FERTILITY PROBLEMS: MONITORED CYCLE USING ULTRASOUND AND BLOOD TESTS

One clinic, Reproductive Healthcare in North London, uses a process called a monitored cycle. This involves taking a number of ‘snapshot’ tests over one menstrual cycle to identify the particular point where the cycle is not functioning. Conventionally, tests are all done on different cycles, a 21-day blood test in one month, maybe a laparoscopy another month. But doing it this way makes it hard to get the ‘big picture’ about what is actually happening with your reproductive system. You get more complete information by closely monitoring a single menstrual cycle. The monitored cycle looks at hormonal balance and reproductive function and the way they work together.

Monitored Cycle Using Ultrasound and Blood Tests

At the beginning of the cycle, between days 1 and 3, a blood test is taken to measure oestradiol (from the ovary) and LH and FSH (from the pituitary gland) and to check the egg reserve. This blood test is very useful for older women as it can give an indication of the likelihood of conceiving (ovarian reserve). The blood test also checks the hormone output from the thyroid gland as well as prolactin, both of which are: essential for normal fertility function.

The first ultrasound scan is done between days 6 and 8 of the cycle (day 1 is the first day of the period).

Approximately three serial scans are performed during the cycle. These can show the thickness of the womb lining, and the size, growth and blood flow to the developing follicle in the ovary.

A scan a week after ovulation checks on the functioning of the corpus luteum (which pumps out progesterone, the hormone needed to maintain a pregnancy).The scan at this stage can also determine whether the womb lining is thick enough for a fertilised embryo to be implanted.

A blood test is also performed after ovulation to check on the hormone progesterone.

There is also a test called a hysterosalpingosonogram (HSS) which is usually performed before ovulation to check that there are no blockages in your fallopian tubes. This is an alternative to HSG because it can be done in the first part of the cycle which means that the gynecologist can have a complete set of information by the end of that particular cycle. The HSS does not involve the use of X-rays so there is no radiation risk. A sterile fluid is injected into the uterus and traced with ultrasound as it passes through the fallopian tubes. The scan outlines the uterine cavity and the tubes and shows the spill of fluid around the ovaries.

You can get these monitored cycle investigations done through the NHS. Ask your gynecologist about it. Otherwise you may need to find a private hospital unit or clinic that offers this approach.