| Being infertile means
you will be subjected to a series of tests. These tests
help your doctor to determine what your medical problem
is; and also to monitor your infertility treatment. The
most important test for assessing male fertility is
the semen analysis.
Semen Analysis
Parameter Results /Normal Values
Colour Gray
Coagulate? Yes
Liquefy ? Yes
If yes, time in minutes < 30
Volume (ml) 2 to 6
pH 7.5 to 8.0
Sperm concentration 20-200 ( million per ml)
Grade of sperm motility Grade a,b ( forward progressive)
% motility > 50%
Motile sperm count > 10 million per ml
White blood cells < 1 million/ml
Agglutination nil
Morphology > 30 % normal forms
Interpreting the semen analysis reports can be tricky,
and you need to
remember that values can fluctuate considerably. Read
the chapter on
Interpreting the Semen Analysis from our book, How to
Have a Baby.
For some men with azoospermia ( zero sperm count), your
doctor may need to measure the levels of the following
reproductive hormones, in order to make a diagnosis
of hypogonadotropic hypogonadism.
Normal Hormone Values for men
Testosterone 300 - 1100 ng/dl
Prolactin 7 - 18 ng/ml
Luteinising Hormone ( LH) 2 - 18 mIU/ml
Follicle Stimulating
Hormone ( FSH): 2 - 18 mIU/ml
Estradiol ( Day 3): < 50 pg/ml
Normal Hormone Values for women
The most important tests for women are blood tests for
measuring the key reproductive hormones. We usually
measure 4 key reproductive hormones - FSH ( follicle
stimulating hormone) ; LH ( luteinising hormone) , prolactin;
and TSH ( thyroid stimulating hormone) on Day 3 of the
cycle as part of the basic infertility workup.
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Phase of Cycle
Hormone Follicular Day of LH Surge Mid-luteal
Follicle Stimulating < 10 mIU/ml > 15 mIU/ml -
Hormone (FSH)
Luteinising Hormone
(LH) < 7 mIU/ml > 15 mIU/ml -
Prolactin < 25 ng/ml
Thyroid Stimulating Hormone 0.4 - 3.8 uIU/ml
(TSH)
Values can vary from lab to lab, so please check what
the normal range is in your lab. Interpreting the results
correctly is very important, so please ask your doctor
for help !
The FSH level measures your ovarian reserve ( ovarian
function). A high level ( of more than 10 mIU/ml) suggests
poor ovarian function.
Very low levels of FSH and LH suggest you have hypogonadotropic
hypogonadism.
Normally, the level of LH and FSH is roughly the same.
A high LH with a normal FSH level ( a reversed LH:FSH
ratio of more than 2:1 ) suggests PCOD ( polycystic
ovarian disease).
The TSH is an excellent test for screening for hypothyroidism
( low thyroid function).
A high level of prolactin is called hyperprolactinemia;
and needs to be treated.
The 2 key hormones produced by your ovary are estradiol
and progesterone.
Phase of Cycle
Hormone Follicular Day of LH Surge Mid-luteal
Estradiol ( E2) < 50 pg/ml ( Day 3) > 100 pg/ml
Progesterone < 1.5 ng/ml > 15 ng/ml
The Day 3 estradiol level should be less than 50 pg/ml.
A high Day 3 estradiol level suggests poor ovarian reserve.
The estradiol level rises in the follicular phase as
the follicle matures, and is very useful for measuring
follicular activity. A mature follicles produces more
than 200-300 pg/ml of estradiol; and serial E2 levels
are often measured for monitoring superovulation in
IUI and IVF treatment cycles.
The progesterone level should be more than 15 ng/ml
about 7 days after ovulation. This suggests that the
corpus luteum is functioning normally. A low Day 21
progesterone levels suggests the cycles was anovulatory
( no egg was produced).
If the TSH level is abnormal, the doctor will need
to measure the levels of your thyorid hormones ( T3
and T4).
Free T3 (Triiodothyronine) 1.4 - 4.4 pg/ml
Free T4 (Thyroxine) 0.8 - 2.0 ng/dl
If you are hirsute ( have excessive body hair), then
some doctors will measure the levels of the following
male hormones ( called androgens).
Total Testosterone 6.0 - 86 ng/dl
Free Testosterone 0.7 - 3.6 pg/ml
DHEAS 35 - 430 ug/dl
(Dehydroepiandrosterone sulphate)
Androstenedione 0.7 - 3.1 ng/ml
beta HCG levels
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When you get pregnant, the doctor will monitor the
health of your pregnancy
by measuring your beta HCG ( also known as beta) levels.
A pregnancy should be documented as early as possible.
This is important, because appropriate care and precautions
can then be taken at an early stage. The most sensitive,
accurate and reliable
pregnancy test is a blood test for the presence of beta
HCG
(human chorionic gonadotropin), often just called "beta".
The HCG is produced by the embryo, and is the embryo's
signal to the mother that pregnancy has occurred.
Beta HCG levels vary according to the gestational age.
In a non-pregnant woman, they are less than 10 mIU/ml.
They are typically about 100 mIU/ml 14 days after ovulation
in a healthy
singleton pregnancy. They should double every 48- 72
hours in a healthy
pregnancy.
The levels are higher in a multiple pregnancy; and if
the levels don't double
as expected, this suggests that the pregnancy is unhealthy.
Possibilities
include a non-viable intrauterine pregnancy which will
miscarry; or an
ectopic pregnancy.
If the beta HCG level is more than 1000 mIU/ml, and
the doctor cannot see a
pregnancy sac in the uterine cavity on vaginal ultrasound
scan, then it's
possible you have an ectopic pregnancy.
Beta HCG levels can be measured in the blood by RIA
(radioimmunoassay) , CLIA (chemiluminescent assay) and
DELFIA ( fluorescent immunoassay) testing; and positive
levels (more than 10 mIU/ml) in the blood can be detected
as early as 2 days before the period is missed. In the
old days, the only way of determining the presence of
HCG was by testing the urine, i. e, by using urine pregnancy
test kits. Modern urine pregnancy kits (using monoclonal
antibody technology ) are now quite sensitive and can
detect a pregnancy as early as 1 to 2 days after missing
a period (at a blood HCG level of about 50 to 100 mIU/ml).
The benefit of urine pregnancy test kits is that they
are less expensive; and testing can be done at home
by the patient herself. However, instructions need to
be followed carefully, and errors in interpreting the
test results are not uncommon. These errors could occur
if the urine is too dilute; or if the test is not done
properly; or if there is a urinary tract infection exists.
The major advantage of blood tests is the fact that
they measure the actual level of the HCG in the blood
- and this factor can be very helpful in managing pregnancy
problems, if they occur. Most clinics start testing
beta HCG levels about 14 - 16 days after egg collection;
and repeat the test every 48-72 hours. As the embryo
grows rapidly, HCG levels normally double every 2 to
3 days. Thus, one reliable sign of a healthy pregnancy
is the fact that the HCG levels are increasing rapidly,
and often doctors will measure serial beta HCG levels
3 days apart in order to determine the viability of
the pregnancy. A rising HCG level is reassuring. Typically,
in a healthy singleton pregnancy, the beta HCG level
is about 100 mIU/ml about 16 days after ovulation, though
this level can vary considerably. The levels are higher
in multiple pregnancies; and lower in non-viable pregnancies
and ectopic pregnancies.
Problems with HCG testing can occur if you have earlier
been given HCG (human chorionic gonadotropin) injections
for inducing ovulation. Normally, this exogenous HCG
is excreted by the body in 10 days; but sometimes it
can linger on. This is why, if the HCG level is very
low, the test may need to be repeated, to confirm that
the level is increasing.
What are "biochemical pregnancies" ? These
are pregnancies in which the HCG test is positive after
the period has been missed; the levels increase, but
are still low; and no pregnancy is ever documented on
ultrasound. Biochemical pregnancies are often seen after
IVF and GIFT. While they are not clinical pregnancies,
they are of useful prognostic information, because they
may mean that your chance of getting pregnant in a future
cycle are good.
One drawback with the HCG test is that a positive HCG
simply means a pregnancy is present in the body - it
does not provide any information about the location
of this pregnancy, which may be tubal or ectopic.
During the very early pregnancy, HCG levels are the
only way of monitoring the pregnancy. HCG levels which
do not increase as rapidly as they should may mean that
there is a problem with the pregnancy - the embryo may
miscarry because it is unhealthy; or the pregnancy could
be an ectopic pregnancy. Differentiating between the
two conditions is obviously important, and this is where
vaginal ultrasound plays a key role.
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