sent 17 embryos off and 4 came back genetically normal. Our second round we sent off 2 for testing and both had the translocation. The third round we sent off 2 for testing and one had the translocation and one was completely abnormal.

Related Article – IVF Blog: How To Prepare for an Embryo Transfer

Are Fertility Tests Expensive?

Sadly fertility tests are expensive and physically/emotionally draining. I try to celebrate the small victories and acknowledge and move on from the disappointing results. We must remember we need to be thankful this science exists because if it didn’t, where would we be?

Related Article – Fertility Treatment Costs – The Ultimate Breakdown

I hope this brief explanation helped explain and simplify what my fertility tests involved. If you are reading this, I am sorry you too are struggling to start your family. I feel your pain immensely.

NEVER forget… just because fertility is hard doesn’t mean it can’t be fabulous!

All my love, Blair

(Please note this is not professional medical advice, simply the personal experience and peer advice from a fertility warrior. Not all these tests may be applicable to everyone.)

Related Article – Negative Pregnancy Tests: How to Not Give Up Hope by Alice Rose

Hopefully this fertility blog has given you a deeper insight into the world of fertility tests. We know it may seem overwhelming when trying to conceive, but Fertility Help Hub is here for you, as well as Blair. You can learn more about her journey through her Instagram.