Investigations and ART

Question 1

Orthodox fertility investigations

Answer 1

• Ultrasound scans
• Serum FSH, Oestrogen (Day 1-5) and Progesterone (Day 21)
• Thyroid function
• Glucose levels and IR
• AMH (anti-mullerian hormone)
• Sperm sample
• Testing for infections

Question 2

AMH (anti-mullerian hormone)

Answer 2

AMH is a protein that is used as a marker of ovarian reserve. It is tested using blood and is produced by the ovaries
*↑ AMH could be PCO. ↓ AMH / reserve is likely to respond poorly to IVF drugs.
* AFC (antral follicle count) is done via ultrasound scan to check numbers of follicles in both ovaries.

Question 3

Functional fertility investigations (Female)

Answer 3

• Toxic metals profile
• MTHFR/COMT
• Homocysteine
• Adrenal stress profile
• RBC minerals - intracellular levels zn, mg
• Oxidative markers
• Immune investigations: NK, HLA, antiphospholipid antibodies, ASA
• VMB
• Hormone panel - DUTCH

Question 4

Functional fertility investigations (Male)

Answer 4

• DNA fragmentation
• Serum or urine analysis of amino acids
  Organic acids test

Question 5

Assisted Reproductive Technologies

Answer 5

• Intrauterine insemination (IUI) sperm is placed inside uterus around ovulation to facilitate fertilisation.
• In vitro fertilisation (IVF): Stimulation of ovaries,
  egg retrieval, fertilised in vitro with sperm, fertilised embryos transferred into uterus.
• Intracytoplasmic sperm injection (ICSI): Sperm is injected into egg in vitro (if fertility issue is due to sperm abnormalities).

Question 6

Risks of IVF

Answer 6

• Multiple births
• Premature delivery and low birth weight
• Ovarian hyperstimulation syndrome: swollen and painful ovaries due to injected fertility drugs such as hCG
• Egg retrieval procedure complications
• Ectopic pregnancy (2-5%)
• Cancer