Baseline investigations
85% of couples will achieve a pregnancy within the first year of unprotected intercourse. The likelihood of pregnancy decreases significantly after the first year, and markedly so if the female partner is over 35 years old. Over this age couples are encouraged to seek advise after 6 months of unprotected intercourse. The first step in the evaluation of patients with sub fertility is to assess the couple to determine their fertility potential and possible reasons for their difficulty in conceiving.
An average woman will have approximately 6-7 million immature eggs at 20 weeks in their mothers womb at 16-20 weeks pregnancy. There is a massive loss of eggs in the second half of the pregnancy, such that at the time of birth there are approximately 500,000 – 2 million eggs left. The egg count declines further by puberty. Of these, for the next 40 years or so, approximately 400-500 eggs will ovulate over the woman’s life.
Ovarian reserve testing involves assessing the number of eggs remaining in the ovaries. This measure will help guide the type of treatment that is recommended. Ovarian reserve testing is a 2 part process. The first involves blood work to evaluate the hormones, and a vaginal ultrasound scan performed to count the number of follicles in the ovary (antral follicle count, or AFC). Both are performed in the first week of the cycle. At the time of the ultrasound scan, a sonohysterogram will also be performed to assess the uterine cavity, as the embryo will only grow in a normal uterus.
In keeping with our personalized approach to treatment, the ultrasound scans are performed at Oasis Fertility Center.
Blood work is performed at 2 time points in the cycle to assess ovarian reserve, fallopian tube potency, uterine cavity and sperm health. Additional tests may be needed depending on the results of these investigations. Furthermore, routine blood tests are performed to determine exposure to sexually transmitted diseases (STD). The requisitions for the blood tests will be uploaded to your portal. Please take these to your nearest Alberta Precision Labs facility. These tests need to be performed between days 2-5 of your cycle. Day 1 of your cycle is considered as the day of proper flow. If the period starts before 3 PM, the same day is considered as day 1. Should it start after 3 PM, we regard the next day as day 1. On day 1 of your cycle, please write to “Nursing Team” using your patient portal to make an appointment for the ultrasound scan. You will be scheduled for the scan in the first week of your cycle as above.
Transvaginal ultrasound imaging is performed for your initial investigation and monitoring of your treatment as it allows for more accurate visualization of the ovaries and uterus. The procedure is frequently performed during your menstrual cycle, and generally takes approximately 15 minutes to perform.
During the procedure the vaginal ultrasound probe, covered by a sterile probe cover is inserted into the vagina. The procedure is relatively painless. It is important that your bladder is empty as a full bladder precludes adequate views. You will be asked to empty your bladder just before the scan. The procedure is time sensitive and is usually performed at particular time points during your menstrual cycle. It is important that you message the nursing team through the web portal to book the ultrasound.
There are no complications associated with the procedure, though some women with a history of painful intercourse and pelvic pain may experience slight discomfort. Should you have any concerns or questions, please don’t hesitate to reach out to the nursing team.
This procedure is performed to evaluate the uterine cavity. It is considered as a screening investigation to determine the normalcy of the uterus.
Procedure:
A speculum examination is performed to visualize the cervix. Once the cervix comes into view, a thin tube (catheter) is inserted into the uterine cavity, and the speculum is withdrawn. This is usually the most uncomfortable part of the process.
Transvaginal ultrasound is then performed, and the uterus visualized. Normal saline is then injected slowly while the uterine cavity is examined. Any presence of any abnormalities in the uterus, such as fibroids or polyps are noted. The presence or absence of fluid in the pelvis may secondarily provide evidence of tubal patency.
The examination takes approximately 10 minutes to perform and is associated with minor discomfort, which may be more pronounced in patients with chronic pelvic pain and endometriosis.
Sonohysterogram is performed in the first week of the cycle once the period has ended.
Please follow the instructions for transvaginal ultrasound to book the procedure.
DNA fragmentation test for sperm is a laboratory test that measures the amount of broken DNA in a man’s sperm. High levels of DNA fragmentation can affect the chances of a successful pregnancy. Many studies show that there is a link between sperm DNA damage, infertility and miscarriage.
Men who are fertile tend to have less sperm DNA damage. Men who are infertile tend to have high levels of damage and abnormal semen analyses.
The test is typically performed on a semen sample and can be done in conjunction with other fertility tests such as a semen analysis. The test results are usually reported as a percentage – DNA Fragmentation Index (DFI) which indicates the percentage of sperm cells containing measurable DNA damage. Higher numbers indicate a greater amount of DNA fragmentation.
Several tests have been developed to assess sperm DNA damage. The most frequently used is the DNA Integrity Assay.
There are several causes of high DNA fragmentation in sperm, including varicocele, infection, radiation or chemical exposure, and certain genetic conditions. Men with high DNA fragmentation may be advised to undergo additional testing and/or treatment to address the underlying cause.
It is important to note that the DNA fragmentation test is not a diagnostic test and is used in conjunction with other diagnostic tools to evaluate male fertility. Men with high DNA fragmentation may still be able to father a child through assisted reproductive techniques such as IVF with ICSI.
Report Results
Normal Sperm DNA Integrity (DFI ≤ 15%)
– excellent to good fertility potential
Borderline Sperm DNA Integrity (DFI > 15% to ≤ 30%)
– good to fair fertility potential
Abnormal Sperm DNA Integrity (DFI > 30%)
– fair to poor fertility potential
References:
Bungum M, Humaidan P, Axmon A, Spano M, Bungum L, Erenpreiss J, Giwercman A. Sperm DNA integrity assessment in prediction of assisted reproduction technology outcome. Hum Reprod. 2007;22:174-9.
Spanò M, Bonde JP, Hjøllund HI, Kolstad HA, Cordelli E, Leter G. Sperm chromatin damage impairs human fertility. The Danish First Pregnancy Planner Study Team. Fertil Steril. 2000;73:43-50.
Simon L, Emery B, Carrell DT. Sperm DNA Fragmentation: Consequences for Reproduction. Adv Exp Med Biol. 2019;1166:87-105.
