Quick look at female fertility testing
Infertility is defined as the inability to conceive after over 12 months (six months if the woman is over age 35 or has known underlying factors) of unprotected intercourse. Fertility doctors can often identify the cause of infertility in one or both partners through different diagnostic tests.
For many women, we use the Parryscope® fertility testing technique and approach invented by Dr. John Preston “Pres” Parry. Parryscope testing gently, effectively and quickly evaluates three core aspects of a woman’s fertility: proper openness of the fallopian tubes, ovarian reserve and soundness of the uterus for pregnancy.
Infertility in women can be caused by age, ovulation irregularities, cervical dysfunction, uterine structural abnormalities, hormone imbalances, conditions such as endometriosis, fallopian tube damage or blockage, and rarely genetic conditions.
Related Information: Causes of Infertility
What is fertility testing for women?
Classically, fertility specialists used to say one-third of infertility cases are the result of infertility in only the female partner, one-third are the result of infertility in only the male partner, and one-third are the result of infertility issues in both partners. However, the reality is women have more factors in the reproductive process, with more chances for one of them to go wrong. Most of fertility comes down to sperm, eggs, the fallopian tubes and the uterus. Three out of four are in the woman.
In our practice, excluding subtle male factors that don’t meaningfully change chances, 80-90 percent of the time when there is a clear cause, it ends up being on the female side. This is why we want to make sure we understand the health of the women who come to our practice, as this provides the greatest opportunity to find something fixable that can improve chances of success.
Fertility testing for women generally focuses on the following three factors affecting female reproduction.
One factor of female fertility relates to her ovaries, where both releasing a healthy egg for fertilization and a woman’s “ovarian reserve” (the number of usable eggs remaining) matter. The quality and quantity of a woman’s eggs decreases as she ages.
A second factor that can affect fertility is whether the fallopian tubes are blocked or damaged, as this prevents sperm from reaching the egg for fertilization and also can keep a fertilized egg (embryo) from traveling to the uterus for pregnancy. This is one of the most common reasons for subfertility in young women and it is often missed by not being tested, or hysterosalpingograms (HSGs) don’t identify disease that is present.
The third factor in a woman’s fertility is the shape and overall condition of her uterus. It must be receptive to the embryo for implantation and pregnancy, as well as being fit to carry a healthy pregnancy through birth.
The Parryscope fertility testing difference
Dr. Parry has cared for many women through his career and has performed thousands of fertility tests. But through his experience, he found many combinations of fertility tests available to identify infertility in women – typically including blood tests, physical examinations, biopsies and special imaging procedures – to be inaccurate and painful, and found the results to be confusing for his patients.
Dr. Parry went to work to develop the patent-pending Parryscope® technique, a gentle radiation-free alternative to hysterosalpingogram (HSG) testing, that also works to identify obstructions in the fallopian tubes. Dr. Parry then took this a step further to develop the Parryscope approach, a single office test that can gently evaluate the health of the ovaries and the number of eggs remaining, whether there are any blockages in the fallopian tubes, and the condition of the uterus.
The procedure itself takes about 15 minutes. Then Dr. Parry takes great care in explaining the procedure, the results and the next best step in treating infertility.
The Parryscope approach is an alternative fertility testing method that presents less discomfort and fewer risks to women compared with many contemporary fertility testing and diagnostic approaches. Dr. Parry performs these evaluations himself, providing personal attention to each woman.
Related Information: Learn More About Parryscope
Other imaging fertility tests for women
When needed, special imaging equipment can also be used to assess the general shape and potential structural abnormalities within a woman’s reproductive system. Parryscope testing may be advisable for many women to identify structural anomalies. However, the three common tests that follow can also be used for diagnosis.
HSG is used to examine the shape of the uterus and identify any blockages or damage in the fallopian tubes. The doctor injects dye into the uterus through the vagina and cervix while performing an x-ray. (Alternatively, Parryscope testing does not use dye or x-rays.)
During the HSG procedure the doctor will use a speculum in order to place the instruments that release dye inside the cervix or uterus. During the procedure it is not uncommon for women to experience cramping and discomfort. Cramping and vaginal spotting or bleeding may be experience for 24 to 72 hours after the procedure.
HSG testing poses a risk of allergic reaction, potential infection and damage to pelvic structures from the instruments used. Our studies show that HSG was 110 times more likely to cause women maximum pain compared with the Parryscope technique. The Parryscope technique also doesn’t use radiation and seems to reduce the risk of infection and tissue abrasion.
Also known as vaginal ultrasound, this procedure uses sound waves to help doctors visualize soft pelvic tissue such as the wall & lining of the uterus that cannot be seen using an x-ray.
Pelvic sonograms are used to see, count and measure antral follicles. These small follicles, about 2 to 10 mm in diameter, hold immature eggs that have the potential to develop in the future. The antral follicle count (AFC), or number of follicles, is used to help doctors determine how many potential healthy eggs a woman has on reserve and the best treatment option for the patient.
Pelvic sonograms can also identify uterine fibroids, noncancerous growths in the muscle tissue of the uterus that can sometimes impair blood flow, block the fallopian tubes and affect the overall health of the uterus. The Parryscope technique also performs the test function of a pelvic sonogram.
Saline infusion sonohysterogram
SIS, also called saline infusion ultrasound, is a procedure that evaluates the uterine tissue. During SIS the doctor will insert a saline solution into the uterus to improve the clarity of the ultrasound. This allows the doctor to assess the endometrium (lining of the uterus) to see if there is any scarring, if the lining has thickened or if there are any polyps (small generally noncancerous growths). Parryscope testing also uses a form of saline infusion for visualizing the uterus.
Sometimes doctors will perform sonosalpingography (also known as HyCoSy for hysterosalpingo-contrast-sonography) to assess the fallopian tubes. This is a technique that not many physicians can perform, and they often have to have done quite a few to be good at it. Moreover, it can sometimes only see one fallopian tube instead of both, and many studies show it results in pain comparable to HSG.
Related Information: Parryscope, an Alternative to Painful Testing
Blood tests for ovarian reserve
Female fertility is largely dependent on ovarian reserve, or the number of eggs left in the ovaries. The quality of the eggs and how well the follicles in the ovaries respond to hormone signals from the brain are also important.
Fertility specialists often evaluate ovarian reserve by testing a woman’s blood for follicle-stimulating hormone (FSH), estradiol, clomiphene citrate and anti-Müllerian hormone (AMH) levels. Parryscope testing also evaluates ovarian reserve, but without blood testing, and may be a more appropriate test for some women.
FSH is the hormone that controls the menstrual cycle. Doctors may measure the level of FSH in a woman’s blood to evaluate ovarian function and the quality of eggs. This test is typically done on the third day of the menstrual cycle. FSH is increasingly viewed as a less reliable test, with many fertility specialists preferring AMH or antral follicle count (through ultrasound).
The amount of estradiol, a form of estrogen produced by the ovaries, in the blood is also used to evaluate ovarian function and egg quality. Estradiol levels can help doctors measure the maturity of the follicles inside the ovary and their resulting eggs. Like the FSH test, estradiol is also measured on the third day of the menstrual cycle. This test is valuable for monitoring in IVF, but is rarely useful relative to alternatives for testing ovarian reserve.
Clomiphene citrate challenge test
Also known as a CCCT, a clomiphene citrate challenge test uses benchmark FSH and estradiol levels from the third day of the menstrual cycle and compares them with the 10th day of a patient’s cycle. At that point she will have taken Clomid (clomiphene citrate) for days 5 through 9 of her cycle. This test isn’t frequently performed anymore because of better alternatives, but it was popular in the early 2000s.
Anti-Müllerian hormone test
AMH levels correlate with the number of antral follicles in the ovaries. The more follicles the better, as the woman will respond better to fertility treatment. This, along with antral follicle count (AFC), are considered the two standards for ovarian reserve testing.
Other female fertility tests
During a hysteroscopy a doctor will use a small camera-like device to view the inside of the uterus. This can help identify polyps, fibroids, scar tissue and any other uterine abnormalities. Though large cameras can be used, the Parryscope technique is typically performed with a <3 mm flexible hysteroscope, making it more gentle.
An analysis of the endometrium (uterine lining) can help doctors identify infection, abnormal cell growth and overgrowth of the lining. Spotting or light bleeding is expected, as are cramping and discomfort. A common problem with endometrial biopsy is that it typically samples only 4 percent of the uterus and can miss several conditions.
Thyroid-stimulating hormone (TSH) test
TSH imbalances can cause menstrual cycle problems including anovulation, or the lack of ovulation, which can cause infertility. Untreated thyroid disease has also been associated with miscarriages and – particularly if severe – lower IQ in children born to affected mothers.
This is a minimally invasive surgical procedure used to evaluate the pelvic organs for fibroids, cysts, infections and whether the outer uterus has problems that would affect pregnancy. During the procedure a small instrument outfitted with a camera (laparoscope) is inserted through a small incision on the belly to view the organs.
Next steps: See if Parryscope or another fertility test is right for you
We are very proud of the Parryscope fertility test for women. It is famously gentle, effective and efficient. And if that isn’t the best test for you to start with, we can also perform numerous other tests to understand your fertility. Together, we can come up with the best treatment plan for you and get to work helping you build a family.