THE DIAGNOSTIC CYCLE

Our program offers an efficient diagnostic pathway to determine the cause of infertility. Both partners are evaluated concurrently since male factors are involved in half of the cases.  In most cases, the cause of infertility can be found within 1 to 2 cycles. The diagnostic cycle can be summarized as followed:

	Day 2 or 3:     Baseline sonogram, serum FSH level to check the ovaries.
	Day 7 to 10:   HSG to check the tubes and the uterus.
	Day 13:          Sonogram to check follicular growth.
	Day 15:          Intercourse or Intrauterine Insemination (IUI) if indicated.
	Day 21:          Serum progesterone to confirm ovulation.

Day  2-3                       7-10            13              15                       21

Sono, FSH             HSG          Sono            IUI                Progesterone

         

Follicle Stimulating Hormone (FSH) is secreted from the pituitary and acts on the ovaries to recruit eggs. When the egg reserve declines with age, the pituitary compensates by producing a higher level of FSH to make eggs available for the cycle. A high FSH level at the beginning of the cycle therefore reflects a diminishing egg supply. FSH level should be less than 10 mIU/ml on cycle day 2 or 3. A baseline FSH level higher than 15 mIU/ml is rarely associated with pregnancy even with aggressive treatment.

The Clomiphene Challenge Test (CCT) provides a better assessment of the ovarian reserve than the baseline FSH level. It is a useful test for women of age 35 or older. FSH release is amplified by clomiphene, thus allowing early detection of women with only slight decrease in egg reserve.  In this test, FSH is measured before and after a 5 days course of clomiphene. Passing the test requires FSH level of less than 10 mIU/ml in both instances and gives some assurance of adequate ovarian reserve. The CCT yields no information on the egg quality. Because clomiphene also induces ovulation, the CCT can be combined with an IUI to give the patient a chance to conceive in the same cycle. It is uncommon but not rare to see pregnancies resulted from a failed CCT cycle. The CCT cycle is conducted as followed:

	Day 2 or 3:   Baseline sonogram and serum FSH level to check ovaries.
	Day 5 to 9:   Clomiphene is taken orally 100 mg a day.
	Day 10:        Second serum FSH level.
	Day 13:        Sonogram to assess follicular growth. HCG injection to trigger ovulation.
	Day 15:        Intercourse or intrauterine insemination (IUI) as indicated.
	Day 21:        Serum progesterone level to assess the quality of ovulation.

Day 3       5                           9   10           13           15                     21

Sono, FSH #1                        FSH #2     Sono       IUI             Progesterone Progesterone

Clomiphene

HCG Injection