Pregnancy Planning: Fertility Tests and Infertility Tests

The list of analyzes and tests for couples planning a child is huge. These examinations require time, money and yes, nerves. And what, they are all needed? MedAboutMe tells what is really necessary, what from the list of examinations does not make sense before conception — if there are no special indications to undergo them.

Even more options appear when there are problems with conception. And it’s easy to get confused here too. Our guide to tests and analyzes has all the options with explanations and prices.

Pregnancy planning: what is prescribed and what not to do

Wanting a healthy baby is a normal desire. And to be afraid of possible problems too. It is very easy to play on this fear of complications by assigning potential parents a lot of studies «needed by everyone.» Their list is long — from tests for infections of the genital organs to the identification of biomarkers unknown to ordinary people. And the likelihood of appearing in the list of unnecessary recommendations is quite high.

What analyzes are not needed by all planners?

Screening for toxoplasmosis and cytomegalovirus infection

If a woman is healthy and there are no symptoms of toxoplasmosis or active cytomegalovirus, then an analysis for their antibodies is not needed. As well as it makes no sense to carry them out to all pregnant women. This is also indicated in the clinical guidelines of the Russian Federation (“Normal pregnancy”).

Evidence-based (and official) medicine believes that testing for antibodies to these infections often entails unreasonable therapeutic prescriptions. And the test for antibodies to toxoplasma, in addition, also sins with an increased number of false positive responses.

Genital herpes: when analysis is needed

Herpesvirus infection needs to be treated — if it worsens when there is a rash. It can really be dangerous for a child. But it makes no sense to conduct an analysis without symptoms: 9 out of 10 healthy adults will have class G antibodies (IgG) to the second type of herpes simplex virus. This means that the body is familiar with the virus and herpes can become active. Or maybe not.

Similarly, an uninfected woman can become infected at any time.

Sexually Transmitted Infections (STIs): Does Everyone Need Testing?

Testing for antibodies to STI pathogens is indicated for those who have suspected sexually transmitted infections at the moment or in the past, as well as people who have had or have had sex with several partners (of any gender).

Theoretically, with an orderly sexual life and a single and faithful partner over the past decade, such a study is not needed. But in fact, due to the lack of complete certainty, it is still worth doing — and this is the official recommendation.

This recommendation applies to the detection of chlamydia, gonorrhea, mycoplasmosis, syphilis. But everyone needs an analysis for HIV infection and hepatitis B and C: their pathogens can be transmitted not only through sexual contact.

Tests for ureaplasmosis and gardnerellosis: are they needed?

This is the most common of the completely unnecessary appointments. Ureaplasma and gardnerella are part of the conditionally pathogenic flora that make up the normal microbiocenosis of the vagina. The presence of these pathogens does not indicate danger and does not require therapy — which means that there is no point in conducting tests.

Ureaplasmosis and gardnerellosis are inflammatory diseases that can develop under certain conditions. There are no studies proving the harmful or teratogenic effects on the fetus of these bacteria and the diseases they cause.

However, if there are symptoms of nonspecific vaginitis or its predecessor, vaginal bacteriosis, tests and therapy are needed. In addition to the general effect on the state of the reproductive system, bacteriosis can prevent conception, cause premature birth and some congenital abnormalities of the fetus.

It is important to remember that if there are symptoms or a confirmed diagnosis of vaginosis or thrush in one partner, both should be treated. Otherwise, the likelihood of re-infection is high.

Blood tests when planning pregnancy: are general data needed?

If you regularly undergo medical examinations or health checks (for persons 18-39 years old it is recommended once every 3 years), you feel well, there are no chronic diseases and complaints, then there is no need to additionally take a clinical blood test and «biochemistry» before preparing for conception. They will be carried out in the first trimester of pregnancy to assess the body’s response to gestation.

But if there are complaints, reasons to consider yourself unhealthy — then, of course, it is necessary to identify the causes and, if possible, eliminate them before conception.

Cytology and analysis for the human papillomavirus (HPV): are they needed?

These tests should be done regularly for all women as part of their cervical cancer screening.

Pap test, Pap test, biomaterial for cytology — all this is the name of one study, which is recommended for all women over 21 to take place every three years.

PCR analysis for HPV is recommended from the age of thirty once every five years. The presence of the virus does not increase the risks during pregnancy, however, its oncogenic types (the most dangerous are 16 and 18) provoke the degeneration of cervical cells into a cancerous tumor and other HPV-associated forms of cancer. And, of course, it is necessary to bear a child without such pathologies.

In Australia, the HPV vaccination program has been in place since 2007. There has been accumulated vast experience confirming the absence of complications from vaccinations. But most importantly, today cases of cervical cancer on the whole continent have become extremely rare.

Are all planning women shown tests «for hormones»?

It is necessary to assess the state of reproductive function in terms of the amount of hormones in a planning woman if there are menstrual irregularities, problems with conception. If there are no such complaints, there is no need to donate blood “for female hormones”.

When pregnancy occurs, an assessment of thyroid hormone levels is recommended. If there are deviations in the results, therapy is carried out for successful gestation.

Levels of vitamins, iron, protein, omega: is it necessary?

Checking the levels of vitamin D, iron, protein, omega acids are very popular today. Simplicity captivates: you can identify deficiencies without going to the doctor and quickly eliminate them with the help of self-appointment of various complexes and dietary supplements. We will not repeat once again about the risks of such self-diagnosis and treatment, you just should not do this without professional advice.

However, when preparing for pregnancy, many consider it obligatory to “look just in case” what stocks of these important substances are in the body. And willingly go to the tests. So the general direction of all those planning to conceive in this case is completely unnecessary. Vitamin and microelement deficiencies have corresponding symptoms. And based on such symptoms, the doctor may prescribe additional tests.

Biomarker tests: determination of homocysteine, folate cycle genes, immunocompatibility, etc.

If a clinical blood test “at will” can sometimes be done — for example, there are no clear symptoms of ill health, but something still worries — then these studies are carried out only according to indications! In particular, with habitual miscarriage, aggravated course of a previous pregnancy, history of thrombosis, genetic predispositions.

Consultation with a doctor: an obstetrician-gynecologist or a therapist helps to decide on the appropriateness of such examinations.

Who needs a genetic consultation before pregnancy?

A genetic examination of the first stage is a consultation with a geneticist, which is also not needed by everyone. Even before in vitro fertilization or in the treatment of infertility. To whom is it shown?

• People with hereditary diseases or genetically transmitted malformations of future parents or their close relatives to resolve the issue of the need for screening for the carriage of genetic pathologies.
• In consanguineous marriage.
• At the stage of examination of the causes of infertility or habitual miscarriage.
• During pregnancy — to decipher the adverse results of prenatal screening, invasive methods of prenatal diagnosis.

And what then does everyone need in preparation for pregnancy?

Lots of unnecessary tests. And in fact, all women need only a consultation with a gynecologist. He will collect health data and, if necessary, may prescribe additional tests or consultations of other specialists (most often a therapist and an endocrinologist).

However, if you do not miss scheduled visits with tests and examinations, no new complaints have appeared since the last medical examination and no studies recommended for all women have appeared, then it is quite reasonable to limit yourself to a comprehensive analysis for TORCH infections.

Tests and analyzes for female fertility

Fertility tests are a separate group of studies (although they are often unreasonably included in “planned preparation for pregnancy”). They can give a woman an idea of ​​how easy (or difficult) it will be to conceive a child before embarking on her first (or next) attempts. Let’s figure out who might need them right away and what kind of tests there are.

Fertility is “fertility”, the ability to conceive (and for a woman also bear and give birth) a viable child. And in the case of female fertility, it all starts with ovulation.

Tests, analyzes, ultrasound: how to check ovulation?

How to determine ovulation? In the dynamics of several cycles with anovulatory cycles or irregular periods, this can seem like a long and annoying process. However, without its identification, the path to conception becomes much more complicated. The doctor will help you choose the most optimal way to determine the day of ovulation. And what are the ways?

• Ovulation test strips

These home tests are sold in pharmacies. They respond to the level of luteinizing hormone (LH) in the urine. A positive ovulation test means that a mature egg will be released from the follicle within 24 hours.

Such tests are carried out two days before the expected ovulation and continue until the test becomes positive or within the next two weeks. According to scientists, this occurs 14 days before the onset of menstruation, so the date is determined by studying the duration of several cycles.

With an irregular cycle, the doctor calculates the period between the earliest and latest possible ovulation date.

When conducting home tests for ovulation within 5 days, the probability of detecting the date is 80%. If you spend 10 days, then it increases to 95%.

As soon as the test becomes positive, it is not repeated in this cycle.

If ovulation does not occur for two or more cycles in a row, a specialist consultation is necessary. Normally, women of reproductive age up to 35 years old can have two anovulatory cycles per year, but not in a row. From the age of 35, their frequency may increase.

In addition to home test strips (there are also such strips inside digital tests!) There are also options for determining ovulation by the presence of crystals in saliva using a mini microscope or a smartphone camera attachment (and installing an application).

The cost of a «paper» test strip for ovulation is from 60 rubles, digital tests with replaceable strips from 500 rubles.

• Determination of ovulation using ultrasound

The eggs mature in follicles, fluid-filled sacs. They grow — and the follicles swell with them. This increase can be seen with the help of ultrasound, ultrasound.

Before ovulation, the walls of the follicles become thinner and stretched. The egg, as a rule, comes out at the stage of follicle enlargement within 1.8-2.5 cm. This may be accompanied by unpleasant sensations in the lower abdomen on the left or right.

Ultrasounds can be performed on different days of the same cycle to clarify the condition of the follicles and determine the dates of the fertility window, when conception is most likely. Most often from 5-6 days of the cycle.

• Measurement of basal temperature

This is one of the longest and most demanding methods for calculating ovulation. Basal temperature (on the mucous membranes of the body) is sensitive to changes. Rectal readings are preferred when plotting basal body temperature.

How to measure it?

• Every day at the same time, preferably within half an hour.
• Early in the morning — immediately after waking up and before getting out of bed. Even going to the toilet can affect the readings of the thermometer.
• Lying on your side, insert the tip of the thermometer into the anus. A mercury thermometer is inserted 3-4 cm and wait 7 minutes, the rest of the options are according to the instructions.
• Readings are entered into a graph on paper or in the application.

The thermometer is disinfected daily in an accessible way. Mercury can be wiped with an alcohol-containing substance, digital and others — according to the instructions (if liquids cannot be used, use a damp cloth). This thermometer is used only for basal temperature — so get a separate device.

Normally, just before ovulation and in the next few days, the basal temperature becomes above 37.0 ° C (usually 37.2 ° -37.4 ° C) and decreases only before menstruation. If conception occurs, then the temperature does not fall at the time of the expected menstruation. Its decrease in early pregnancy indicates a threat of miscarriage and other pathologies of gestation.

• Ovulation by blood test

In the blood, the level of luteinizing hormone is determined — its increase helps to predict the onset of ovulation. However, this peak is short-lived and can be missed, so it is wiser to use test strips to detect the amount of LH in the urine.

In the blood, they can also determine the hormone estradiol (a type of estrogen), which is produced in growing follicles. Its amount increases before the release of the egg. However, these indications are affected by the drugs used in the IVF stimulation protocol, in which case the level of this hormone helps track the growth of follicles, but is not considered a marker of ovulation.

A week before the onset of menstruation, the amount of progesterone in the blood rises. This can affect a woman’s well-being, but post factum does not help determine ovulation.

Definition of ovarian reserve

If a woman is unable to conceive, a fertility doctor may recommend a test to determine her ovarian reserve, the quality score, and the number of eggs left in her ovaries. Doctors sometimes offer these tests to women who are interested in their ability to conceive not only after unsuccessful attempts, but also because of the patient’s age or other factors.

An ovarian reserve test usually consists of a blood and/or urine test to determine levels of the hormones inhibin B, anti-Müllerian hormone (AMH), and follicle-stimulating hormone (FSH). The first two indicators usually decrease as the number and quality of eggs in a woman decreases, and the third tends to increase.

But a startling new study shows that decreased ovarian reserve may not actually be a predictive sign of infertility. The authors say their study, published in JAMA, should convince women not to rely too much on such tests when making decisions about their reproductive health.

In addition, scientists are also concerned about the downside of the definition of ovarian reserve. Dr. Steiner reports that a positive test result in a 35-36-year-old woman can mistakenly reassure and encourage her to wait a couple more years before conception or egg freezing. And that two-year period can make a huge difference to fertility.

To summarize: it is worth determining the ovarian reserve only according to indications (for example, at the age of over 35 years and unsuccessful attempts to conceive for six months), and you should focus on positive test results immediately, without expecting that this condition will last for a long time.

Male fertility analyzes and tests

In men with analyzes and tests, everything is a little easier. Spermatozoa are produced constantly, and sometimes up to a very respectable age.

There are two main examinations that are prescribed to identify the causes of infertility: a spermogram and a MAR test (MAR test). And additions to them that may be required after evaluating the results.

What will the spermogram show?

Spermogram — analysis of seminal fluid, which is needed when assessing the presence or risk of male infertility as a result of trauma, endocrine disorders, infections of the genitourinary system and chronic diseases, such as varicocele, prostatitis.

What is studied with a spermogram?

Sperm is examined in two categories:

• Physical and chemical indicators of the ejaculate (volume, consistency, viscosity, acidity, inclusions and much more);
• Characteristics of spermatozoa: their number, motility, morphology (structure), the ratio of normal and immature cells, etc.

Based on the results, information is generated: are there any signs of inflammatory processes (leukocytes, erythrocytes) in the seminal fluid, how many full-fledged and mobile spermatozoa are there.

Spermogram according to Kruger: how is it different?

The reliability of the results is affected by the criteria by which semen is evaluated. The standard is considered to be a spermogram according to the criteria of the World Health Organization (WHO) from 2010, it is also a “Kruger spermogram”.

Dr. T. Krueger developed these criteria back in 1986, but they are still considered the most reliable. Why is it important how a spermogram is made?

Some laboratories conduct research according to the recommendations of the times of the USSR, in which the program for studying the characteristics is smaller in comparison with the requirements of Dr. Krueger. In this case, the entire assessment is based on the study of an unstained preparation under a microscope, which makes it impossible to accurately identify morphological changes in cells.

To whom is a spermogram indicated?

This analysis is done to assess the fertility of a man. It is prescribed both to healthy people with suspected male factor infertility, and to patients with prostatitis, genital tract infections, varicocele, hormonal disorders, and groin injuries.

The spermogram is also indicated for assessing the effectiveness of vasectomy, sterilization surgery, and in the process of preparing a couple for IVF or ICSI, in vitro fertilization methods and intracytoplasmic sperm injection.

How to prepare and how to donate sperm for analysis?

Before donating the ejaculate, you must refrain from sexual intercourse, masturbation — in general, from any situation of semen excretion for three to seven days. The period of abstinence must be remembered. Since, for reliability, the spermogram is taken more than once, then before the next studies it will be necessary to withstand the same period without ejaculations — otherwise the sperm concentration will be different, and the comparison will not work.

After diseases with elevated temperature (even 37.1 ° C), baths, saunas, taking alcoholic beverages or prostate massage, you must endure seven days before taking the test, otherwise this may affect the results.

To be referred for a spermogram, the doctor must find out about everything that you are taking — from medications to vitamins and dietary supplements. Because even regular over-the-counter ibuprofen for pain affects testosterone production, which can affect sperm characteristics. The doctor will tell you what you can continue to take, what to pause with, and will note which spermogram results will need to be evaluated taking into account the influence of the drugs.

According to the recommendations of urologists of the Institute for the Study of Urological Diseases, you need to donate sperm:

• After a day without increased physical activity (sports) and a good night’s sleep.
• It is best to collect ejaculate in the laboratory, not at home. During transportation, spermatozoa may lose their mobility (it lasts only 60 minutes in a container) or die completely (survival requires a temperature of 20-37 ° C). If you still have to collect at home, you need to take the material to the laboratory immediately, and place the container in the inside pocket of your jacket, jacket, etc.
• They hand over the ejaculate in a separate room with a closed door, stimulating the penis on their own. Semen is collected in a transparent sterile plastic container for analysis with volume labels. These are sold in any pharmacy. As a rule, laboratories provide it, but it is better to find out in advance.
• The first portion of the ejaculate contains the largest amount of sperm, so you should try to get all the sperm into the container. If it did not work out, you must inform the employee who will receive the biomaterial.
• You can not use latex lubricants and condoms, latex changes the composition of sperm. You can’t use an ordinary condom either, only special non-toxic ones are suitable (which are not sold everywhere. If you can’t collect the ejaculate in a container, ask for one in the laboratory).
• Coitus interruptus or oral stimulation for testing is also prohibited — the vaginal environment and saliva change the pH of the semen and reduce sperm motility, in addition, they can add bacteria to the seminal fluid.

The doctor should decipher the results of the spermogram: in addition to the criteria, there may be options from 14 deviations, in addition, the ideal result of the spermogram does not mean the absence of problems, but the bad one does not mean the impossibility of becoming a father.

As an addition, related studies can be prescribed based on the results of a spermogram: determination of the level of prolactin, testosterone, markers of urogenital infections, etc.

MAP test: why is it needed and what will it show?

This study is indicated for male infertility with normal spermogram results. The MAP test (MAR test), or mixed antiglobulin analysis, helps to diagnose the immunological causes of infertility by identifying the percentage of motile spermatozoa that are able to fertilize an egg versus those that are not.

This is determined using the analysis of seminal fluid (direct MAR test) or blood (indirect) by a bunch of germ cells with antisperm bodies (ASAT) or immunoglobulins of classes A and G (IgA and IgG). The most valuable information for diagnosis is the definition of IgA.

• What is ASAT in the MAP test?

ASAT are special proteins with a carbohydrate component that are produced by the testicles and appendages. They are actively synthesized after injuries, with infections, inflammatory diseases, etc. (against the background of prostatitis, varicocele, cancer, pathologies of the genital organs).

These proteins act on membrane antigens on the spermatozoon in such a way that, while maintaining its shape and mobility, it loses the ability to fertilize the egg, although outwardly it looks quite high-quality and healthy.

Differences between spermogram and MAP test

Both tests are needed to determine the cause of fertility problems in men.

• A spermogram is a more general examination that may not reveal a problem if all indicators are within the normal range, and conception does not occur. It allows diagnosing genetic, infectious, viral causes, suspecting mechanical obstructions in the seminal canals, etc.
• The MAP test is a narrower study. It helps to diagnose the immunological causes of infertility. Its results indicate the number of mobile, but not fertile cells. Indications for its implementation are good spermogram results if it is impossible to conceive a child for a year or more. In other cases, it does not need to be done.

The cumulative results of both examinations in most cases make it possible to accurately describe and analyze the clinical picture of the pathology.

What else can be prescribed to men?

• The study of DNA fragmentation of spermatozoa is necessary only after the normal results of several spermograms and idiopathic infertility (when it is not clear what is the reason). The analysis is expensive (from 6900 rubles together with a spermogram — it is not carried out separately), it is really needed quite rarely.
• The HBA test shows how well the sperm attaches to the shell of the egg (to the hyaluronic acid in its composition). Also indicated only with normal results of several spermatograms. The cost in Moscow is 4500-7000 rubles.
• PCR test for the presence of chlamydia, mycoplasmosis, ureaplasmosis is indicated when an excess of leukocytes is detected in the semen, which indicates inflammation. The cost for one infection is from 370 rubles.
• According to the same indicators — an increased number of leukocytes — an analysis with sperm culture for microflora can be prescribed if the doctor suspects a bacterial infection. Cost — from 1760 rubles.
• Blood test for sex hormones: testosterone and follicle-stimulating hormone (FSH in men, despite the name, stimulates the formation of sperm and affects the secretion of testosterone). It is needed if the cells in the ejaculate are less than normal — sometimes this is due to a lack of sex hormones (hypogonadism). The cost for one indicator is from 750 rubles.