Female Fertility Work Up

The Day 2 – Day 3 Hormone Profile Test evaluates key hormones that are integral to a woman's reproductive cycle. Understanding the delicate balance of these hormones is crucial in assessing female fertility. These hormones include:

Follicle-Stimulating Hormone (FSH): Essential for stimulating the growth and maturation of ovarian follicles, each containing an egg.

Luteinizing Hormone (LH): Plays a pivotal role in triggering the release of a mature egg from the ovary.

Estradiol (E2): A form of estrogen that promotes the thickening of the uterine lining, preparing it for potential implantation.

Prolactin: An essential hormone for lactation. However, elevated levels of prolactin (hyperprolactinemia) can impede ovulation, disrupt menstrual cycles, and prevent implantation. Maintaining balanced prolactin value is essential for a successful IVF outcome.

Thyroid Stimulating Hormone (TSH): An essential hormone for optimal thyroid gland function. Elevated levels of TSH can lead to menstrual irregularities, ovulatory dysfunction, and reduced IVF success rate.

Optimal Timing for Testing:

To ensure the most accurate hormone measurements, this test should be conducted on day 2 or day 3 of your menstrual cycle.

How is this Test Conducted?

A small blood sample, approximately 2ml – 3ml, is drawn during the specified window of your cycle to assess the levels of these hormones.

Purpose of the Test:

The results offer valuable insights into your ovarian function and reserve. They also help predict your response to ovarian stimulation medications if such treatment becomes necessary. This test is a vital tool in fertility evaluations, guiding personalized treatment plans for optimal outcomes.

The AMH test measures the number of remaining egg follicles in a woman’s ovaries and helps predict how well she may respond to ovarian stimulation during fertility treatment. Higher AMH levels generally indicate a better expected response to Controlled Ovarian Stimulation (COS).

Correlation with Age: AMH levels are closely linked to a woman’s age. Women over 35 typically show lower AMH values, which may indicate diminished ovarian reserve and reduced responsiveness — or even non‑responsiveness — to ovarian stimulation medications.

What is the timing for this test? The AMH test has the advantage of not being cycle‑dependent, allowing flexibility in scheduling. However, for optimal consistency, it is recommended to perform the test between Day 2 and Day 7 of the menstrual cycle.

How is this test done? The test requires a small blood sample, usually between 2 ml and 3 ml, to accurately measure AMH levels.

The Day 21 Progesterone (Ovulation) Test is a blood test used to confirm whether ovulation has occurred.

It is typically performed on Day 21 of a 28‑day cycle, when progesterone levels should be at their peak.

For women with irregular cycles, the test may be paired with additional hormonal evaluations to provide a more complete picture of ovulatory function.

A transvaginal ultrasound provides detailed images of the reproductive organs.

It assesses:

• Uterus – fibroids, polyps, congenital abnormalities

• Ovaries – cysts, polycystic ovary syndrome (PCOS)

• Endometrial lining – thickness and pattern

• Antral follicle count (AFC) – an important measure of ovarian reserve

Ultrasound is a cornerstone of female fertility evaluation.

The Hysterosalpingogram (HSG) is a specialized radiological procedure that provides a detailed, image‑based evaluation of a woman’s reproductive health. This test is primarily used to determine:

• The patency of the fallopian tubes, which is essential for natural conception. • The contour and structure of the uterus, helping diagnose conditions such as intrauterine adhesions (Asherman’s syndrome) and other possible uterine abnormalities.

Important Consideration

At Viva Fertility Clinic, we typically recommend conducting a semen analysis for the husband or male partner first, to rule out male‑factor infertility before proceeding with the HSG test.

Optimal Timing for HSG

To ensure accuracy and safety, the HSG procedure is scheduled after menstruation and before ovulation—specifically between cycle days 5 and 10. This timing helps avoid disrupting a potentially implanting embryo.

How Is This Test Done?

The procedure involves gently passing a small catheter through the cervix into the lower part of the uterine cavity. A radiopaque contrast fluid is then injected through the catheter to fill the cavity. As the fluid flows through the uterus and fallopian tubes, a series of X‑ray images is taken to visualize the reproductive structures.

Sono‑HSG is an ultrasound‑based alternative to HSG that uses saline or water to fill the uterine cavity, allowing clinicians to assess

• tubal paten
• uterine abnormalities such as fibroids or polyps.

It offers key advantages, including no radiation exposure, better visualization of pelvic structures, and reduced discomfort.

When Can I Do This Test?

The test is performed between cycle days 5 and 10 and takes about 10–20 minutes

How Is This Procedure Done?

It involves inserting a small catheter trans-cervically into the lower part of the uterine cavity and injecting either water or normal saline through the catheter to fill the uterine cavity. A video image of the fluid's movement is then captured with ultrasound.

A minimally invasive procedure where a small camera is inserted into the uterus.

It helps diagnose and treat:

• Polyps

• Fibroids

• Scar tissue (Asherman’s syndrome)

• Uterine septum

Hysteroscopy is often recommended when ultrasound or HSG suggests abnormalities.

Tests may include:

• Cervical swabs for infections

• Pap smear (if due)

• Screening for STIs such as chlamydia or gonorrhoea

Untreated infections can affect fertility and pregnancy outcomes.

In addition, several routine assessment tests are essential for overall health and fertility. They include:

• Blood Group and Rh Factor: Determining blood type and Rh factor helps assess compatibility between partners and identify potential risks during pregnancy.

• Genotype: Genotype testing identifies genetic variations that may affect fertility or reveal inherited conditions.

• Random Blood Sugar: Monitoring blood glucose levels supports overall health and helps detect or manage conditions such as diabetes.

• Anti‑HIV and Anti‑HCV: Screening for HIV and hepatitis C is crucial for the well‑being of both partners and for safe fertility treatment.

• VDRL (Venereal Disease Research Laboratory): This test detects syphilis, a sexually transmitted infection that can impact fertility and pregnancy outcomes.

• HBsAg (Hepatitis B Surface Antigen): Screening for hepatitis B helps prevent transmission and supports safe reproductive care.

Once investigations are complete, your specialist will discuss:

• Identified causes of infertility

• Treatment options such as ovulation induction, IUI, IVF, or surgery

• Lifestyle modifications to improve fertility

• Timelines and success expectations

At Viva Fertility Clinic, we tailor every treatment plan to the woman’s age, diagnosis, and personal goals.

Conclusion

Female fertility investigations provide essential insight into reproductive health and are a vital first step in the journey toward conception. With accurate diagnosis and personalized care, many women achieve successful pregnancies — even after years of difficulty.

At Viva Fertility Clinic, we are committed to guiding you with expertise, empathy, and hope.

If you’re travelling from outside Abuja, Nigeria. Consider booking  morning appointment allows you to complete your fertility work‑up on the same day, saving you time and reducing the need for multiple trips.