Diagnosis

Below is a list of diagnosis options. Please choose the gender that you wish to learn more about.

Female

Blood Hormone Assessment

Prior to beginning your treatment, it is helpful to assess the levels of several hormones, since hormonal disorders are often causative or contributory factors in menstrual cycle and/or ovulation abnormalities. Although there is no consensus as to how often hormone levels should be assessed, we generally prefer to obtain levels of the following hormones if they have not been assessed in the previous 12 months:

  • Anti-Mullerian Hormone (AMH)
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Thyroid-stimulating hormone (TSH)
  • Prolactin

Additionally, there are several other hormones that we frequently evaluate to determine your response to treatment and/or assess the progress of an early pregnancy. These tests will often be drawn in the morning, performed in conjunction with an ultrasound, and reported to you later in the same day:

  • Estradiol
  • Progesterone
  • Human Chorionic Gonadotropin (hCG)

Less frequently, we will obtain other blood tests that are more specific to your diagnosis. Some testing panels are sent out from our office to outside laboratories and, as a result, there may be an interval of a few days to several weeks (dependent upon the complexity of the testing) before we can provide you with the results.

Hysterosalpingogram (HSG)

A hysterosalpingogram (HSG) is an x-ray of your fallopian tubes, uterus, and pelvis. This test will provide us a better indication as to whether your fallopian tubes are open, damaged, or blocked and also help determine if there are any structural problems inside your uterus (e.g. scarring, fibroids, polyps, congenital malformations). An HSG is scheduled sometime between your fifth and twelfth cycle days. Therefore, we ask that you call our office the first day you begin your period; we consider cycle day one to be the first day of menstrual flow or, if menstrual flow begins after 6 PM, the following day is designated as day one.

The HSG is performed at a hospital in the radiology (x-ray) department. It is always performed as a brief outpatient procedure. Please advise us if your insurance provider requires that the test be performed at a specific hospital. You should plan to arrive at the hospital 30 minutes before the actual test time to allow for registration. The scheduled time is determined by the availability of the x-ray suite.

There is no preparation for an HSG. You may have food beforehand, although we suggest something light. We also encourage you to take ibuprofen, naproxen, or acetaminophen 30 minutes before the test to reduce cramping during the procedure. During the test, you are positioned on an x-ray table with foot rests similar to a pelvic examination.

Your physician will place a speculum in order to visualize your cervix, and use an iodine-based cleanser prior to placement of the HSG catheter. Once the catheter is passed into the uterine cavity, a tiny balloon is inflated to hold it in place. The speculum will be removed prior to instillation of x-ray dye. The dye will then fill the uterus and fallopian tubes, and flow out into the pelvis. Several pictures will be taken as the dye is injected. The entire process normally takes only 10 to 15 minutes.

Occasionally, you will continue to experience some cramping for a few hours after the HSG. Additional administration of one of the above medications should help relieve the discomfort. You may also notice some spotting and/or discharge after the test. This is very normal and should resolve within 48 hours. If pain or bleeding continues, a fever develops, or you have another concern, please contact the office immediately.

Hysteroscopy

The most detailed evaluation of the uterine cavity is through the use of a camera or hysteroscope. The advantages of this approach are that it provides a ‘gold standard’ diagnostic assessment of the uterus while simultaneously allowing for the treatment of the condition observed during the hysteroscopy. A hysteroscopy is performed as an outpatient procedure under anesthesia and typically will last between 30 to 60 minutes, although more complicated problems can mean a longer surgery. Some of the conditions that we are able to treat through a hysteroscopic method include:

  • Polyps of the lining of the uterus (endometrial polyps)
  • Severe narrowing of the cervix (cervical stenosis)
  • Benign cavitary tumors that arise from the muscular layer of the uterus (uterine fibroids)
  • Congenital abnormalities of the uterus (uterine septum)
  • Abnormal uterine bleeding
  • Scarring within the uterine cavity (intrauterine adhesions)

The recovery time from this procedure is usually no more than 2 to 3 days and many patients are able to resume their usual activities sooner. If a hysteroscopy has been recommended to you, Dr. Moghadam will provide you with specific details and answer all your questions in a preoperative consultation.

Laparoscopy

A laparoscopy is recommended as a diagnostic evaluation under a number of circumstances including:

  • Symptoms or history suggestive of endometriosis
  • Abnormal or inconclusive hysterosalpingogram (HSG) findings
  • Pelvic pain unresponsive to medical therapy
  • History suggestive of pelvic scar tissue (adhesions)
  • Ovarian cyst(s) unresponsive to observation or medical therapy

This procedure involves placement of a camera through a very small (5 to 7 mm) incision in your navel and other delicate instruments through one or more similar incisions in your lower abdomen (bikini line). Once inside your abdomen, Dr. Moghadam is able to provide you with a thorough assessment of your pelvic anatomy, including your ovaries and fallopian tubes, and treat many conditions that can be either inciting or contributory causes of infertility.

Performed in an outpatient setting under anesthesia, a laparoscopy typically lasts between 1 to 2 hours, although more difficult cases can be longer. The typical recovery period following surgery is 5 to 7 days dependent upon the extent of the laparoscopic procedure. Before you give serious consideration to undergoing a laparoscopy, Dr. Moghadam will provide you with specific details and answer all your questions in a preoperative consultation.

Pelvic Ultrasound/Antral Follicle Count

 A pelvic ultrasound is a test that is useful in many circumstances when a woman is seeking evaluation and treatment of infertility. Since a transvaginal ultrasound provides a close-up assessment of the pelvic organs, this is the approach that we will most often utilize. For women with irregular menstrual cycles or abnormal bleeding, a pelvic ultrasound can be helpful in determining which medication(s) to administer for cycle regulation. Most frequently, we will obtain a pelvic ultrasound to evaluate your response to medications that stimulate the ovaries in the context of ovulation induction.

Before a stimulation cycle is begun, we recommend undergoing a baseline ultrasound, usually performed on day 2 or 3 of your cycle. This helps to ensure that there are no residual cysts from your previous cycle (i.e. the ovaries are in a baseline state) and allows Dr. Moghadam to perform an important evaluation of your ovaries—the antral follicle count (AFC).

Each woman possesses a finite number of follicles in each of her ovaries dating back to before birth, and a certain number of these follicles are brought to the forefront each month. Since these small (between 3 to 10 mm) early follicles are visible via ultrasound early in the menstrual cycle, the AFC is helpful in selecting a specific stimulation protocol for each patient. Multiple articles have demonstrated that the AFC is perhaps the best predictor of patient response to medication (i.e. the number of mature follicles); research has also suggested that an AFC greater than or equal to 11 follicles was a significant predictor of live birth following in vitro fertilization (IVF) cycles (Maseelall PB, Fertility & Sterility, April 2009).

Saline-Infusion Sonogram (SIS)

A sonohysterogram or saline-infusion sonogram (SIS) is a specialized ultrasound of your uterine cavity to identify and characterize abnormalities such as fibroids, polyps, scarring, and congenital malformations.

Please call our office on the first day of your menstrual flow (day 1). This test is scheduled between your fifth and twelfth cycle days, and is performed in the office as a brief procedure. We again suggest that you take ibuprofen, naproxen, or tylenol 30 minutes before the test to reduce cramping.

To begin, you will be placed on the examining table and positioned on foot rests as with a pelvic examination. Your physician will place a speculum to visualize your cervix and clean with an iodine-based solution before placement of a thin catheter into the lower portion of the uterine cavity. Once the catheter is in place, the speculum is removed, and the transvaginal ultrasound probe will be inserted vaginally to visualize the catheter. Using gentle pressure with a syringe, a sterile saline solution is then placed into the uterine cavity for direct visualization of any abnormalities under ultrasound.

Occasionally, you may experience some light cramping and/or some light bleeding or watery discharge after the test. This will usually resolve within 48 hours. If pain or bleeding continues beyond this time, a fever develops, or if you have any other questions you should contact us immediately for further instruction.

Male

Semen Analysis

A semen analysis is a useful preliminary test to determine whether or not there is a need for further evaluation and/or treatment for male factor infertility. Once you have made an appointment, the specimen can either be obtained in a private collection room at one of our two locations (Austin Fertility Institute office or Austin Surgical Hospital) or following home collection—please remember that when the specimen is obtained at home it needs to be dropped off no later than an hour after collection. In either case, the male partner should not have had any ejaculation in the preceding 3 to 5 days.

Although the analysis includes comprehensive assessment of the sample provided, there are primarily three features that we focus upon in gauging the fertility potential of the male partner:

  • Sperm Count (expressed in millions of sperm/milliliter of specimen)
  • Sperm Motility (expressed as the combined percentage of rapidly and slowly forward-moving sperm)
  • Sperm Morphology (expressed as the percentage of sperm exhibiting a perfectly normal head, midpiece, and tail)

If any of the above parameters are abnormal, we will usually recommend a second semen analysis obtained at least two weeks after the initial assessment before recommending further evaluation or treatment.

Urologist Referral

 For more severe cases in which the male partner has a very low concentration of moving sperm (e.g. fewer than 5 to 10 million) on at least two semen analyses, or if there are no sperm in the ejaculate (azoospermia), Dr. Moghadam will often refer you to a urologist with experience in male fertility evaluation and treatment. It is important to remember that each semen specimen represents a 90-day ‘snapshot’ of a male partner’s sperm quantity/quality—lifestyle, medical, and/or surgical interventions to improve semen parameters will often take up to 6 months before it is clear if they have been beneficial. If you are a patient that is new to our practice, please contact us and we can help you find a male infertility specialist.

Due Date Calendar