Evaluation Of Female Partner

• Detailed menstrual, medical, surgical and sexual history is taken
• After a detailed history, pelvic ultrasound is performed to asses the uterus and ovaries. Ultrasonography mainly transvaginal can help in detecting the cause behind infertility in some cases
• Uterus is assessed for the size, endometrial lining, blood flow and any other abnormalities like Abnormal uterine shapes (Septate uterus, bicornuate uterus), Fibroid uterus, Endometrial polyp, Calcifications, Adhesions or Ashermann syndrome
• Ovaries are assessed for the volume and follicle count which gives an estimate of the ovarian reserve or to detect any other abnormalities like Polycystic ovaries, Ovarian cyst (Endometrioma, Dermoid cyst, Simple cyst, corpus luteal cyst etc), Poor ovarian reserve, ovaries stuck to uterus as in PID
• Abnormal tubal pathology like Hydrosalpinx (fluid filled in the tube), Pyosalpinx (pus filled in the tube) ,Ectopic pregnancy can also be diagnosed with TVS
• Certain blood tests may be advised to find out any hormonal problems

Follicular Monitoring

• Follicular study is done in a fertility clinic
• It is better done transvaginally then trans abdominally
• It can be done in a natural as well as a stimulated cycle
• It is ideally started from D2 when the women is menstruating to assess the AFC(Antral Follicle Count)
• Then it is repeated on D8/9 and then every alternate day to monitor the growth of follicle (Egg in the ovary) and its rupture (Ovulation) and also the endometrial lining in response to follicle

One of the important tests to asses ovarian reserve is serum AMH i.e. Anti-Mullerian Hormone and AFC

After that, the couple is explained about normal fertility and advice given based on the reports

What is AMH ?

• AMH that is Anti-Mullerian hormone is a hormone secreted by granulosa cells of pre-antral and antral follicles of the ovary. It gives an estimate of ovarian reserve (that is no of eggs remaining) which determines fertility
• It is blood tests which can be performed on any day of menstrual cycle
• They decrease with increasing age of the women
• If AMH count is good, it indicates good fertility status
• A women is born with fixed no of eggs for her lifetime which only reduce with age. Hence it is important to complete the family in time before the reproductive potential of women diminishes
• AMH levels and fertility potential
  
  
• It is important to remember that AMH levels decline and FSH levels increase as women ages. In other words, normal AMH and FSH levels change depending on a woman’s age.Because of this, focusing on age-specific AMH and FSH levels allows us to best assess a woman’s ovarian reserve, devise an appropriate treatment plan and estimate her IVF pregnancy chances.
  
  

What is AFC ?

AFC Is Antral Follicle Count.

• It is assessed by transvaginal ultrasonography on second or third day of your periods.
• It gives an estimate of the follicles that can be recruited in that menstrual cycle.
• Normal AFC should be 3-8 follicles less than 10mm in each ovary.
• Total AFC less than 5 indicates poor ovarian reserve.
• AFC of 5-15 indicate normal reserve.
• AFC of more than 15 indicates polycytic ovaries.