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Fertility Basics

Thrombophilia

posted on June 25, 2019, 5:44 p.m.
4.5/ 5 (1 Votes)

Thrombophilia is a condition of the predisposition of increasing blood clots in the body. It typically remains a severe medical condition of abnormal clotting of flowing blood to distinct parts of the body of the patient. The risk of excessive blood coagulation elevates in the presence of thrombosis (blood clots in veins). Almost 50 percent of people, who suffer from thrombosis are identified to possess Thrombophilia. For instance, patients who have Deep Vein Thrombosis (DVT) condition in their legs possess to have symptoms of thrombophilia. Usually, only a few cases are detectable with blood clotting abnormality, though, most of them only develop thrombophilia with additional risk factors. Thrombophilia blood clotting condition does not include any specific treatment rather than consuming blood thinners for a lifetime along with the implementation of certain lifestyle measures. However, recurring clotting is an indication of early detection of thrombophilia and might require long term preventive blood thinners or anticoagulation medicines. (1) People who are undetectable with thrombophilia have 12 percent chances by the age of 60 to develop its symptoms. About 60 percent of the people deficient of antithrombin, once in a lifetime usually experience thrombosis. Also, about 50 percent of patients suffering from a severe protein C deficiency and almost about one-third of the total population with protein S deficiency face increased chances of blood clotting condition Thrombophilia. These patients possess a substantial risk of thrombosis when have activated protein C resistance in their body due to factor V Leiden, which is genetically passed to the patient. These people at least once face an event of a thrombotic condition until the age of 60. A patient possessing factor V Leiden prevails to be at a lower risk of thrombosis. However, it dwells prominent chances of additional factors like immobilization. Most of the people with prothrombin mutation never generate thrombosis. (1) In this article we will look at the following points: What is Thrombophilia? What are the signs and symptoms of Thrombophilia? What are Thrombophilia and Venous Thromboembolism? What are the causes of Thrombophilia? What is the significance of diagnosis in Thrombophilia? Who to test for Thrombophilia? Why screening of Thrombophilia is done? What is the treatment of Thrombophilia? How does Thrombophilia affect Pregnancy? Thrombophilia: The two major types of thrombophilia include a group of acquired and inherited disorders. It increases the tendency of clotting in the blood. A human body maintains a sophisticated balance of blood coagulation (clotting) system for healthy circulation of the blood. Our blood contains platelets (clotting blood cells) and multiple proteins of coagulation which helps the blood to function properly. These essential platelets encourage the body in preventing excessive clotting and bleeding. It is very crucial for our body to produce blood clot (thrombus) in the injured area. The blood starts to overflow when these injuries are caused to the sensitive blood vessels. Injuries from severe trauma, accidental cuts, fractured bone, and surgery are cured on time by the spontaneous formation of the blood clotting. Bleeding becomes unstoppable during these minor to severe injuries if clot formation does not appear. Clotting of blood prevents the severe overflow of the blood and to heal the injury naturally. In case, a patient is suffering from blood clotting disorder like thrombophilia, then the balanced coagulation system involves a tendency of the thrombosis. Excessive clotting in the blood vessels in different parts of the body is known as hypercoagulability or hypercoagulable state of blood vessels in patients. (2) (3) Signs and symptoms of Thrombophilia: People with thrombophilia do not possess any specific symptoms, neither any health problems are evident in the current health status. The symptoms start indicating when blood clotting begins due to thrombophilia. One who is already diagnosed with thrombophilia is usually at an elevated risk of developing Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE). DVT is a medical condition, which causes the formation of blood clots in the deep blood vessels. Patients suffering from thrombophilia are usually detected with DVT in their legs. The symptoms include swelling, redness, pain, or warmth in the affected area. Pulmonary embolism is another relentless condition often tested with thrombophilia. A pulmonary embolism develops because of blood clotting being lodged in the arteries of the lung. In rare cases, thrombophilia produces air bubbles moving towards the lungs. These air bubbles are the main reason for causing shortness of breathing. Lungs are mainly affected by the condition of thrombophilia when pulmonary embolism is taken into consideration. (4) Both the conditions of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) are associated with thrombophilia. Both DVT and PE are collectively referred to as Venous Thromboembolism (VTE). Below we have mentioned the warning signs of DVT and PE in association with thrombophilia. Pain, inflammation, and tenderness in your leg (usually in calf) Increased pain in the affected area of the patient Warm skin in the clotting area Redness of skin at the back of the leg and below the knee Severe pain in the chest or upper spine  Shortness of breathing Dry coughing, but one may cough blood out or secrete mucus including blood Light-headedness or dizziness Fainting Thrombophilia and Venous Thromboembolism: As it is known, that thrombophilia involves inherited or acquired disorders, which are directly associated with an increased propensity to Venous Thromboembolism (VTE) in patients. Thrombophilia acts as one of the essential determinants of VTE. A maximum number of patients, who are suffering from VTE, possess one or more defects of thrombophilia. Causes of thrombogenic factors in VTE are deficiencies of natural coagulation inhibitors like antithrombin deficiency, protein C deficiency, and protein S deficiency. A high risk of thrombosis is also identified in the case of antiphospholipid syndrome and in the homozygous forms of factor V Leiden and specific prothrombin. (5) Patients with VTE need personal attention from the doctors, as they are suffering from a chronic condition which requires proper medical care and management. The patients require a thorough medical examination, timely monitoring tests, and treatment for a prolonged time. In rare cases, the treatment extends for a lifetime. A positive result of thrombophilia affects the therapy or treatment of VTE. If endogenous anticoagulant deficiencies, homozygous forms of factor V Leiden, and specific prothrombin (antiphospholipid syndrome) are found in the patient, then it influences the treatment of VTE prominently. Treatment should be separated not only as per the type of thrombophilia but as per the patient’s present condition and additional risk factors associated with the patient. (6) Causes of Thrombophilia: Thrombophilia is caused because of two major reasons inherited deficiency or abnormalities and acquired abnormality. The most common known cause for years for the occurrence of thrombophilia includes inherited abnormalities. These deficiencies are present due to the natural inhibitor protein of the coagulation system. These inhibitors progressively work to control the formation rate of blood clots in the body. The deficiency of the fibrinolytic system in the body is the major of thrombophilia. This protein helps in breaking down the blood clots after their formation. Fibrinolytic system deficiencies are rare and do not require a medical test to confirm the same. (7) Below we are mentioning a few numbers of deficiencies and abnormalities, which causes thrombophilia: Protein C Free Protein S Antithrombin Protein C APC Resistance Assay Factor V Leiden mutation Prothrombin gene mutation (G-20210-A) Lupus anticoagulant (LA) The details of these components are given below: Free Protein S: Protein S is a cofactor of anticoagulant activity depending upon the amount of Vitamin K in the body. The anticoagulant activity here refers to the movement of Activated Protein C (APC). The activity involves two forms of protein S in plasma. The two forms are free protein S (40%) and protein S linked with C4b-binding protein (60%). Only the free form of protein S is present in the functional cofactor activity. The deficiency of protein S is caused mainly because of reasons either hereditary or acquired after the birth of the baby. Protein S deficiency is highly associated with an elevated risk of developing venous Thromboembolism (VTE), particularly in young people. As the free protein S form is only involved as a cofactor, therefore it counts to be a measure to check thrombophilia. Protein C: Deficiency of protein C has been associated with a high risk of thrombotic disorder. It plays an important part in the anticoagulant regulatory mechanism. It gradually converts thrombin to an Activated Protein C (APC). Antithrombin (AT): It is a natural and most important inhibitor of blood coagulation. For successful and effective heparin (Anticoagulant) therapy inclusion of Antithrombin is very important. It also comprises of protease enzyme, which performs a function of cutting and splitting of enzymes. The deficiency of AT promotes a higher risk of thrombotic disorders.  APC Resistance Assay: Protein C is the main element, which activates factor V and Viii in the human body. It possesses a naturally occurring inhibitor of blood coagulation. In an APC resistance condition, plasma inpatient does not produce sufficient anticoagulant response towards Activated Protein C (APC). This medical condition is caused due to VQ506 gene mutation. This produces an essential factor of V Leiden, a factor V molecule. These factors are resistant to the formation of cleavage by activated protein C. Prothrombin gene mutation (G-20210-A): A mutation (alteration) in factor ll gene (G-20210-A) is present in the untranslated portion of the gene. The factor ii gene is present from the start of the gene. This mutation factor is also an important part of the regulatory system for the gene. Individuals who possess this mutation factor possess higher levels of factor ll than normal. The elevated risk of thrombosis is also another function of Prothrombin gene mutation. Factor V Leiden mutation: The recognition of Factor V Leiden mutation is carried out by employing PCR technology. This process is used to distinguish the genotype in the already present abnormality. PCR examination is carried out on each of the samples that have a diminished APCR or have a family history of the presence of factor V Leiden in their body. Lupus Anticoagulant (LA): Lupus Anticoagulant (LA) is a distinctive acquired abnormality, which is associated with an elevated risk of venous thrombosis. Basically, LA refers to the important autoantibodies produced by our immune system. These antibodies mistakenly attack vigorously on our healthy cells present in the body. They specifically aim at phospholipids including their associated proteins. These antibodies also act to interfere with the blood clotting and increase the risk of blood clotting. LA results in prolonged coagulation tests depending upon phospholipid. Other medical tests which are recommended to check LA are Activated Partial Thromboplastin Time (APTT) or Dilute Russell's Viper Venom Time (dRVVT). In this medical test, no specific coagulation factor is inactivated for accurate medical test results. Lupus Anticoagulant (LA) test is basically associated with a spectrum of autoimmune disorders, infections and to find the exact medical treatment for the respective medical condition. A requirement to test LA is suggested because of the following important factors: Unexplained prolongation of APTT  Recurrent immature fetal loss believed to be due to placental infarct Unexplained thrombotic tendency Diagnosis of Thrombophilia: Patients with inherited thrombophilia are identified easily by coagulation experts knowing their few symptoms. The experts evaluate the patient's own or family history of Venous Thromboembolism (VTE). Thrombophilia usually does not require a separate thrombophilia profile blood test if there is any existence of VTE in any of the direct or indirect family members. (8) Thrombophilia should not be tested when a patient is consuming the medicines of anticoagulation. Preferably, one should wait for at least two weeks, after discontinuing the medicine for accurate medical results. An expectant woman or a patient taking combined oral contraceptives or hormone replacement therapy should avoid going for the medical tests for thrombophilia.  Who are the candidates for Thrombophilia test?  Below we have mentioned certain condition in which patient should go for thrombophilia profile blood test: In patients, who have unprovoked Venous Thromboembolism (VTE), before the advancing age of 40 years. Recurrent unprovoked thromboembolism Thrombosis in rare locations of the body like visceral vein thrombosis, cerebral veins, and upper extremities vein thrombosis. Presence of Venous Thromboembolism (VTE) in a first-degree family relative clearly indicates there are high chances of occurrence of this medical condition in the concerned individual himself.  Women with a history of past fetal loss or three unprompted early miscarriages should go for thrombophilia profile test (it is essential to eliminate cardiolipin antibodies and lupus anticoagulant in these cases).  Incomprehensible skin necrosis, particularly if one is consuming vitamin K antagonists (e.g. Warfarin) Babies and newborn with Purport Fulminant (a certain type of skin lesion) The patient should also get a checkup of thrombophilia profile blood test for the below-mentioned deficiencies: Protein C Protein S Antithrombin APCR and Factor V Leiden Protein gene mutation  Lupus Anticoagulant (LA) Thrombophilia Screening: A screening of coagulation includes different assays of Protein C, Free Protein S, Antithrombin III, Activated Protein C Resistance, and Lupus Anticoagulant screening. Amongst all the acquired conditions connected with venous (and arterial) thromboembolism, an influential role is played by the antiphospholipid antibody syndrome. It also helps in moderate hyperhomocysteinemia screening. The antiphospholipid antibody syndrome is determined by repetitive positive tests for Lupus Anticoagulant (LA), solid-phase anti-phospholipid antibodies, thrombocytopenia, and fetal loss. Hyperhomocysteinemia is typically caused by an inherent deficiency of the enzymes associated with its metabolism. However, it has also been attributed to poor dietary consumption of vitamins, which serve as cofactors of folic acid and B12. Therefore, it becomes easy and effective to treat acquired thrombophilia with the help of dietary supplementation. (9) (10) Thrombophilia Treatment: Thrombophilia treatment is available, but complete elimination is not possible in case of the inherited or genetic type of thrombophilia. Thrombophilia treatment depends on many factors like age, overall health, family history or lifestyle. One can perform the below-mentioned measures to lower the effects of thrombophilia: One should make efforts to get rid of the habit of smoking and opt for a healthy lifestyle  Lose weight and maintain a healthy weight Exercise regularly Go for a healthy diet Try to avoid long periods of inactivity or sedentary lifestyle Treatment of thrombophilia consists of Warfarin and heparin medicines. Warfarin being an oral drug involves some days to show its effects. Heparin is another helpful injectable medicine to treat the blood clotting fast. Heparin is usually taken along with Warfarin to show immediate results. A regular blood test becomes essential to know that one is consuming an appropriate amount of Warfarin. A blood test includes a Prothrombin Time Test (PT) and International Normalized Ratio (INR). Sufficient dose is very essential during thrombophilia treatment higher dosage leads to excessive bleeding. With inherited thrombophilia, one can still prevent increased blood flow because of the intake of blood thinners. This can be checked with the aid of periodic blood testing. One may also use Thrombophob gel to receive a cure for such conditions. Thrombophob Gel (Heparin Sodium IP) is suggested to help manage a variety of ailments associated with thrombophilia such as circulation conditions, phlebitis, thrombophlebitis, varicose, bed sores, hemorrhoids, sprains, strains, contusions, grass burns, hematomas, and scars. Thrombophob uses are included in the advanced procedure of heparin therapy, which helps in penetrating the tissues to relieve symptoms with antiphlogistic and anti-exudative effects, which decrease inflammation and pain, increase metabolism, and aid faster healing. How does Thrombophilia affect Pregnancy? The connection between thrombophilia with Recurrent Pregnancy Loss (RPL) has proved to be an indisputable fact. Thrombophilia produces a hypercoagulable state (excessive blood clotting). It produces arterial or venous thrombosis at the place of implantation of an embryo or in the placental blood vessels. Anticoagulants are an efficient treatment for RPL in pregnant women with acquired thrombophilia because of antiphospholipid syndrome. The positive results of RPL treatment with anticoagulants in women are supportive along with Inherited Thrombophilia (IT). Although the confined side-effects of anticoagulants are limited and mostly reversible, doctors today do not suggest using anticoagulants in women with RPL, IT, or those with unexplained pregnancy losses.  Recurrent Pregnancy Loss (RPL): Thrombophilia is a general cause of RPL and mostly seen in 40–50% of cases. Pregnancy is considered to be a hypercoagulable state. However, if gestation is affected by thrombophilia, the hypercoagulable state will become critical. It may also impair the bloodstream through the maternal veins, causing Deep Vein Thrombosis (DVT). Blood clots in the placental blood vessels because of thrombophilia leads to fetal growth restraint and even fetal loss. Therefore, anticoagulants have become a popular treatment of recurrent pregnancy loss. (11) Thrombophilia turns out to be a major problem if ignored and not considered in the initial phase itself. Timely treatment will help the patient in soothing the pain and discomfort. It will also help them recover soon. Thrombophilia with inherited condition requires long term treatment whereas acquired thrombophilia can be cured with a healthy diet. Different thrombophilia profile blood test helps in evaluating the exact cause and dosage of the medicine for the appropriate treatment of the condition. Thrombophilia causes certain chronic as well as lifelong problems such as RPL, PE, swelling of legs and breathing problems. A regular test of thrombophilia can save the patient from any further blood clotting which can severe the patient's condition. A doctor may suggest blood thinner avoid such condition in the future. Maintaining a healthy lifestyle also prevents the body from being dehydrated. Consuming sufficient water keeps the toxins away from the blood and maintains a healthy flow of the blood in the patient. You can also visit our website to read about other potential and informative articles. Such informative content on infertility, medicines, and treatment may help you in gaining more facts about your problems. For queries, you may also contact us on +918929020600.

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Fertility Basics

Fallopian Tube Tests

posted on June 28, 2019, 3:05 p.m.
4.5/ 5 (1 Votes)

Fallopian tubes are an important part of the reproductive system in women. It is a muscular and extremely motile tube, capable of very intricate and coordinated movements. The lining of the fallopian tube is filled with tiny hairs called cilia that push the egg along the inside of the tube. At the juncture of the tube and the uterus, the tube acts as a sphincter, contracting and closing, holding the egg back until exactly the right time to release it into the uterus. For fertilization to take place successfully the fallopian tubes must remain open, undamaged and in a proper functioning state. The resulting embryo is then transported to the uterus for pregnancy. Tubal factor infertility is the result of scarring, blockage or dilation (hydrosalpinx) of the fallopian tube. A blockage may occur due to pelvic surgery, endometriosis or pelvic infections, in particular, pelvic inflammatory disease (PID). Hysterosalpingogram (HSG) is one of the most preferred medical tests to evaluate the fallopian tubes. It can also be evaluated by a specialized ultrasound (Fem-Vue procedure) or occasionally at the time of laparoscopy. In Vitro Fertilization (IVF) is the best fertility treatment for women with tubal factor infertility that cannot be surgically corrected. In this article, you will find useful content regarding fallopian tubes and some of the standard test to check fallopian tube blockage or damages. In this article we will look at the following aspects: What is a Fallopian tube? What is the function of the Fallopian tube? What is Tubal Factor Infertility? What is fallopian Tube Tests? What are the causes of Blocked Fallopian Tubes? What are the different tests available for Fallopian Tubes? Fallopian Tube: The female reproductive tract is represented by one ovary and one fallopian tube on each side of the uterus in a woman. They are muscular tubes that are lined with delicate hair-like structures. These hairs work in both directions, helping an egg to travel from the ovaries down to the womb (uterus) and helping sperm travel up from the womb. Each tube measure about the size of a pencil and consists of a lumen surrounded by smooth muscle. The lumen is trumpet-shaped, the end attached to the uterus is narrow and the end adjacent to the ovaries is wide. Each of the fallopian tubes ends at the fimbriae, a small, fingerlike projection through which eggs move from the ovaries to the uterus. The fimbriae are connected to the ovary. The fimbriae catch and guide an egg once the ovary releases it. The fallopian tubes play an important role in conception because most eggs are fertilized in the fallopian tubes when natural intercourse is taken into consideration. If any part of the fallopian tube is damaged, for example by surgery or an infection, there is a possibility of blockage due to the scar tissue. (1) Functions of the Fallopian Tube: The fallopian tubes have three main important functions: Picking up the eggs (oocytes) from the ovary Fertilizing the oocytes Transporting the fertilized ovum into the uterus. (2) The fallopian tubes can be evaluated with the help of a laparoscopic procedure or a hysterosalpingogram. It can also be combined with chromotubation (passing dye through the tubes). The uterine tube allows passage of the egg from the ovary to the uterus. When an oocyte is developing in an ovary, it is compressed in a spherical collection of cells known as an ovarian follicle. Just prior to ovulation, the primary oocyte completes meiosis I. It forms the first polar body and a secondary oocyte which is arrested in metaphase of meiosis II. This secondary oocyte is then successfully ovulated. The ovaries and the follicle wall rupture, allowing the secondary oocyte to escape. The secondary oocyte is caught by the fimbriated end and travels to the ampulla of the uterine tube where typically they meet the sperm and fertilization occurs. Here, meiosis II is promptly completed. The fertilized ovum, now a zygote, travels towards the uterus boosted by the activity of tubal cilia and activity of the tubal muscle. The early embryo requires significant development in the fallopian tube. Successful embryo implantation occurs on the fifth or sixth day at the desired location. The endometrium of the uterus reestablishes after the implantation so that the embryo comes to be deeply embedded in the endometrium itself. The release of an oocyte seems to be random and does not alternate between the two ovaries. Occasionally, the embryo implants into the fallopian tube instead of the uterus, creating an ectopic pregnancy, also known as a 'tubal pregnancy'. (3) Tubal Factor Infertility: Fallopian tubes are highly fragile if they are blocked. Certain diseases like Endometriosis, Pelvic Inflammatory Disease (PID), infections, and Sexually Transmitted Diseases (STD's) can cause damage to the fallopian tubes. The fallopian tube allows the sperm to swim from the uterus toward the egg, while the distal end of the fallopian tube (the fimbria) picks up the ovulated egg. When fertilization takes place in the fallopian tube at least one of the tubes should function properly allow the sperm to fertilize an egg, so that the resulting embryo can be successfully transported to the uterus. If the fallopian tube is blocked, distorted or scarred, the egg and sperm cannot combine. Additionally, a partially blocked or damaged fallopian tube may allow the sperm to reach the egg for fertilization but not be able to lead to the implantation of the embryo in the uterus of the concerned woman. This ultimately leads to ectopic or tubal pregnancy, which can lead to serious complications in the respective pregnancy. (4) What are the Fallopian Tube Tests? The fallopian tube test is an important part of the overall testing for infertility treatment. Several women who have experienced recurrent miscarriages or who have not successfully conceived despite trying for many years are usually sent in for fallopian tube test to check for the presence of any problems. Tubal disease and abnormalities are responsible for nearly half of the cases of female infertility. Damage to the fallopian tubes can occur as a result of infection or inflammation in the pelvis. (5) Pelvic infection and inflammation is called Pelvic Inflammatory Disease (PID) and is caused by the following: Sexually transmitted diseases such as Chlamydia and gonorrhea Infections following a miscarriage, termination of a pregnancy, childbirth, or the insertion of an IUD Infections following surgery for ovarian cysts or a perforated appendix Endometriosis Blockages and adhesions (scar tissue) can alter the function of the fallopian tubes which can cause infertility. Some women with tubal damage from PID are not aware it has happened until they try to become pregnant. (6) Fallopian Tube Testing: The Basics: There are several ways for a doctor to provide treatment if the fallopian tubes are blocked or damaged. Diagnostic testing is important in determining the issue and how best to deal with it. The simplest and oldest diagnostic test for blocked fallopian tubes is the Rubin Test (RT) where gas is released into the uterus through the cervix either with a syringe or a special machine called a "Rubin apparatus". The doctor listens to the abdomen with a stethoscope to check if the gas is passing through the fallopian tubes. It is not a reliable test and most doctors do not prefer it today. Blood tests to check for chlamydial antibodies are another way to determine the possible cause of any damage to the fallopian tubes. Chlamydia is one of the most common tubal conditions that affects most of the women in the West. If blood antibodies for Chlamydia are found it indicates exposure to the Sexually Transmitted Diseases (STD's) at some point, putting the woman at high risk for tubal damage. Causes of Blocked Fallopian Tube: Scar tissue or pelvic adhesions is usually one of the reasons for a blocked Fallopian tube. However a number of factors can be responsible for it, these are as follows: Pelvic inflammatory disease(PID): PID can cause scarring or hydrosalpinx in the fallopian tubes. Endometriosis: A painful disorder in which tissue that normally lines the inside of the uterus (endometrium) grows outside the uterus. Endometriosis most commonly involves fallopian tubes, ovaries and the tissue lining your pelvis. The endometrial tissue hardly spread beyond the pelvic organs. Sexually Transmitted Diseases (STDs): Gonorrhea and Chlamydia are important preventable causes of Pelvic Inflammatory Disease (PID) and infertility. Without proper care and treatment, Chlamydia can develop into fallopian tube infection in women. It is very dangerous because this disease develops without showing any notable signs and symptoms. Further progression of PID and such silent infection in the upper genital tract are known to cause permanent damage to the fallopian tubes, uterus, and surrounding tissues, ultimately leading to infertility. Ectopic Pregnancy: Past ectopic pregnancy can also scar the fallopian tubes to a certain extent. Fibroids: When the fibroid is closely attached or bulged into the uterine cavity, it can have a significant impact on the fallopian tube. Fibroids can obstruct the fallopian tubes, resulting in difficulty while trying to conceive. Fibroid blockage of the tube does not allow the embryo to pass into the uterine cavity, where it could successfully implant on the endometrial lining. Fibroids can also cause problems during pregnancy as well. Pelvic Adhesions: Pelvic adhesion can significantly pose to be a hindrance to female infertility. Pelvic adhesions may be associated with such an infection in the tubes. The presence of pelvic adhesions may not necessarily block a fallopian tube, but render it dysfunctional by distorting or separating it from the ovary. It has been reported that women with distal tubal occlusion have a greater risk of HIV infection. One cannot prevent each of the causes of blocked fallopian tubes. However, one can decrease the risk of sexually transmitted infections by using a condom during sex. Fallopian Tube Assessment Tests: Various medical tests and procedures have been described but only a few of them are currently in vogue in clinical practice. These are given below: Laparoscopy: Laparoscopy is a surgical procedure in which numerous small (about half an inch to an inch) incisions are made in the abdomen. A camera is placed through one of the incisions and long, thin instruments are placed through the other incisions. The camera is used to visualize the pelvic organs while the instruments are used to retract and operate as needed. A laparoscopy procedure is usually performed on an outpatient basis or as part of the patients stay in a hospital. The procedure of the test conducted differs significantly depending on the patient's condition and also the doctor's practices. A laparoscopy is generally done while the patient is asleep under general anesthesia. Laparoscopy can be done for various reasons. It can be done for purely diagnostic reasons to determine if there are pelvic adhesions, fallopian tube issues, endometriosis or a whole host of other issues present that can affect the pelvis and fertility. It can also be done for corrective reasons. Surgery can be used to treat endometriosis, pelvic pain or adhesions and remove or fix the Fallopian tubes. Chromopertubation is a method for the study of patency of fallopian tube in women suspected of suffering from infertility. The catheter is infused with blue dye and finally placed in the uterus. The camera that was placed in the abdomen, as part of laparoscopy, is utilized directly for viewing and assessing the fallopian tubes and dye. If the dye fills up and spills out the tubes (fill and spill) then doctors can analyze if the tubes are open. Chromopertubation is considered the gold standard or one of the best tests to evaluate the fallopian tubes. However, Chromopertubation is usually not the first test performed because it requires surgery while a hysterosalpingogram does not. (7) Hysterosalpingogram (HSG): A Hysterosalpingogram (HSG) is the process of checking the fallopian tube and the uterine cavity with the help of an x-ray. Hysterosalpingogram is an outpatient procedure that usually takes less than 5 minutes to perform. This test is usually conducted after the menstrual period ends but before ovulation. The test can be done under x-ray guidance or under ultrasound guidance at one of the local hospitals. HSG does not require surgery, therefore, it is much less invasive than a laparoscopy. A traditional HSG is done under fluoroscopic (X-ray) guidance where a catheter is placed in the uterus and contrast (a dye that can be seen on x-rays) is infused into the uterus. Several x-rays are taken and the doctor observes if the dye fills up and spills out of the tubes (fill and spill). The latest version of HSG is popularly known as "Sono HSG". This test is most often performed in some of the best infertility centers. It is done under ultrasound guidance so it avoids exposing patients to x-ray radiation. Similar to a traditional HSG, a catheter is infused with saline and water and placed inside the patient's uterus. An ultrasound is performed and the doctor sees if the air bubbles fill up and spill out of the tubes (fill and spill). If fill and spill occur, the doctor can easily conclude if the tubes are open. If this does not occur the tubes may not be truly blocked. There are several reasons such as tubal spasms which can cause blockage even though the tubes are open. Sometimes if an HSG is abnormal, a laparoscopy and Chromopertubation are performed to check and confirm if a true blockage is present. (8) Salpingoscopy: Saline Salpingosonography (SSG) test can be performed in an infertility clinic. This procedure takes 15 minutes and is done under ultrasound (sonography). The patient does not need anesthesia as it is well tolerated. Women usually prefer SSG over other diagnostic procedures for blocked or damaged tubes. In this, sterilized saline is passed through the uterus. The expert surgeons check as the fluid flow through the tube. The tubes appear grey and the fluid tends to appear black. It is originally performed during laparotomy for reconstructive tubal surgery to assess the mucosa of the infundibulum and ampulla. Prediction of fertility outcome by laparoscopy can be improved when combined with salpingoscopy. The two medical tests significantly complement rather than substitute each other. Special expertise and equipment are required, making salpingoscopy an expensive proposition. As it is implemented during laparoscopy, its risk profile is differentiated. It was the first tubal assessment test that disclosed a new world of detailed in-vivo images of the actual site of human fertilization. It can clearly determine the presence or absence of anatomical distortions, especially adhesions between and destruction of mucosal folds on a micro-endoscopic. Lesions of the infundibulum and ampullary segment have been detected in patients with apparently normal tubes on HSG and laparoscopy. (9) Falloposcopy: Falloposcopy is an advanced medical diagnostic and operative procedure that involves introducing a tiny camera into the fallopian tubes. The tubes are inserted through the vagina to look into the cell layer that lines in the inside of the tube known as the epithelium. It also helps to keep a check and see if there are any obstructions in the fallopian tubes that may block the passage of eggs. Falloposcopy is helpful for the evaluation of abnormalities in the fallopian tube that can cause infertility in women, and in some cases to correct any abnormality present in the same. Abnormal conditions of the fallopian tubes that require Falloposcopy are: Damage to the interior cell lining Damage or abnormal conditions of blood vessels Shrinking, narrowing or blockage of the tubes Impacted debris Falloposcopy is considered a delicate procedure that can be associated with various complications. Falloposcope by itself can damage or rarely even perforate the fallopian tube, if not performed correctly. For this reason, it may be considered if a woman is suspected to have a potentially treatable tubal factor infertility. Correction is easily available in case of abnormalities such as narrowing and blockage during the procedure. Medically assisted methods of fertilization can be considered such as In Vitro Fertilization (IVF) if the conditions of the fallopian tube are considered optimal. Although not commonly practiced, the falloposcopy can also be inserted during open or laparoscopy surgery through the fimbria. (10) Transvaginal hydrolaparoscopy (THL) Transvaginal hydrolaparoscopy (THL) is an alternative procedure to Hysterosalpingography (HSG) and laparoscopy that allows direct visualization of the female peritoneal cavity. THL is more commonly performed in Europe and China than in the United States. In this procedure, a trocar is passed through the vagina into the Pouch of Douglas, and an optic scope is placed through the trocar sleeve, allowing close examination of the uterus, ovaries, fallopian tubes, and peritoneum. No abdominal incision is required in Salpingoscopy. This procedure can be successfully accomplished in a basic clinical setup. THL can also be performed in conjunction with Chromopertubation, salpingoscopy, microlaryngoscopy, and hysteroscopy. Dr. Antoine Watrelot a famous gynecologist from France coined the term “fertiloscopy” for the combination of these procedures. In contrast to traditional HSG for evaluation of tubal patency, THL additionally permits direct inspection of the tubal mucosa. Because the vaginal trocar is passed parallel to the axis of the fallopian tubes, the optic scope can more easily enter the tubal lumen. This permits inspection of the inner tubal microarchitecture. A vaginal and rectovaginal examination is performed to evaluate the axis, size, and mobility of the uterus and to evaluate for pelvic masses or pathology in the Pouch of Douglas. A speculum is then efficiently placed in the vagina. If in a clinical setup, local anesthesia may be given by rubbing a lidocaine swab on the vaginal mucosa for 10 min followed by a paracervical block of lidocaine. THL has the advantage of not requiring an abdominal incision, thus perhaps being more cosmetically appealing to patients. Also, in contrast to traditional HSG for evaluation of tubal patency, THL is favorable in that it allows direct examination of the tubal mucosa because the axis of optic scope insertion through the vagina permits easy access for salpingoscopy. Lysis of adhesions, ablation of endometriosis, and ovarian drilling also can be performed using the transvaginal approach. Patients with extensive adhesions and endometriosis are probably better served by a laparoscopic approach that permits insertion of more than one operative instrument at a time. THL also may be combined with hysteroscopy. (11) Importance of Fallopian Tube Testing: Tubal disease and abnormalities are responsible for nearly half of the cases of female infertility. Any kind of inflammation or infection in the pelvis can damage the fallopian tubes. Pelvic infection and inflammation is called Pelvic Inflammatory Disease (PID) and is caused by: STDs such as Chlamydia and Gonorrhea Presence of Endometriosis Infections following a miscarriage, termination of a pregnancy. Infections which occur after childbirth, or the insertion of an IUD Infections which occur following surgery for ovarian cysts The function of the fallopian tubes can also be altered by blockages and adhesions ultimately causing infertility. Some women with tubal damage from PID are not aware it has happened until they try to become pregnant. (12) Rubin's test: Tubal perfusion pressures Dye injections with culdocentesis Injection of radiolabeled xenon solution with gamma-camera screening Selective salpingography and tubal catheterization Hystero Contrast sonography Women who are suffering from endometriosis, previous ectopic pregnancy or PID are recommended HSG to screen for tubal occlusion. For ruling out tubal occlusion this can be a more reliable test, less invasive and makes more efficient use of resources than laparoscopy procedure. Further, more research needs to be done to ascertain the value of Fertiloscopy and Falloposcopy while examining couples who experience fertility problems. The couples who are not able to conceive after having one year of regular unprotected sexual intercourse can opt for further clinical treatments, including semen analysis and assessment of ovulation. These treatments can help the infertile couple to live their parenthood dream successfully. There are three categories of medical tests that have an established correlation with pregnancy, namely semen analysis, tubal patency tests by hysterography or laparoscopy and tests to detect ovulation. Women suspected to have similar conditions should opt for laparoscopy so that any tubal and other pelvic pathology can be detected early and treatments can be provided at the right time. A patient can undergo three cycles of ovulation induction before checking tubal patency in case there are no complications associated with pelvic or tubal blockages. For infertile couples evaluation of tubal patency is a key component of the diagnostic workup. However, there are technical limitations for available methods for evaluation of tubal factors. This must be considered when technique yields abnormal results. The difficulties involved in tubal function should not be overlooked by a single test while assessing the tube through various medical tests available. Looking for tubal patency by flushing liquids through the tubes should not be taken into account. For women with tubes that might be open as simple pipes that conduct fluid, just simple patency of the tube might give false reassurance. It is not always functional as far as eggs and sperm are concerned. Various tests are available when it comes to the treatment of tubal damages in terms of safety, accuracy, effectiveness, and prognostic ability. However, the evidence base is good for the older tests, i.e. HSG and laparoscopy with a dye test. We hope this article provided you with detailed and useful information regarding the fallopian tube and the different types of medical test for checking fallopian tube blockage or damage.  If you are suffering from blocked or damaged fallopian tubes and are looking for respective treatments, Elawoman can help you. Also, if you are looking for the best fertility treatments like IVF, IUI or the best Gynecologist in your city Elawoman can assist and guide you in getting a quick appointment. You can contact us today at +918929020600 for further assistance.

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Fertility Basics

Progesterone Test: Need, Indications, Test Results

posted on June 15, 2019, 4:27 p.m.
4.5/ 5 (1 Votes)

A progesterone test helps in measuring the level of progesterone hormone with the help of a blood test. The levels of progesterone hormone vary during a woman’s menstrual cycle and different crucial phases of life. If conception has occurred, progesterone levels continue to rise as the body gets ready to support a developing baby in the womb of the woman. A test of progesterone levels in the first trimester could indicate whether the pregnancy is viable. Progesterone and Progestin: Progestin is a form of progesterone hormone, which plays a vital role in a woman’s menstrual cycle and pregnancy. Progestin is used in combination with another hormone known as estrogen, hormonal birth control pills, skin patch, and vaginal ring. It also can be used by itself in the form of progestin-only pills and the birth control injection. (1) Progesterone is an effective progestational steroid hormone secreted by the female reproductive system. It is linked to the menstrual cycle, pregnancy, and development of an embryo. Progestin is an artificial form of progesterone that is proved its usefulness in a range of cases. Progesterone is a steroid and a hormone as well. It has some prominent roles, particularly in the process of reproduction. (2) This article gives detailed information about: What is Progesterone Test? What are the possible indications for Progesterone Test? Why do women need a Progesterone Test? What happens during the Progesterone Test? What does Progesterone hormone do? When is Progesterone Test Recommended? What is the significance of Progesterone Test Results? What are the factors affecting Progesterone Test Results? Frequently asked questions related to progesterone test What is Progesterone Test? Serum progesterone is a blood test which has been considered as an effective test to discriminate a viable pregnancy from an ectopic pregnancy or abortion. Low progesterone values are linked with miscarriages and ectopic pregnancies. Both ectopic pregnancy and miscarriage are considered non-viable pregnancies, and high progesterone concentrations with viable pregnancies. Progesterone test can help fertility doctors check for possible fertility issues or ovulation. It can also determine whether everything is alright with an ongoing pregnancy and to ascertain the root cause of abnormal bleeding from the uterus. Serum progesterone is not always enough to diagnose a particular problem but it can help detect the problem when performed in combination with other tests. (3) Progesterone is a hormone in females that increases in concentration during a viable pregnancy. Studies have suggested that a single progesterone measurement in the first trimester can distinguish a viable pregnancy from a nonviable one, but results are contradictory. The results or outcomes of the progesterone test were more impactful when it was performed in conjunction with a transvaginal ultrasound. Various research studies showed that in a major number of cases, women who had low progesterone levels had non-viable pregnancies. During the first trimester, about a third of pregnant women experience vaginal bleeding or abdominal pain. A viable pregnancy can be detected with the help of an ultrasound, but in a majority of over 30 percent cases, the results are uncertain. (4) Levels of progesterone vary during a woman's menstrual cycle. The levels start out low and then rise subsequently after the ovaries release an egg. When women become pregnant, progesterone levels continue to rise as their bodies get ready to support a developing baby. However, in cases where the egg is not fertilized (conception fails to occur), the progesterone levels will go down and the period will begin. In a pregnant woman, progesterone levels are about 10 times higher than they are in a woman who is not pregnant. Men also produce progesterone hormone, but in much smaller amounts when compared to women. (5) Progesterone levels are usually low during the follicular stage of a menstrual cycle. Ovulation is called the 'luteal stage' when the egg is released by the ovaries into the fallopian tube. After ovulation, progesterone levels rise for over 5 days before going back down. If pregnancy happens, the progesterone hormone levels begin to rise from the ninth week of pregnancy until the 32nd week of pregnancy. The placenta begins to produce progesterone after 12 weeks to help the pregnancy stay healthy. The levels of progesterone hormone vary to a certain extent as per the stage of a woman’s menstrual cycle and pregnancy. This is the reason why this test is repeated many times throughout the pregnancy. Certain types of cancer sometimes may lead to abnormal progesterone levels in men and women. (6) Indications for Progesterone Test: The most common indications for a progesterone test are: To determine the reason for abnormal uterine bleeding To determine the cause of female factor infertility To determine if and when ovulation is taking place in a woman Observe a high-risk pregnancy to determine fetal health and placenta To determine the chances of miscarriage To diagnose an ectopic pregnancy. An ectopic pregnancy takes place when the fertilized gets attached to a place other than inside the uterus. Most of the ectopic pregnancies occur in the fallopian tube and that’s why they are also called tubal pregnancies. (7) Why do women need a Progesterone Test? A progesterone blood test is considered to be the best sign of ovulation. Women need a progesterone test to help find and manage some minor to major causes of infertility and to improve the chances of achieving a healthy pregnancy. The main role of this steroid hormone is to help prepare the uterus so that it can successfully receive, implant, and support a fertilized egg in an ongoing pregnancy. A progesterone test is performed in conjunction with various other female hormones. A progesterone test works with proper examination and evaluating the level of progesterone hormone in the blood. Every month, the hormone estrogen causes the lining of the uterus, the endometrial lining, to develop and replenish itself which leads to the release of an egg from the ovaries. Luteinizing Hormone (LH) has a major role in the same event. The process is called ovulation. A corpus luteum then forms in the ovary at a place where the egg was released and starts producing progesterone. This progesterone, which is supplemented by small amounts produced by the adrenal glands then curbs the endometrial growth and prepares the uterus for the possible implantation of a fertilized egg. When fertilization does not take place, the corpus luteum degenerates, levels of progesterone hormone drop and menstrual bleeding begins. When a fertilized egg gets implanted into the uterus, the corpus luteum produces progesterone hormone. The egg then forms a trophoblast which leads to the production of human Chorionic Gonadotropin (hCG) hormone. After a few weeks, the placenta replaces the corpus luteum as the main source of the hormone, thereby producing relatively large amounts of progesterone during a normal pregnancy. Progesterone hormone is produced at a much lower level in males which involves the growth and development of sperm. (8) Progesterone Test Preparations: What happens during the Progesterone Test? A progesterone test does not require any specific preparation. A progesterone test is a simple blood test which is done by collecting a blood sample from the patient. The only point a patient needs to make note of is the time of her last menstrual period. The patient must inform the doctor about the first and last day of her period. For women who experience light bleeding pattern or beginning with spotting, the first day is considered the day of comparatively high bleeding. For pregnant women, it is required to make note of the time period for how long the woman is pregnant. The fertility doctor or another health care expert will insert a needle in a vein in one of your arms or hand and take a bit of blood which is further sent in a lab for testing. (9) Certain medications may interfere with blood test results so consulting a doctor would be helpful. (10) What does Progesterone hormone do? Progesterone plays a major role in preparing the tissue lining of the uterus in order to allow the fertilized egg to the implant with success It helps in maintaining the endometrial lining of the uterus throughout pregnancy Progesterone prevents further egg release until pregnancy has terminated It also helps in preventing fertilization of more than one egg at a time, although more than one egg is occasionally released Progesterone hormone helps in restricting the muscular contractions in the fallopian tubes once the egg has been transported This crucial hormone plays a vital role in fetal development during pregnancy The hormone also helps in stimulating the breast tissue to promote lactation and causes the glands to advance ready for the production of milk Strengthens the pelvic wall muscles for the preparation of healthy labor at the end of the pregnancy When is Progesterone Test Recommended? The most common conditions under which progesterone levels may be measured are: During an infertility evaluation, when a woman is struggling in getting pregnant and her highly-skilled healthcare provider wants to confirm that she is ovulating normally; the test may be recommended a few times during a woman's menstrual cycle to observe any change or fluctuations in progesterone levels in the body. When it becomes necessary for the physician or healthcare provider to understand when ovulation has occurred and following medicine therapy for ovulation induction. When symptoms like uterine spotting and abdominal pain occur, suggesting a possible risk of ectopic pregnancy or threatened miscarriage, a progesterone test is recommended in such cases. This test is also suggested where a woman's case requires progesterone replacement therapy to help retain her pregnancy. Periodically throughout in the cases of a high risk pregnancy, a progesterone test to observe placenta and fetal health When a non-pregnant woman witnesses abnormal uterine bleeding Progesterone Test Results: Interpretation of progesterone hormone test results relies on the reason for testing. It also requires the demand of the situation at which a woman is in her menstrual cycle or pregnancy. Progesterone levels usually start to rise when an egg is released from the ovary, rise for several days, and then either continue to rise in the first trimester or fall to initiate menstruation in the concerned woman. When the progesterone levels do not increase and decrease on a monthly basis, a woman may not be ovulating or having regular menstrual periods. This can also lead to infertility in the respective woman. If levels do not rise normally during the first trimester, the pregnancy can be considered to be ectopic and/or may be failing. If serial measurements do not depict rising progesterone levels over time, there may be issues with the viability of the placenta and fetus. Low levels of progesterone may be associated with: Pre-eclampsia Fetal death/miscarriage Lack of menstruation (amenorrhea) Ectopic pregnancy Decreased function of ovaries Toxemia - a condition commonly called as preeclampsia is a condition that may happen late in pregnancy but could be serious if left untreated High levels of progesterone may be associated with: A rare form of ovarian cancer Adrenal cancer Ovarian cysts Glands producing too much progesterone Progesterone Test Results Range: Progesterone levels are measured in nanograms per milliliter (ng/mL). Below are ranges that are considered normal in progesterone test results: 0.1-0.3 ng/mL for prepubescent girls 0.1-0.7 ng/mL for women who are in the follicular stage of their menstrual cycle 2-25 ng/mL for women who are in the luteal stage of the menstrual cycle 10-44 ng/mL during early pregnancy 19.5-82.5 ng/mL during the second trimester 65-290 ng/mL during the third trimester Other conditions that may depict abnormal progesterone test results: Increased progesterone during pregnancy indicates that the woman is carrying twins or an abnormal type of pregnancy known as a molar pregnancy. Increased progesterone when a woman is not pregnant could mean that she has a certain type of ovarian tumor known as a lipid ovarian tumor or chorionepithelioma. Decreased progesterone levels during pregnancy could mean that a woman is at risk of spontaneous abortion (miscarriage) Decreased progesterone when a woman isn't pregnant could mean that she doesn't have enough female hormones. This condition is known as hypogonadism. Factors affecting Progesterone Test Results: The factors which might affect the result of the progesterone test include certain medications like birth control drugs or steroids. Frequently asked questions related to progesterone test: Q. Do patients need to fast for a progesterone blood test? Progesterone test usually does not require fasting. The results of progesterone test can be availed by the patient in one or two days. Insurance and a fertility doctor's order are not mandatory while ordering this test. It is a female hormone produced by the ovaries during ovulation. Q. What are the levels of progesterone hormone that indicate ovulation? Ovulation usually takes place in the mid of the menstrual cycle. A progesterone level above 3 usually indicates that ovulation has occurred and a level 10 or higher generally determines adequate production of the progesterone level to maintain a healthy pregnancy. Q. What other tests does serum progesterone involve? The progesterone blood test is performed in conjunction with other tests in order to obtain accurate results. Other blood tests may be performed to check on the ability of the patient to get pregnant. An ultrasound may be recommended to measure the thickness of the lining of your uterus or the endometrial lining. A specific blood test may be recommended, if a patient is already pregnant, to figure out if there are any issues with an ongoing pregnancy. For patients with pain or bleeding who did not undergo an ultrasound, the progesterone test was significantly less accurate in predicting the viability of a healthy pregnancy. (11) Q. What are the risks associated with a serum progesterone test? Certain risks surround the person who is undergoing the serum progesterone test. For most people, these risks are ignorant and minor. During the blood test, the patient might feel some stingy pain when the needle is inserted into the vein for taking out the required amount of blood. He/she might bleed for a few minutes after the needle is removed, which settles down in some time. A bruise might also develop in the area surrounding the test site. Afterward, the site may be sore. More serious complications are rare in the progesterone test. Other rare complications or risk associated with progesterone testing can be inflammation of your vein, fainting, and infection at the puncture site. If patients already have a bleeding disorder, the risks of a blood draw tend to be at a higher level. Q. How do you know your progesterone is low? If you aren't pregnant, some symptoms of low progesterone may include: Low libido Hot flashes Migraine or headache Depression, anxiety or mood swings Absent or irregular menstrual cycle Q. What does a 21-day progesterone test tell depict? Day 21 fertility testing depicts a woman's progesterone level to determine whether ovulation has occurred. It is performed on day 21 of the menstrual cycle (Day 1 is the first day of flow, not including any spotting). A low progesterone level on Day 21 suggests the cycle was anovulatory (no egg was produced). Serial estradiol (E2) levels are usually measured for observing superovulation in ART methods such as Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF) treatment cycles. Q. Foods which help in low progesterone: Some foods which are considered helpful in low progesterone include: 1. Zinc Zinc is considered to be a vital nutrient for progesterone hormone. It has an effective role to play infertility and body development during pregnancy. Foods which are rich in zinc are: Kidney beans Cashew nuts and almonds Chickpeas Shellfish These foods can help in reducing the symptoms causing low progesterone levels in pregnant women. 2. Vitamin B-6 Vitamin B-6 has an important role to play in managing liver function, which helps to keep the crucial hormone levels balanced. Foods that contain high levels of vitamin B-6 include: Bananas Chickpeas Potatoes Tuna Spinach Lean Red Meat Q. How to test progesterone levels at home? Progesterone check is a finger-prick blood test kit. With the help of this finger prick kit, the test for progesterone levels can be performed at home in a hassle-free manner. It is then sent to the accredited laboratory for analysis. It’s a useful blood test for women who are planning to start a family. The test is also helpful for women who want to check whether they have ovulated. A progesterone test kit is the most reliable and proven medical method to establish whether a woman has ovulated, in a quick and affordable manner. In order to achieve highly accurate results from this test, it’s important that a woman takes it on day 21 of her menstrual period (or 7 days before the start of your next period). The best time to perform a progesterone test is 4 to 5 days after the Luteinizing Hormone (LH) is detected as the progesterone hormone is released after ovulation. Results of the progesterone test: 2 lines depict Negative progesterone test 1 line depict Positive progesterone test Thus, medical tests are useful in different stages of a woman's life. The use of these medical tests needs to be performed. Elawoman is here to help you in solving all the queries related right from planning to start your pregnancy journey until the successful baby delivery. Just like the progesterone test results, Elawoman can set you on the right path towards a healthy pregnancy and good health. Feel free to visit elawoman.com or call us at +918929020600 to get complete guidance and effective counseling for all infertility and IVF related issues.

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Fertility Basics

Endometrial Biopsy

posted on June 17, 2019, 3:56 p.m.
4.5/ 5 (1 Votes)

The endometrium adequately fulfills a key role in the female reproductive system. It is furthermore known as a major part of the reproductive organ 'uterus'. Endometrial lining majorly produces key hormones in the menstrual cycle. This also provides nutrition to the developing embryo during pregnancy. The tissue, which builds a woman's endometrial lining, serves as an internal wallpaper of the uterus. A uterus is a pear-shaped organ of the woman's body, which provides space for an unborn baby to develop for nine months. In rare cases, the endometrium undergoes several abnormalities like endometriosis, hyperplasia, and cancer. Endometrium promptly follows a natural flow in the menstruation cycle. However, if this particular flow is disturbed, then endometrial abnormalities commence in the concerned individual. Doctors traditionally perform some of the quality and effective medical tests to examine such conditions and identify the root cause behind unusual endometrial conditions. One of the important and preferred medical tests includes an endometrial biopsy. Endometrial biopsy indications generate when an endometrial thickness increases and the cells start growing abundantly outside its specified space. In this case, the lining of endometrial continues to build upon ovaries, fallopian tubes, and lining of the pelvis in the woman. Unwanted growth of the endometrial lining in uterus hinders the continuous process of menstruation and pregnancy. It also leads to the cysts (endometriomas) made up inside the ovaries, scar tissues, and adhesions. A few other abnormalities identified through endometrial biopsy are endometrial hyperplasia caused due to perimenopause and most crucial endometrial cancer. (1) In this article, you will get to know about the following: What is Endometrial Biopsy? What are the endometrial biopsy indications and uses? What are the Contraindications while performing an Endometrial Biopsy? How severe endometrial biopsy pain goes and how long does it take to heal from a biopsy? What is the relevance of the endometrial biopsy test? What are the symptoms of endometrial thickness pregnancy and normally? What are the preparations that need to be done before an endometrial biopsy? What are the Materials and types of equipment used during the biopsy? Explain the endometrial biopsy procedure steps, while performing an Endometrial Biopsy? What happens to the sample, removed from the lining of my uterus? Following is the deep analysis and explanations of the above questions. We have also tried to cover the maximum number of aspects related to the endometrial biopsy: What is Endometrial Biopsy? Endometrial Biopsy includes the process of removing a small tissue piece from a normal endometrial thickness range. Primarily, a sample of an overgrown tissue from the endometrial lining of the uterus is taken out to examine further with the assistance of a medical specialist. A sample of the tissue can show the formation and changes in the working of the cells present in the endometrium. This change in normal endometrial thickness range takes place due to the abnormal build-up of the tissue and hormonal variations. The sample of an endometrial tissue also defines certain other conditions in the body, like uterine infection (endometritis). The endometrial biopsy is normally performed without any use of anesthesia in a clinic. Doctors typically take 10 minutes to perform the biopsy session with ease which depends on the expertise of the doctor. (2) (3) An expert pathologist performs the examination of the sample under the microscope. Performing other required medical tests may only suggest for the occurrence of cancer, but a biopsy of the exact tissue precisely helps in specifying the presence of cancer. A pathologist is a specialist doctor who only performs and interprets laboratory samples. The doctor also performs an evaluation of cells, tissues, and organs to diagnose accurate disease. A doctor performs the biopsy test with a very thin tube, which extracts a small sample from the uterus to test for a specific condition. A patient encounters endometrial biopsy pain, bleeding, and cramps during and sometimes after the process. The symptoms which are seen in the patient are similar to women menses. Usually, these common and minor symptoms cure in a short period of time. One may also consume a Non-Steroidal Anti-Inflammatory Drug (NSAID) as prescribed by her doctor to reduce endometrial biopsy pain. Endometrial biopsy proves to be an accurate and effective test to diagnose uterine cancer and cause of normal endometrial thickness range. Women suffering from vaginal bleeding prior to the test require a subsequent test with dilation and curettage (D&C). This advanced procedure is substantially needed if abnormal cells are undetected during a biopsy. D&C is another similar but more prominent procedure to remove a tissue sample from the uterus. It is a more painful process, so anesthesia is considered mandatory during the procedure. Endometrial biopsy indications and its uses: A woman with a below-mentioned indication needs to obtain an endometrial biopsy, especially when she is not pregnant: Chronic anovulation: A woman whose ovaries are not releasing eggs regularly similar to Polycystic Ovary Syndrome (PCOS). Usually, these women are at elevated risk for endometrial problems in terms of size as well. Undergoing an endometrial biopsy helps in assessing their endometrial lining thickness of the uterus. In fact, the biopsy also ensures that the patient is not suffering from any severe diseases like endometrial hyperplasia or cancer. Abnormal vaginal bleeding: Endometrial biopsy helps in confirming the presence of an abnormality in the lining of the endometrial like endometrial hyperplasia or cancer. Uterine Cancer: If a woman suspects to have uterine cancer, then the biopsy plays a key role in identifying the location of cancer cells in the uterus of a woman. These cancer cells are usually present in the endometrium or the cervix region of the uterus. Woman infertility: Performing a biopsy on time also confirms when the woman had her last ovulation cycle. However, the same can also be checked through a regular blood test of the progesterone level. (4) Contraindications while performing Endometrial Biopsy: Below we are mentioning some reasons where patients are not advised to go for endometrial biopsy: Prolonged Vaginal bleeding Pregnancy Infection Presence of Perforation in uterus or cervix Minor spotting and mild cramping Fever or chills Severe lower belly pain Details of the above-mentioned points are explained below (5): Prolonged Vaginal Bleeding: Subsequently, a patient suffers vaginal bleeding due to the surgery for another few days. The bleeding is common, and one may also use a pad or consume medication to relief bleeding. In case, one is suffering from heavy bleeding then, she should immediately contact the doctor. Pregnancy: The procedure is strictly prevented during pregnancy as it harms a child and significantly damages the proper progression of the pregnancy. Therefore, it is advisable to promptly inform the doctor about the pregnancy before beginning with the biopsy. Infection: Due to the usage of various medical instruments, a patient may attain vaginal infection. Usually, the case is rare when a patient attracts an infection after undergoing endometrial biopsy, but precautions should be kept in mind before commencing with the treatment. Presence of perforation in uterus or cervix: There is another rare condition when a hole forms in the wall of the uterus due to a thin plastic catheter in the instrument. This usually happens when the uterus's angle positions from up to down. Foul-smelling drainage from your vagina: A patient will experience cramps and spotting of blood along with mucus for some days after the biopsy is performed. This mucus may smell bad for some days due to the interference of instruments in the vagina. Fever or chills: A woman gone through endometrial biopsy may suffer weakness, minor fever, and chills as a common side effect of the biopsy. Severe lower belly pain: The procedure depends upon removing a small tissue sample from the endometrial lining of the uterus. Any minor cut or surgery in uterus normally takes a few days to get healed depending on the manner it is dealt with. It may even evolve severe pain in the abdominal while curing. Similarly, in an endometrial biopsy, the rigorous or severe pain generates for some time. Therefore, one should strictly follow the medication prescription to ensure that timely cure occurs without severing of the condition. The severity of endometrial biopsy pain and recovery time: It is necessary to inform the patient about the severity of the endometrial biopsy pain so that she can prepare for the same. The surgery, which is performed for the biopsy enhances the degree of pain and uneasiness in some of the patients. Sometimes, the patient feels sick and requires bed rest for the next 1-2 days. However, medicinal drugs available at a normal drug store help in bearing the continual pain. But before a patient intakes medication, he must consult her doctor. Along with medication, the patient should also avoid doing stressful work and vigorous exercise. It is seen in some rare cases that the psychology of a woman also impacts due to severe continuous pain. An endometrial biopsy causing excruciating pain also influences the ability to conceive negatively. It practically takes one week to get properly recovered from the side effects of the endometrial biopsy. During this time span, one should avoid any type of insertion into the vagina like a tampon and abstain from performing intercourse. Significance of Endometrial Biopsy Test: Endometrial biopsy assists a doctor in effectively finding out the unknown and actual cause of heavy or irregular bleeding. It also proves to be one of the major and common medical procedures to accurately identify and help in confirming the presence of endometrial cancer in the patient. Although the endometrial tests are held in a conventional clinic or in a hospital, an exceptionally skilled and expert doctor is required to perform such a complicated and important medical tests. The endometrial biopsy also assists the doctor in precisely identifying the hormonal levels associated with endometrium lining and subsequent changes in the viable cells of the endometrial lining of the uterus. Common Symptoms of Endometrial Thickness: Endometrial hyperplasia refers to a condition when the endometrium or its lining inside the uterus, becomes thicker than the normal thickness. The thickness of the endometrial lining contributes to the occurrence of cysts and unusual bleeding. However, in rare cases, untreated and ignored symptoms of abnormalities of endometrial lining evolve into uterus cancer. Usually, the endometrial hyperplasia occurs due to excessive estrogen in the body without progesterone. The ovulation is restricted when progesterone does not rise and shedding of the endometrial lining does not occur. The endometrium lining continues to thicken in a positive response towards estrogen. The cells of endometrial lining club-together and make it abnormal. This condition rarely leads to cancer in a woman. Hyperplasia mostly occurs in menopausal and perimenopausal conditions, when ovulation does not occur, and the formation of progesterone levels becomes extinct. A common, yet most prominent reasons and symptoms of having an irregular or abnormal endometrial lining is abnormal bleeding through the uterus. One must contact the doctor in case any following symptoms are found: (8) (9) Heavy and prolonged bleeding than usual periods. Menstruation cycle, which occurs in a shorter span of time (21 days). Any bleeding from the uterus after the menopausal phase Preparations need to be done before Endometrial Biopsy: Here are some of the essential and important preparation one must follow before going for the endometrial biopsy test (10): A health care provider must listen to and clear out all the doubts of a patient before a biopsy. Before performing the procedure, a consent form will be given to the patient to seek his permission and awareness about the procedure. This permits the doctor to perform the procedure. It is advised to read the form thoroughly and clear all doubts right away from the health care team. Usually, one does not need to take any specific measures before the procedure begins. Though, the physician may recommend the patient to have an effective pain reliever at least half an hour before the procedure. If one is pregnant or believes to have symptoms creating the possibility of the same, then informing the doctor will be helpful. One must inform the doctor about her sensitivity and allergies towards any of the items like iodine, latex, tape, or anesthesia. Informing the doctor if the patient is already consuming regular prior prescription and herbal supplement. This will help the doctor to follow the procedure accordingly. One must inform the doctor about the history of bleeding dysfunctions, or if there is any routine intake of blood-thinning medicines (anticoagulants). Medicines, which involves thinning of blood like aspirin, and any other medicines affecting blood clotting may hinder the body from healing. One may be told to cease the consumption of these medicines before the procedure for a certain time period. A health care provider also asks the patient to maintain a record of her menstrual cycles. One must schedule the procedure at a particular time of her cycle after consulting the medical specialist. If the health care provider gives the patient a sedative before beginning the procedure, then someone will be required to drive the patient home afterward. Therefore, a companion with the patient will be significant to motivate and deal with the patient's condition in a positive manner. It is essential to bring a sanitary napkin to use it right after the procedure completes. Based on a patient's health condition, the physician may call for additional preparation. Materials and equipment used in biopsy:  Below are the materials, which are needed to perform endometrial biopsies (11): Formalin Container (for specimen) Drape Hand gloves Speculum for vaginal to effectively perform a uterine ultrasound A metal container of cotton balls soaked in medicinal providing (or pre-packaged povidone swabs) A catheter for endometrial suction To properly grasp the cervix, a cervical tenaculum is required Ring forceps to wipe cervix with cotton balls Gauze (4x4s) Cervical dilators Anesthetic gel-like Xylocaine or spray Scissors The procedure of Endometrial Biopsy: Endometrial biopsy methods vary depending on the patient's condition and her doctor's expertise. (6) (7) (12) In routine, an endometrial biopsy follows the below-mentioned process: The patient will be requested to undress from the region down the waist. She will then be asked to wear a comfortable hospital gown to avoid discomfort during the procedure. The patient will be asked to empty her bladder right before performing the crucial procedure of biopsy. A doctor will carefully insert a unique device popularly termed as a 'speculum'. The successful and smooth insertion of the speculum into the vagina will widen the walls of the vagina apart. This will precisely reveal the cervix for the procedure. Subsequently, the cervix will be cleaned thoroughly to prevent infection. An expert doctor will only employ an antiseptic solution for the cleaning procedure. The doctor will also numb the operational area utilizing a small and thin needle to inject vaccination, or an effective numbing spray will be applied to the patient's cervix region to anesthetize it. A specific type of forceps, known as a 'Tenaculum', is employed to hold the cervix constant to perform a biopsy. This is the most complicated and delicate step of the endometrial biopsy. During this step, a patient will naturally proceed to feel intuitive about minor cramping. When the Tenaculum is applied precisely to the operational area one may feel minor discomfort as well. A thin, rod-like instrument uterine sound will be carefully inserted from the cervical opening. It will reliably determine the proportional length of the uterus, normal size of endometrium in mm and its exact location for a biopsy. This procedure will also generate some cramping. The uterine sound will then be withdrawn gently. A catheter, which typically resembles a thin tube, will be carefully inserted through the cervical opening into the uterus. A catheter includes a narrower tube known as an 'internal piston', which is present inside it. The experienced doctor will remove the inner tube instantly forming the suction at the tip of the catheter. The doctor will smoothly twist and gently move the tip of the catheter in and out to accumulate minor parts of endometrial tissue in the uterus. A major reason for performing a biopsy decides the amount of the tissue and location of the surgery. The doctor will gently remove the catheter and a speculum from the uterus. The tissue will be efficiently stored in a preservative safely. The endometrial tissue will be forwarded to a specialized laboratory for functional analysis. What happens to the sample, removed from the lining of my uterus? The removed sample or tissue is sent to the hospital or specialized laboratory for comprehensive analysis. The descriptive analysis is performed professionally by a sub-specialist known as a pathologist. The tissue cells are carefully examined under the microscope. The pathologist is adequately skilled to perform the test and confirm if cancerous or precancerous cells are existing in the endometrium lining or not. The clinic will inform the patient with the results once the reports are available. Endometrial lining examination becomes a must in case symptoms are getting worse and the pain becomes unbearable to handle anymore. Timely checkup can save one from pain and stress associated with the medical test. Endometrial biopsy is a very effective medical test in terms of identifying the exact cause of bleeding from the uterus. One should timely visit a doctor without keeping her health at risk and get started with the advised medical treatment. If you are looking for details on other blood tests, medicines, and infertility treatments, then please visit Elawoman's medicine info and infertility treatments section. You can also contact us and connect to our experts on +918929020600. You can also visit our website to check the best fertility centers, and success stories of patients who opted for infertility treatments at these centers.

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Fertility Basics

A Guide To Cervical Mucus Test

posted on June 15, 2019, 2:45 p.m.
4.5/ 5 (1 Votes)

The female reproductive system comprises several crucial organs which have their individualistic roles in the timely and proper functioning of the body. The cervical mucus secretions fill the opening of the cervical canal and contribute effectively to the dual roles of the cervix. Cervical mucus testing has many advantages as it allows women to not to solely rely on external methods of testing. Cervical mucus test is beneficial as it almost cost-free except for a menstrual calendar or a thermometer to check for the basal body temperature. These methods do not pose any side-effects as no medications are involved in these methods. These roles include preventing the ascent of pathogens and facilitating the ascent of sperm to the fallopian tubes. The cervical mucus is composed of water (95–99 percent), bactericidal proteins, ions, plasma proteins, enzymes, and mucins. The role of cervical mucus is to prevent sources that may cause infections from entering the uterus via the cervix in the woman. It is also responsible for providing nourishment and helping sperm to get transported via the cervix into the uterus. Fertile cervical mucus is an indication of the occurrence of ovulation in the concerned woman. For those who are planning to start their families, this is the best time (ovulation) to have sexual intercourse to conceive. There's a change in the amount and consistency of cervical secretions (cervical mucus) during different times in a woman’s menstrual cycle. This can be checked this by gently placing the middle finger into the vagina and pushing it up to the middle knuckle linked to it. For the first few days after a woman’s period, they will probably find that the vagina is dry and mucus cannot be felt. As the hormonal levels rise to prepare the body for ovulation, women will probably find that they start to produce mucus that is moist, sticky, white, and creamy. This is the start of the fertile period of a menstrual cycle. Immediately before ovulation, mucus gets clearer, wetter, and slippery – a bit like raw egg white. This is when a woman is most fertile. The mucus should then soon return to being gluey and thicker consistency, and after 3 days the particular woman should no longer be fertile. With the help of these methods, women can become more alert of their monthly cycles and associated physiological changes. Below are explained some of the benefits of Cervical Mucus test: Affordability: It is the best method for those using it as a natural method of preventing pregnancy. The method is affordable as no extra cost is associated with this method except for the medical consultations if any. Easy to Use: Cervical mucus test is easy to use. With the help of observations and test charts, over 90 percent of women are able to identify their most fertile days. The simplicity to use it makes it more demand among women who do not want to take medical assistance at the primary level. Non-invasive, natural and medicine-free: Cervical mucus method is non-invasive and does not require any medications or devices for the procedure. (1) In this article, we will learn in detail about: What is cervical mucus? What is a cervical mucus test? What are the cervical mucus changes? What is the role of Cervical Mucus test in fertility levels? How to test Cervical Mucus? How to prepare for Cervical Mucus Test? How to use the Cervical Mucus test? What are the cervical mucus observations? What are the risks associated with Cervical Mucus test? What is a Cervical Mucus Method? What is the significance of Cervical Mucus in In Vitro Fertilization (IVF)? Frequently Asked Questions related to Cervical Mucus Test What is cervical mucus? Cervical mucus test can be used for predicting ovulation if a woman has received adequate knowledge in the cervical mucus method. This also helps if she is dedicated to careful observation of her cervical mucus changes. Various different tests have been based on the biochemical constituents, quantity, and physical properties of cervical mucus. However, regular use of vaginal discharge for ovulation monitoring in women needs that the tests be more practical for obtaining accurate sample collection. These tests should be more objective for the detection of causes of cervical mucus changes in the concerned patient. (2) The cells lining a woman’s cervical canal are responsible for secreting mucus. The consistency of this mucus changes over the monthly cycle. When a woman is fertile, the mucus changes its consistency and structure. This allows the sperm to travel on its way to the egg. When women are most fertile, the mucus will be clear, stretchy, and abundant. To give women an idea of the consistency of mucus, this type of fertile mucus is often abbreviated as EWCM (Egg-white Cervical Mucus). When women are not fertile, the mucus is cloudy, sticky, and doesn’t stretch. (3) What is a Cervical Mucus test? Cervical mucus is gel-like or fluid discharge from the cervix. The consistency and amount of cervical mucus keep on changing throughout a woman’s menstrual cycle. This is due to the hormone levels, which fluctuates throughout the cycle. Hormones stimulate glands in the cervix in order to produce mucus. Cervical mucus can help in predicting ovulation, so a woman can track the mucus to help achieve or avoid pregnancy as per her and her partner's family planning goals. This is known as 'cervical monitoring' or 'fertility awareness'. Women should use a backup method of birth control if they’re trying to avoid pregnancy. This will help them effectively to prevent pregnancy. Cervical Mucus Changes: The amount, color, and consistency of cervical mucus in each cycle is different for every woman. General cervical mucus changes include the following: Cervical Mucus During Period: During the menstrual cycle, blood will cover the mucus. Women may not notice it during these days of menses.   Cervical Mucus After Period: Immediately following the period, women may experience dry days. On these days, women may not notice any discharge.   Cervical Mucus Before Ovulation: Women body produces mucus before the release of an egg or before ovulation occurs. At this time, the cervical mucus may be yellow, cloudy or white. The mucus may feel gummy or stretchy inconsistency.   Immediately Before Ovulation: Just prior to ovulation, the estrogen levels in women are increasing. They may see more clear, watery, stretchy, and slippery mucus. This mucus may remind them of the consistency of egg whites.   Cervical Mucus During Ovulation: The stretchy, clear mucus that’s the consistency of egg whites is present during ovulation. The consistency and pH of this mucus are protective for sperm. For this reason, women who are trying to conceive prefer having sex on their ovulating days.   Cervical Mucus After Ovulation: There’ll be less discharge of mucus in women after ovulation. The mucus may turn cloudy, thicker, or gluey again. Some women may also experience dry days during this time period.   Cervical Mucus during Pregnancy: A small amount of vaginal discharge is generally present in the respective location throughout the month. This discharge changes during the different stages of pregnancy and during the different phases of a woman’s menstruation cycle. This type of condition is known as 'leukorrhea'. The discharge is usually thin and milky-white. The term is frequently used while referring to vaginal discharge during pregnancy, although leukorrhea is also diagnosed in the non-pregnant women. In the first trimester of pregnancy, this vaginal discharge or cervical mucus increases, and, over time, develop into the mucus plug. Eventually, this mucus plug tends to block the opening of the cervix, to prevent any infection from entering the uterus and harming the fetus. At the end of a pregnancy period, as the cervix begins to dilate and prepare for delivery, the mucus plug slowly breaks down and may come out of the vagina in small bits or in large clusters. Role of Cervical Mucus Test in Fertility: Cervical mucus plays an important role in a woman’s reproductive system. When a woman is in the non-fertile stages of her menstrual cycle, the discharge becomes thick and gluey which contributes effectively to prevent infection. When a woman is about to ovulate, it becomes abundant and more watery, which allows the sperm to swim more easily and to survive. Cervical mucus plays a crucial role in female fertility levels as well. Infertility is the most important factor arising in the reproductive health of a woman. It helps in the sperm migration via female reproductive tract, morphological, and biochemical transitions to sperm, and contact of egg and sperm in the oviduct. The causes of infertility can be found in a majority of cases. Secretion levels of vaginal discharge help in finding out the current fertility levels in the body. (4) How to test cervical mucus? Cervical mucus testing is one of the best ways to get in touch with what is happening in a woman’s body throughout her monthly cycle. Keeping a record of the changes in the amount and consistency of this discharge can also help women improve their chances of getting pregnant. After a month or two of regular observation, women will be able to determine the days where sexual intercourse is more likely to result in a successful conception. Here’s how the process works: Check for the secretions before and after urinating by wiping with toilet paper. Insert a clean finger into the vagina to obtain a sample of mucus. Observe (and record) the consistency of the mucus (vaginal discharge), and use the chart mentioned below to identify the fertile window. This mucus can be white, clear, cloudy, or yellowish. This mucus can have either a gluey or stretchy consistency. Use thumb and forefinger to see if the mucus obtained stretches or not. Time of Menstrual Cycle Mucus Consistency Fertility Status End of Periods No mucus noticed Not fertile After 3-4 days No mucus noticed Not fertile After 3-5 days Cloudy, minimal or sticky discharge Not fertile A woman may experience egg-white mucus which is wet, clear, stretchy, and abundant inconsistency in the next 3-4 days of cycle timing. This happens before and during ovulation. In the next 11-14 days of the cycle timing, no noticeable mucus can be found which indicates that the respective woman is not fertile in this phase of her menstrual cycle. A woman is considered to be highly fertile when she has stretchy and abundant mucus. How to prepare for Cervical Mucus Test? To use the cervical mucus method, it's required to understand the different ways cervical secretions change during a normal menstrual cycle. Although the particular length of these phases may vary, women should contact their health care provider if their cervical secretions don't follow the above-mentioned pattern. Women may have developed an infection, which requires medical attention. For women who want to use the cervical mucus method for birth control, should consult their health care provider first if: They recently had their first period, gave birth, or stopped taking birth control medications or other hormonal contraceptives Women breastfeeding their babies Women are approaching menopause Women have a condition that hinders regular ovulation, like polycystic ovary syndrome The use of cervical mucus method is discouraged by health care providers in cases where women have persistent reproductive tract infections. How to use the Cervical Mucus test? Record cervical secretions for several cycles: Starting from the day after menstrual bleeding ends, observe, and record cervical secretions on a daily and easy to record chart. To avoid confusing cervical secretions with semen or normal sexual lubrication, avoid intercourse or use contraception during the first cycle. Also, avoid douching, which can wash out cervical secretions, thereby making it difficult to notice any changes in the secretions. Check for the cervical secretions before and after urinating: Wipe the vagina carefully from front to back with toilet tissue. Observe the color (yellow, clear, white or cloudy), consistency (sticky, thick or stretchy) and feel (dry, slippery or wet) of the secretions. Also, make sure that you note sensations of moistness or dryness present in the vulva. Plan sex carefully during fertile days. Women are most fertile when their cervical secretions are wet, abundant, stretchy, clear, and slippery — almost like a raw egg white. For those who are planning for pregnancy, this is the right time to have sex. Ovulation most likely occurs during or one day after a woman’s last day of this type of vaginal discharge — known as the 'peak day'. For those who are planning to avoid pregnancy, unprotected sex is off-limits from the day of the beginning of cervical secretions until four days after the peak day in the monthly cycle. For those planning intercourse before cervical secretions begin, should avoid having sex the next day and night so that they don't confuse semen and arousal fluids with cervical secretions. Some health care providers also suggest avoiding unprotected intercourse or using a barrier method of contraception even at the time of periods. During this time, it becomes difficult to detect cervical secretions when they are mixed with menstrual blood. Interpreting and noting down cervical secretions can be challenging at such times. Most women need more than one instructional session to analyze the pattern of secretions in a typical menstrual cycle. Cervical Mucus Observations: Appearance: Many women observe cervical mucus on toilet paper after wiping; however, finger testing can also be performed to check for the consistency of mucus. To perform finger testing, lift the mucus off the tissue and check it right in between the finger and thumb. The appearance, color, and consistency of the vaginal discharge should be observed carefully. Sensation: In order to detect sensation produced by cervical mucus, a woman should make note of the sensations that are felt at the vulva (i.e., the lips of the vagina). The sensations which are present in the cervical mucus include damp, dry, and wet or slippery. During Ovulation: Type 1 and Type 2 cervical mucus are usually associated with the beginning of a menstrual cycle and reduced fertility levels. Type 3 cervical mucus is a transitional type of cervical mucus, which indicates that a woman is entering the fertile window. Type 4 cervical mucus is investigative of the most fertile time of a woman’s menstrual cycle. Intercourse during this period will likely increase the chances of pregnancy. Multiple studies have shown that the best chance of pregnancy is when intercourse takes place on a day which is near ovulation and Type-4 cervical mucus is present in the cervix. (5) The common phenomena of women reporting a 'feeling' of being pregnant is known as 'confirmation bias'. Most women remember their early pregnancy symptoms and ignore or forget (not consciously) most of the menstruation cycles when they also had those same signs but had not conceived. The observations from a vulva of cervical mucus help in predicting not only the fertile days of menstruation cycle but also the highest chances of conception within the fertile phase of the menstrual cycle. Monitoring and identifying the consistency of mucus provides additional information not provided by other reproductive methods to identify the fertile time period. Specifically, methods based on cycle monitoring by daily vaginal ultrasound and/or LH detection via urine tracking are not much indicative about the probability of conception at a specific time in the fertile interval within an anovulatory cycle. (6) It is very important to check for the mucus every day, every time a woman goes to the bathroom, and before she goes to bed. If they miss or skip looking at the mucus they will not be having a total record of their fertility levels. At the end of the day, after the last check before going to bed, the most fertile mucus indication should be recorded on a fertility chart. (7) Risks Associated with Cervical Mucus Testing and Method: Testing cervical mucus for the purpose of promoting fertility levels in the body does not pose any potential risks. Likewise, using the cervical mucus method for birth control has no direct risks. However, the method doesn't offer protection from urinary tract infections or sexually transmitted disorders. In addition, the risk of unintended pregnancy with the cervical mucus method is somewhat triggered as compared to other methods of birth control. It's estimated that as many as 23 out of 100 females practicing the cervical mucus method for birth control achieve pregnancy in the first year of trying for a baby. Yet, with correct use, the pregnancy rate can be as low as 3 out of 100 women per year using the cervical mucus method for birth control. What is a Cervical Mucus Method? The cervical mucus method involves recognizing significant changes in the consistency of mucus produced by the cervix and in how discharge looks and feels like. Just before ovulation, the amount of mucus produced by the cervix noticeably rises, and the mucus becomes slippery and thin. Just after ovulation, the amount of this discharge decreases, and it becomes thicker in consistency and less noticeable at the same time. In order to prevent pregnancy, women should avoid getting indulged sexual intercourse or use a contraceptive method of birth control from the time she may first notice any cervical mucus. To promote pregnancy, women should have intercourse every day or every other day when the slippery and thin vaginal discharge is evident. While using methods that rely on cervical mucus, women should be aware of any changes in their health or daily routine that could make reading the symptoms of ovulation challenging. Feminine hygiene products, medications, douching, breastfeeding, sexual intercourse, or having a pelvic test in which lubrication is used all can change the appearance of the cervical mucus. (8) Significance of Cervical Mucus in In Vitro Fertilization (IVF): A study was conducted to observe the effect of removing the cervical mucus before Embryo Transfer (ET) in the IVF procedure or Intracytoplasmic Sperm Injection (ICSI) procedure. (9) Various studies have shown that the removal of cervical mucus prior to embryo transfer procedure in In Vitro Fertilization (IVF) procedure can have a positive impact on the pregnancy rate. It is being told that the presence of cervical mucus can result in obstruction in the path of an embryo. (10) However, a confirmation is still awaited for this statement. (11) Cervical Mucus Test vs. Ovulation Test: Cervical mucus method is advantageous as the testing does not require a woman or a couple to book an appointment with the doctor. Cervical mucus method needs to be utilized in combination with the calendar method. A cervical mucus test comes without any side effects. The method can also work as an effective indicator that the calendar method is working well. The cervical mucus method is considered to be 75 percent to 95 percent effective in preventing pregnancy. It's more effective when women have regular menstrual cycles and are able to notice certain signs of ovulation. Cervical mucus testing promotes responsibility-sharing and communication within couples. These methods do not involve medical contraindications as such. These methods are reliable as they are accepted within all religions and cultures without facing any kind of controversies. (12) Ovulation testing is usually recommended by doctors for women who are having trouble getting pregnant. If this is the case, blood tests are used to test whether or not a woman is ovulating at a normal rate. Monitoring cervical mucus is the best way for a woman to predict her most fertile days. Other methods may include tracking periods and Basal Body Temperature (BBT). Frequently Asked Questions related to Cervical Mucus Test: Q. Does cervical mucus increase before periods? When a woman is menstruating, the blood flow covers the mucus, so they may notice any discharge. Days, when women are currently in their menstrual phase, are considered unsafe days. The body during this time makes more mucus when an egg starts to ripen, prior to when ovulation is about to happen. This mucus is usually cloudy, yellow, white, or and it feels to be tacky or sticky. Q. How do you monitor cervical mucus? The most accurate method to identify changes in cervical mucus is to collect and analyze a sample of mucus on a regular basis. To do this, wash and dry your hands well, then insert the middle or index finger into the vagina, getting as close to the cervix as possible. One can notice mucus while using a toilet paper to wipe. Consistently using the same method each day can prove to be helpful in monitoring cervical mucus. For those who are planning to become pregnant, they may take notice of "pregnancy signs" such as fatigue, increased food cravings, and morning nausea. However, hormones that proceed the menstrual cycle can also lead a woman feel nauseated, fatigued, and hungry for certain foods, so they can feel pregnant even when they are not. Checking their cervical mucus or looking for other "pregnancy" symptoms is not a reliable method of confirming pregnancy. Having a missed period and performing a pregnancy test can prove to be the most reliable method to confirm that a woman is pregnant. Looking for transitions in cervical mucus is also not the best method of telling whether a woman is pregnant. Changes in the cervical mucus are an accurate reflection of the activity of a woman’s reproductive hormones. The observations and charting will be an accurate record of these changing hormonal events. For any irregularities in hormonal patterns, such as an unusual pattern of discharge or abnormal bleeding, you can talk to the best fertility experts at Elawoman. Feel free to visit elawoman.com to find more related informative blogs or get your queries related to infertility and IVF treatments answered by dialing +918929020600.

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Fertility Basics

Ovarian Reserve Testing

posted on June 14, 2019, 3:27 p.m.
4.5/ 5 (1 Votes)

Infertility treatments involve certain medical tests which are performed as per the requirement of the patient's case. The concerned infertility specialist advises the same to the patient. Fertility experts prefer performing an Ovarian Reserve Test (ORT) on a patient before initiating the In Vitro Fertilization (IVF) treatment. The ORT series of medical tests follows a standard procedure of blood tests, and a urine test. In today's life, conceiving a baby has converted into a substantial problem of infertility among couples. Voluntary or involuntary, if pregnancy delays, then gradually the ovary reserve in the woman either starts declining its quality or quantity of follicles. Declining of ovarian reserve is a natural phenomenon these days. Women in mid to late 30s find it even more difficult to get pregnant. Turning over to these ORT tests reveal the deterioration in women's follicular pool and oocyte quality. The ovarian reserve testing additionally confirms the number of eggs left in the ovaries. Further, it helps in recognizing the reproduction ability of a woman to sustain a healthy and successful pregnancy. Growing older naturally decreases specific capabilities to perform in one's daily life. One such condition is to ovulate, fertilize, and achieve pregnancy. Unlike men, a woman carries all the limited number of eggs in her ovaries that she will produce in her entire life or most probably till the age of the 50s. Ovarian reserves work on the inverse correlation between female ovulation and age. Our most of the advanced infertility technologies still lack direct assessing and determining the condition of ovaries in women. However, infertility experts have discovered a few indirect ways or test to determine the condition and health of an ovary reserve. As soon as months pass every month, a healthy egg ovulates, and medical expert performs these tests during periods to check the desired hormonal levels in the body. A woman after trying for a minimum of 6 months, at the age of 35 should get her ovarian reserves tested on time. (1) (2) In this article, you will find useful content related to the following aspects: What is the significance of ovarian reserve testing? What is the average cost of Ovarian Reserve Testing (ORT)? What are the tests to identify the number of Eggs? Also, explain the following tests: Follicle Stimulating Hormone (FSH) Estradiol Clomiphene Citrate Challenge Test (CCCT) Inhibin B Test Anti-Müllerian hormone Test (AMH) Antral Follicle Count test Women after their 30s undergo, a natural process of a gradual decline in their ovary sacs, both with respect to quality and quantity. As per one of the recent researches, particularly at the age of 37.5 years, the critical figure of egg cells prevails only 25,000 in women. ORT tests indirectly, provides some valuable facts about the remaining follicular pool in a woman's ovaries. The valuable results of the following tests help in determining the quality and quantity of viable eggs. These tests also define the accurate production of the following required hormones in the body: Follicle Stimulating Hormone (FSH) Estradiol Hormone Anti-Müllerian Hormone (AMH) Antral follicle counts In this informative article, we will view the ovarian reserve tests and their significance. We will be compiling each and every key aspect of these tests to make the information useful. Significance of Ovarian Reserve Testing (ORT): A study performed on 750 women has shown evidence that Ovarian Reserve Testing (ORT) does not confirm the possibility of pregnancy with a high number of egg follicles. The three markers used in the study are: Anti-Müllerian Hormone (AMH), Follicle-Stimulating Hormone (FSH), and Inhibin B Due to awareness about these tests and health conditions, women are more and more willing to undergo these tests to check their potential to achieve pregnancy in the future without artificial method. A boom in the ovarian testing has become prominent because a woman with their work commitments seeks to achieve pregnancy in their 30's. In the same study, women who were never found with any infertility problems were tested. The basic concept or reason behind the study was to find below-mentioned points: A number of eggs or number of years left for fertility in women with advanced age. The functioning of the remaining eggs in ovarian reserves. How will the ovaries respond during IVF treatment? All the 750 women were in the age bracket of 30 to 44 years. These women were constantly trying to get pregnant within a time span of three months or less, but they were unsuccessful. Using the three biomarkers, both categories of a woman with lower and higher levels of egg reserves were tested and had the same results. It was found that women possessing a lower hormone level with diminished ovarian reserves conceived through natural stimulator similar to women with a high level of ovarian reserves. The first attempt was successful with hormone stimulators within one year. Therefore, the study created an impression that the entire ovarian reserve test does not give accurate results about their future chances of having children. As per the opinion of experts who conducted this study, a woman with low values of test unnecessarily bears the stress of being infertile, whereas a woman with a high level of ovarian reserves might incorrectly assure about her pregnancy. Many doctors also believe that these medical tests are very helpful and prominent in the short term rather than in the long term. (3)(4) Another important factor of Ovarian Reserve testing relies on the quality of eggs. A woman with poor egg quality struggles to achieve pregnancy even if she has a high number of egg follicles in her ovaries. Similarly, a woman with less number of reserves can achieve pregnancy fast if her quality of eggs is excellent. However, there is no specific test, which tells about the accuracy of egg quality. Cost of Ovarian Reserve Testing: Signs of Diminished Ovarian Reserve (DOR) include several important ORT tests like AMH Test, FSH Test, and Inhibin B test. These ORT tests assist in evaluating normal functions, reason, and ability of the ovary to perform fertility treatments. The ORT test identifies the competencies of an ovary to provide viable egg cells for retrieval in IVF procedure. These egg cells otherwise, later turn into mature eggs and rupture out of the small sacs in the ovaries. The cost of ovarian reserve testing is about Rs. 1400/- to Rs. 3500/-. The ORT tests also include FSH and AMH test costs. The cost may also vary depending upon the medical experts and location of clinic and hospital. Tests to identify the number of Eggs: We have mentioned below all the tests, which are useful in testing the number of immature eggs in the ovaries. These medical tests are usually performed on the 3rd day of the periods: On Day 3, a patient is examined with a blood test to estimate the levels of FSH, LH, and estradiol. On Day 5, doctors advise the patient to start a 5-day course of Clomiphene citrate. On Day 10, the patient return to the clinic for another FSH/LH/Estradiol blood test. Here is the number of women's potential eggs according to their below age are: At the time of birth: 1-2 million Puberty: 1 million At the age of 25: 300,000 Around the age of 35: It declines below 300,000 till menopause. Follicle Stimulating Hormone (FSH): Follicle-stimulating hormone (FSH): It is the chief hormone of the reproduction cycle. It is one of the essential hormones, which helps in the development of eggs and sperm. The FSH test majorly checks for FSH in the blood and urine. The hormone is specifically produced by the pituitary gland, which has a locus at the base of the brain. Another important part of the brain is Hypothalamus. Hypothalamus directly stimulates the pituitary gland to release the hormone FSH. The stimulation is of FSH is influenced by Gonadotropin-Releasing Hormone (GnRH) released by the hypothalamus. The GnRH hormone stimulates FSH and luteinizing hormone (LH) together, as both the hormones are fundamental in reproduction. (5) (6) FSH helps in the growth and maturation of the egg in follicles during the follicular phase of 14 days with respect to the menses cycle. It also initiates the production of estradiol from the egg follicles. At the end of the follicular phase, the surplus FSH hormone is controlled by estradiol and progesterone only. FSH enhances the ability of the ovary to respond to Luteinizing Hormone (LH). After menopause, both hormones, FSH and LH levels increase in a woman's body. Significance of FSH test: The FSH test to check a reserve as a marker was introduced over 30 years ago. The purpose was to use FSH to predict the response of the ovaries in In Vitro Fertilization (IVF) treatment. The test is an indirect method of checking the ovarian reserve. The test relies on feedback inhibition of FSH hormone from the pituitary gland. The test measures the feedback depending upon different ovarian factors, and the production of FSH hormones. A woman with a normal ovarian reserve usually has sufficient production of ovarian hormones. At the beginning of the menstruation cycle, FSH is substantially maintained completely with the assistance of ovarian hormones. A high level of FSH at the beginning of the menstruation cycle signifies poor ovarian hormone production. The test blood sample taken on the 3rd day of menses is used to check FSH levels in the body. Estradiol: Estradiol: It is a form of estrogen hormone, which is one of the key hormones for reproduction. The hormone is released from the ovaries, the adrenal cortex, and the placenta when the FSH hormone stimulates the ovaries to develop the eggs. The estradiol hormone is also released from breasts, outer genitals, uterus, fallopian tubes, and vagina. It also helps in balancing the growth of the same. Estradiol basically adjusts the excessive FSH level in the body. When the level of Estradiol is more than the desired levels, FSH levels become low or normal. FSH and estradiol tests are performed simultaneously on the 3rd day of menstruation or menstrual cycle. When ovaries are not growing the eggs, even after the release of FSH hormones means that the ovaries require more FSH hormone. To fulfill the requirement pituitary gland release more FSH hormone, it effectively elevates the additional quantity of FSH in the blood. This ensures the medical experts that ovaries are not performing efficiently in response to the FSH hormone. Once the estradiol is released in ample quantity, it will control the level of FSH in the body. A steep rise in the levels of estradiol during the test also indicates an early occurrence of puberty than usual known as precocious puberty. The low level of estradiol indicates late puberty. The test assists the doctor in identifying to treat hypopituitarism or decreased function of the pituitary gland. The test is important in the following (7) (8): Abnormal menstrual periods Abnormal vaginal bleeding Infertility in women Clomiphene Citrate Challenge Test (CCCT): Clomiphene Citrate Challenge Test (CCCT): This test is traditionally carried out to evaluate the condition of the ovaries by giving a medicine clomiphene citrate. This is a fertility drug (Clomid, Milophene, Serophene). This medicine is taken orally in 100 mg to influence ovulation in the respective woman. The medicine induces the ovaries to release more than one egg per cycle, which eventually increases the chances of reproduction. An ultrasound monitors the effects of this medicine on the ovaries and finds out any prominent and visible effects on the ovaries. This test is substantial in infertility treatments like In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), or artificial insemination in a woman. The successful test includes the following hormones to evaluate the positive response of the ovarian reserve: FSH (Follicle Stimulating Hormone) LH (Luteinizing Hormone) Estradiol Inhibin B Test: Inhibin B: It is a key hormone in ovarian reserve testing. It is generated along with Inhibin A from specific small cells in the ovarian follicles. It is another chief hormone to suppress FSH hormones in the blood. A consistent reduction in inhibin B has been observed prior to the menopause in women. The test is likely to be performed on the 3rd day of the menstruation cycle. A level above 45 pg/ml blood is classified to be normal. Poor functioning of the ovary sacs is mostly affected by the changes in the secretion glycoprotein hormones like Inhibin B and Anti-Müllerian hormone (AMH). Inhibin B also helps in identifying certain types of ovarian tumors and the number of eggs available in the reserve to achieve pregnancy. With the increasing age of a woman, their decreasing ovarian follicles start declining the secretion of AMH and Inhibin B. Inhibin B hormones make it difficult to interpret the results in premenopausal women because of its fluctuations in a menstruation cycle. (11) Doctors have found two most effective and recent tests to count the number of eggs present or left in a woman's ovaries. These two medical tests are the following ones: AMH (Anti-Müllerian Hormone) Test: AMH (Anti-Müllerian Hormone) test: It is a protein hormone produced by special cell-based inside the follicles. The level of this hormone in the blood provides an estimation of the total number of egg cells in the ovaries. Due to the constant availability of the hormone in the blood, the doctor at any time is able to perform the test. A normal level of the hormone should be between 1.0–4.0 ng/ml. (9) The hormone refers to a protein, which helps in the development of the reproductive tract both in the male and female fetus during the pregnancy tenure. This hormone is produced before birth by testes and ovaries. In the 8th week of conception, the fetus has two sets of ducts. Both the sets of ducts are separate from each other. Out of them, one turns out to be a female reproductive system if female chromosomes are present in the body and the second duct disappears. Whereas, the presence of male chromosomes, disappears the female duct and continues to produce the male reproductive system. When the fetus is growing male reproductive part then it releases anti-Müllerian hormone, whereas female fetus releases Müllerian hormone. It becomes valuable to evaluate anti-Müllerian at the initial stage of developing follicles, which sustains the support to the eggs before the event of fertilization. The more follicles are present in the ovaries which reflects additional anti-Müllerian hormone produced by her ovaries. Therefore, assessing AMH can positively measure the number of follicles present in the woman and how many are left. Assessment of AMH is substantial in IVF treatment to measure the response of ovaries and what amount of medication is required in IVF. It is also observed that a high level of AMH sometimes identifies the presence of Polycystic Ovarian Syndrome (PCOS) in women. Antral Follicle Count Test: Antral Follicle Count Test: During Antral Follicle Count (AFC) test, a doctor with the help of an ultrasound counts the visible follicles during periods. Each follicle has unique formations as it carries an immature egg in it. These immature eggs have an appropriate, potential to grow as a baby if fertilize on time or goes through a normal process of ovulation. The test helps in evaluating the number of total eggs. It also provides a brief idea that how many eggs can be frozen by a woman during one cycle. If the doctors perform this test at the beginning of the menstruation cycle, then it provides with most prominent results which help the patient as well. The ovaries contain small antral follicles, which are filled with natural fluid and immature eggs. The test is performed on the menstruation cycle 2nd, 3rd, and 5th day. The shape and sizes of the follicles are different from one another in ovaries. Therefore, it becomes easy to identify and count them separately. The test also assists in predicting the chances of the success rate in the In Vitro Fertilization (IVF) cycle. The test helps in recognizing the presence of mature follicles in ovaries, which can be stimulated by medications for a successful IVF procedure. Retrieved eggs are directly linked with the IVF success rate. The test is more accurate and substantial than the FSH test during the IVF procedure. (10) All the above-mentioned medical tests are very useful in examining and analyzing the good prognosis in the woman for reproduction. However, all the tests are usually helpful in unknown fertility, and advancing age. These tests are best used in apprehending the response of the ovaries towards IVF treatment. Though, analyzing the quality of the eggs is still a huge problem in the field of infertility medicine. None of the tests apparently states the quality of the eggs for the successful production of an embryo. It was clear from the beginning of this article that women with merely a high number of oocytes may not likely to get pregnant. Only a woman with good quality of eggs is able to conceive without much difficulty even in advancing age. A major drawback of these tests is their variation in each of menstrual cycles in women. The retrieval of the oocytes is postponed if the follicles are insufficient, and ovaries are not responding positively. In this condition, the tests are repeated in the subsequent month. (12) Thus, medical tests such as ovarian reserve testing (ORT) are some of the advanced and recommended tests which are advised by infertility experts for successful execution and completion of the chosen infertility treatment. To know more about different fertility issues you can visit our website elawoman.com. Our informative blogs will help you to understand clearly the infertility problems, treatments, and medications. You can also contact us to know further clarify your queries by calling us +918929020600.

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Fertility Basics

Luteal Phase Defect (LPD) – Causes, Symptoms and Treatment

posted on June 14, 2019, 4:49 p.m.
4.5/ 5 (1 Votes)

It is important for women trying to have a baby or those who may plan pregnancy in the future, to be aware of all the factors affecting female fertility. Although the advent of IVF and infertility procedures has made treatment of infertility issues possible, women must take care of certain early alarming signs of infertility. Women having short menstrual cycle are at an elevated risk of Luteal Phase Defect. It is mentioned that women whose menses are shorter than 21 days may suffer from luteal phase defect or short follicular phase. The luteal phase is the second part of a woman’s menstrual cycle, which takes place post ovulation. The estimated time between ovulation and the beginning of periods should be 12 to 14 days. If the duration is shorter than this, this means the corpus luteum is not producing enough hormone progesterone to maintain the uterine lining of the uterus. Even if an egg is fertilized and becomes an embryo, a pregnancy cannot be sustained as there is no support for the embryo to get successfully implanted in the uterus. There are many medical and natural therapies today which are proved to be helpful for women for leading into a happy and healthy life in terms of fertility. This article contains detailed information about the following aspects of Luteal Phase Defect: What is a Luteal Phase Defect (LPD)? Relationship between Luteal Phase Defect and progesterone hormone What is the role of Luteal Phase Defect (LPD) in pregnancy? What is the significance of Luteal Phase Defect in miscarriage? What are the causes of Luteal Phase Defect? Symptoms of Luteal Phase Defect What is the diagnosis of Luteal Phase Defect (LPD)? What is Luteal phase insufficiency and Short Luteal Phase? What is the treatment of Luteal Phase Defect? What are the natural therapies to treat Luteal Phase Defect? Frequently Asked Questions about Luteal Phase Defect What is a Luteal Phase Defect (LPD)? Luteal Phase Defect (LPD) is a condition wherein the endometrial or uterine lining doesn’t grow in the required manner each month. Due to this improper growth of the endometrial lining, it becomes difficult for a woman to achieve pregnancy or to remain pregnant to full term. The luteal phase is one of the four main phases of a woman’s menstruation cycle. It takes place after ovulation (when a woman’s ovaries release an egg) and before the period starts. During this time, the uterine lining normally gets thicker in order to prepare the uterus for a healthy pregnancy. The luteal phase is considered as the latter phase of a woman’s monthly cycle. This phase takes place with the formation of the corpus luteum and ends in either pregnancy or luteolysis. (1) This phase begins after ovulation, which lasts about 14 days (unless fertilization occurs) and ends just before the menses of the woman. In this phase, the ruptured follicle gets closed after releasing the egg and a structure called a 'corpus luteum' is formed. Corpus luteum is responsible for producing increasing quantities of the hormone progesterone, along with small amounts of estrogen. A defective corpus luteum in the secretion of progesterone hormone turns out to be a major cause of female factor infertility or early spontaneous miscarriage. Progesterone is considered as the primary hormone associated with luteal phase stage in women. One of the main functions of progesterone hormone in a woman is to help support and guide a developing embryo in the pregnant woman. (2) Relationship between Luteal Phase Defect (LPD) and Progesterone Hormone: Progesterone hormone is significantly higher during the luteal phase than other phases of a menstrual cycle. The combination of these hormones helps in maintaining the thickened uterine lining, waiting for a fertilized egg to implant in the uterus. When a fertilized egg implants in the lining of the uterus, it produces hormones, which are essential to maintain the corpus luteum. This includes hormone Human Chorionic Gonadotropin (HCG), which is detected in a urine test for pregnancy. The corpus luteum keeps producing the increased levels of progesterone hormone that are required to maintain the thickened endometrial lining. When pregnancy doesn’t take place, this corpus luteum becomes shriveled and dies. This usually happens around day 22 in an average 28-day menstrual cycle. The drop in progesterone hormone levels makes the lining of the uterus to fall away in case of absence of pregnancy. This is known as menstruation. This cycle repeats on a monthly basis in a non-pregnant woman and ceases in a pregnant woman during the pregnancy period. (3) Luteal Phase Defect (LPD) Chart: Women open up a lot of possibilities for themselves by recording their daily fertility related signs. Fertility charting is proved to be a useful method for women to assist them in achieving or prevent pregnancy. Fertility charting can answer important queries about the luteal phase, thyroid function, ovulation, and cycle health. Women can get a detailed image of their reproductive health by recording their cervical fluid viscosity, waking body temperature, and other useful data on a regular basis. It is so far the best tracking activities for women to live a healthier and happier life. Fertility charting involves learning to consider the short window of time when a woman is actually fertile. A reasonable number of women still believe that they are fertile throughout their menstrual cycle, while the truth is that there is only a 5-7 day window each cycle when a woman is actually fertile. Fertility charting can prove to be highly useful to protect and prevent pregnancy. Even as a contraceptive method, fertility charting has proved to have an appreciating 100 percent efficacy rate. Along with luteal phase defect, fertility charting can also help couples in identifying the right time for them to have sex in order to increase their chances of getting pregnant without putting a lot of efforts. Signs on the fertility charts that can indicate a luteal phase defect and low progesterone include the following: A short luteal phase of fewer than 10 days in length: It is sometimes told that a luteal phase under 11 days in length proves to be challenging for women with such condition. Premenstrual spotting during the luteal phase of the menstrual cycle, particularly if it begins less than 10 days after ovulation A non-existent temperature rise or a low-temperature rise in the presence of a positive progesterone blood test can be alarming Unstable temperatures during the luteal phase in the woman An early drop or delayed rise in temperatures after ovulation Role of Luteal Phase Defect (LPD) in Pregnancy: It has been reported that over 6 to 10 percent of women are experiencing luteal phase defect. It is being concluded in current infertility scenarios in general population that if women who have been trying to get pregnant without success and with no obvious cause identified, they may be suffering from a condition known as 'luteal phase defect'. Luteal phase defect can have serious outcomes on pregnancy as the condition is difficult to diagnose without fertility charting. In addition, Luteal Phase Defect (LPD) is usually not detected during standard fertility investigation in a woman. The good news is that these types of defects can be identified with the help of fertility charting. Once the condition and cause have been diagnosed, there are numerous therapies, which can be used to treat the problems associated with Luteal Phase Defect (LPD). Significance of Luteal Phase Defect (LPD) in Miscarriages: Luteal Phase Defect (LPD) or deficiency refers to a problem with the luteal phase. In this condition, the endometrial lining of the uterus is not optimally prepared for successful implantation of a fertilized egg. LPD is considered as a theoretical cause of miscarriage and infertility in women. The idea underlying luteal phase defect is that if the uterus is not fully receptive of pregnancy, then either a woman will not conceive at all or the pregnancy will not implant properly. This will ultimately lead to miscarriage. Luteal phase defect can also be a significant cause of repeated miscarriages. It is when women have low levels of progesterone hormone over a series of menstrual cycles. Causes of Luteal Phase Defect (LPD): A luteal phase defect can happen to a woman if her ovaries don't release enough progesterone hormones or if the endometrial lining doesn't respond to the hormonal levels in the body. The condition has connections to many health problems, including conditions like: Anorexia Nervosa: It is an eating disorder characterized by difficulties maintaining the desired body weight, stature, height or age in growing children. A distorted body image is also observed in many cases. (4) People or children experiencing anorexia restrict the types of food they eat and the number of calories intake. Some people experiencing anorexia eat large amounts of food at once and then purge when they are not able to digest it. (5) Endometriosis: Endometriosis is a medical condition affecting women wherein, tissues responsible for making up the uterine lining starts to grow outside the uterus. Symptoms of endometriosis include painful periods, pain in the lower abdomen, painful sexual intercourse and of course, presence of infertility issues. (6) Extreme workout routine/exercise: Strenuous exercise or workout can impair ovulation in women. Too much exercise can lead to a luteal phase defect in some of the women. A shorter luteal phase can affect a woman in achieving pregnancy in certain specific ways. Hyperprolactinemia: Hyperprolactinemia is a medical condition wherein a person has higher-than-normal levels of prolactin hormone in the blood. The main function of prolactin hormone is stimulating breast milk production after delivery. Sporadic luteal-phase hyperprolactinemia is a relatively common phenomenon with progesterone hormone deficiency. (7) Obesity: Studies have shown that the length of periods and the luteal phase is possibly affected in obese and overweight women. This clearly indicates that increased weight also impacts the overall weight of a woman. (8) Polycystic Ovary Syndrome (PCOS): Certain hormone imbalance like Polycystic Ovarian Syndrome (PCOS) can lead to a longer luteal phase than the desired time frame. Thyroid disorders: Thyroid disorders can affect fertility in several ways resulting in luteal phase defect, anovulatory cycles, sex hormone imbalances, and high prolactin (PRL) levels. Many times, treating these conditions can help women correct their luteal phase defect. Symptoms of Luteal Phase Defect (LPD): There are several factors which can lead to a Luteal Phase Defect (LPD). The most common factor is considered to be low progesterone hormone levels. Progesterone hormone is an important hormone required for preserving the endometrial lining and pregnancy during the first trimester of the pregnancy. In cases where a woman’s progesterone hormone production does not reach the optimal level during the first trimester, the chances of occurrence of luteal phase defect are increased. (10) When a woman has a luteal phase defect, she may notice conditions such as: Miscarriage More frequent periods Spotting between periods Trouble getting pregnant Diagnosis of Luteal Phase Defect (LPD): An endometrial biopsy can help in detecting a luteal phase defect. For those who are concerned by a short luteal phase, a simple blood test to check Progesterone hormone levels can help them understand what is happening with their body. A pelvic ultrasound can also help IVF specialist measure the thickness of the uterine lining in the concerned woman. Depending on the diagnosis, the infertility specialist may suggest the best treatment plan for increasing progesterone levels. (11) Diagnostic Criterion for Luteal Phase Defect (LPD): Diagnostic tests for Luteal Phase Defect (LPD) are influenced by and are based on certain physiologic observations. These observations are explained below: The response of the endometrium is a reflection of the luteal-phase progesterone and estrogen and follicular-phase estrogen When implantation takes place, secretion of progesterone hormone by corpus luteum relies on increasing human chorionic gonadotropin hormone levels Failure of hCG hormone levels to increase directly leads to the failure of corpus luteum and a decrease in progesterone hormone levels Progesterone hormone is secreted in pulses The length of the normal luteal phase is relatively fixed at 12-14 days The levels of progesterone hormone peak in non-pregnancy cycles over 6-8 days after ovulation (12) Luteal Phase Insufficiency: Luteal phase insufficiency is one of the major reasons for implantation failure and has been responsible for spontaneous miscarriage and unsuccessful or failed In Vitro Fertilization treatment. (13) Luteal phase defect is typically observed in women with polycystic ovaries, prolactin disorder, and thyroid problems. Low progesterone environment is created iatrogenically following the interventions in assisted reproduction. Use of Gonadotrophin-releasing hormone analogs to prevent the LH surge and aspiration of granulosa cells during the oocyte retrieval may impair the ability of corpus luteum to produce progesterone. Luteal phase insufficiency usually takes place due to inadequate production of progesterone. Progesterone is critical for the secretory transformation of the uterine lining, which permits implantation as well as maintenance of early pregnancy. (14) Short-Luteal Phase: A short luteal phase length can have a significant negative impact on natural fertility levels of a woman. A shortened luteal phase is often considered as a clinical manifestation of luteal phase defect. A luteal phase defect often results in dysfunctional endometrial lining development during the narrow interval. It usually happens when an embryo is present in the uterine cavity and is capable of implantation. In such cases, women with typical signs of a Luteal Phase Defect, like a shortened luteal phase, may experience a failure of implantation or maintenance of pregnancy. (15) Treatment of Luteal Phase Defect (LPD): The cause of the luteal insufficiency can be the failure of maternal recognition of pregnancy. Supplementation with exogenous progestins can successfully help in maintaining the pregnancy in the absence of endogenous progesterone. (16) There are three methods of therapy commonly used for treating Luteal Phase Defect. However, a highly-qualified fertility doctor will be the one best to guide which treatment option is right for particular health and medical condition. The most common way to treat luteal phase defects is to give the woman extra progesterone. Progesterone supplementation can effectively help in preventing the loss of pregnancy when given to women having a luteal phase defect. Usually, progesterone supplementation is begun three days following ovulation. It is therefore important to accurately document the day of ovulation, as starting progesterone too soon may increase the risk of tubal pregnancy in the respective patient. It is common for women to use urinary ovulation predictor kits to determine the day of ovulation. As the Luteinizing Hormone (LH) surge typically comes before ovulation by 18-30 hours, progesterone supplementation is begun four days after the initial detection of the LH surge. Correcting a luteal phase defect can often be comparatively simple, though it may take a little time for a woman’s menstrual cycle to normalize and for fertility to be restored. The three methods which are used to treat luteal phase defect are: Clomiphene citrate or human Menopausal Gonadotropin (hMG) for stimulating follicular growth. It helps in triggering the ovaries to make more follicles, which are responsible for releasing eggs. hCG hormones help in starting ovulation and increasing the production of progesterone. Supplemental hCG for improving corpus luteum secretion of the hormone progesterone Additional progesterone hormone after ovulation given by injection, orally or with the assistance of vaginal suppositories or gel is used in most of the cases Fertility charting can help in determining the length of a luteal phase and can determine if a woman has low progesterone levels in her body. Luteal phase defect is projected to affect over 3-4 percent of women who have ‘unexplained infertility’. Estimates of up to 63 percent chances have been projected for women who repeatedly miscarry and 6-10 percent chances of miscarriage are present for women who are diagnosed as fertile or do not possess any kind of infertile issues. Progesterone hormone is responsible for the increase in basal body temperature after ovulation. Therefore, if the basal body temperature does not remain increased for a minimum of 12 days, a woman may have a luteal phase defect. Natural therapies to treat Luteal Phase Defect (LPD): Low progesterone levels and luteal phase defect can be treated effectively with a variety of methods which include natural therapies. The natural therapies may include modification of routine diet, herbs, progesterone cream, and supplements. (17) Chasteberry (Vitex) Chasteberry, which is a fruit of the chaste tree, is used as a dietary supplement for infertility, menstrual problems, menopause symptoms, and other medical conditions related to females. Research study has shown that this fruit has also been used to treat reproductive disorders with effective and proven results. (18) Vitamin B6: The vitamin B6 supplement has benefited a lot of women to have a lengthened luteal phase in case of the presence of possible abnormalities. Vitamin B6 has a hormonal balancing effect on a woman’s body. Vitamin B6 can be found in salmon, turkey, tuna, bananas, liver, and green veggies. Women should consult their doctors before consuming this supplement in their routine diet. Green leafy vegetables: Green vegetables are rich in B vitamins, which are essential for proper hormonal balance in every woman's body. Vitamin C: It has been reported in several research studies that vitamin C helps in improving hormone levels. It also helps in increasing fertility levels in some women with luteal phase defect. Foods which are rich in vitamin C are broccoli, papaya, bell peppers, strawberries, Brussels sprouts, and oranges. Progesterone Cream: One of the most common medical treatments for the treatment of luteal phase defect is to use progesterone cream. It helps in lengthening the luteal phase. Progesterone cream is available at the medical stores, but they need to be applied only after consulting with the concerned gynecologist. The cream should be used twice a day in the areas such as the inner thigh, inner arm, or neck after the occurrence of ovulation. This helps in fetching the desired results following the completion of the treatment. Antioxidants: Studies have revealed that women who had luteal phase defect have significantly lower levels of antioxidants than healthy women. Oxidizing free radicals are now considered to be a major reason for around 40 percent of sperm damage. Women should make antioxidants a vital part of their everyday diet regime by enjoying blueberries, blackberries, garlic, kale, strawberries, sprouts, broccoli, plums, and red peppers. Alternative therapies: Alternative therapies also prove to be beneficial for patients who are looking for a solution for Luteal Phase Defect (LPD). Acupuncture therapy has been scientifically proven for regulating the monthly cycle of a woman. Acupuncture is highly beneficial particularly in lengthening the luteal phase. Women can hire an acupuncturist who specializes in helping patients with infertility issues. For this type of treatments, most acupuncturists recommend weekly sessions of acupuncture. Medical treatment: There are many medical treatments available to help women with luteal phase defect. For those who are considering medical treatments as an option, should take the opportunity to discuss the possible treatments with their fertility doctor. Frequently Asked Questions about Luteal Phase Defect (LPD): Q. How is Luteal Phase Defect (LPD) diagnosed? Luteal phase defect can be diagnosed in an endometrial biopsy. Women, who are concerned by a short luteal phase, can get a simple blood test done to check Progesterone levels. A pelvic ultrasound can also assist in measuring the thickness of the uterine lining in the concerned woman. Q. Is there anything a woman can take or do to help lengthen a short luteal phase? Depending on the diagnosis, the infertility specialist may suggest a treatment plan to increase progesterone levels in women. Certain lifestyle changes and dietary habits can help women in lengthening the luteal phase during their non-pregnant stages of life. Q. What can be the reason for low progesterone production? There are a few reasons a woman might not be able to produce enough progesterone, particularly if she suffers from any of the following: Polycystic Ovarian Syndrome (PCOS) Endometriosis Thyroid disorders Obesity or Anorexia For those who are unable to conceive or experiencing recurrent miscarriage due to a short luteal phase can be distressing and discouraging. It’s important that patients don’t ignore fertility related issues. The sooner they seek help from a specialized doctor to diagnose the underlying cause for a particular condition, the sooner they will be able to receive treatment and have a healthy pregnancy. The best way for a woman to find out about the length and quality of the luteal phase is to start tracking and charting her menstrual cycles. It is advisable to keep a record of 2-3 consecutive menstrual cycles in order to have a better understanding of the menstrual cycle and luteal phase. If you have any concerns related to hormone levels or wish to know more about the luteal blood test, Elawoman can help you out. For further information about luteal blood tests or any other information related to infertility or IVF treatments, visit pregnancy section of elawoman.com or book an appointment with the best infertility experts practicing at some of the best infertility centres at +918929020600.

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Fertility Basics

Hysterosalpingography (HSG)

posted on June 11, 2019, 3:22 p.m.
4.5/ 5 (1 Votes)

Across different parts of the world, infertility seems to be a huge and widespread problem these days. There are several reasons for woman infertility, male infertility, and certain unknown facts about not achieving pregnancy (popular unknown infertility). In specific cases, couples try for several years to obtain pregnancy, but the efforts go wasted due to unknown causes. However, today with advanced and innovative technology treatments of infertility is possible. Many tests like Hysterosalpingography, Hysteroscopy, Laparoscopy, and Genetic testing exist to uncover the concise reason behind infertility in such cases. The test outcomes assist the physicians to identify and target the exact cause of supporting unaccomplished pregnancy in the respective patient. One of such prevailing infertility condition includes blocked fallopian tubes in a woman. Fallopian tubes enact a substantial role in the functioning of fertilization. It is the locus where fertilization inside a woman takes place. After rupturing an ovary sac, the egg promptly goes towards a fallopian tube to wait for the sperm to infuse it. Whereas, sperm travel through the cervix of the uterus, goes deep inside the fallopian to fertilize the egg. After the fertilization, the mature egg or embryo travels back from a fallopian tube to reach the uterus. At the moment, if a fallopian tube is barred, then the sperm will find it difficult to progress and pass the obstruction to reach the egg. In HSG test such obstruction is identified and suitable treatments are suggested to successfully achieve the pregnancy. In this article you will find details about the following mentioned questions: What Is a Hysterosalpingogram (HSG) test? What are the vital steps involved in the HSG test procedure? How to prepare for the HSG test? How does the patient experience during the HSG test? How does one conceive successful pregnancy after HSG Test? Is radiation released during the HSG test safe? What are the specialized types of essential equipment used in the HSG test? What are the HSG test side effects? What do the valuable results of the HSG test signify? What is the HSG test cost in India and around the world? Tubal-factor infertility is a problem caused by scar tissue, pelvic infections, surgery, endometriosis or hydrosalpinx. These conditions hinder the free traveling of eggs and sperm into the fallopian tube to result in fertilization. According to The American Society for Reproductive Medicine (ASRM), around 25 to 35 percent of female infertility is potentially caused by blocked tubal factors. Hysterosalpingogram (HSG) is a crucial and effective test to ascertain the reason for blockage in the uterus of the woman. An HSG test is also recommended by a doctor in case of recurrent miscarriages to check the irregular shape or structure of uterus including the endometrial lining. These structural problems are usually caused due to polyps or fibroids, which makes it difficult to sustain a pregnancy. However, removing them with an excellent medical test like the HSG test, one may achieve pregnancy naturally without spending any additional money. (1) What Is a Hysterosalpingography? Hysterosalpingography (HSG) is a medical test procedure to perform an in-depth inspection of the uterus in a woman. The procedure is also known as uterosalpingography. It refers to the radiologic procedure where the shape, uterine cavity, and patency (openness) of the uterus are measured. In this procedure, a special medical instrument dye is employed to look through special X-ray inside the womb and fallopian tubes. A physician injects a radiopaque material in the cervical canal. The process also includes the use of fluoroscopy along with image intensification for a precise viewpoint. To perform an HSG procedure, it takes about 30 to 45 minutes on an average depending on the case and expertise of the surgeon. To analyze the internal conditions, the insertion of a thin catheter is viable via the uterine cervix. Along with the catheter, a special radio-opaque contrast material dye is also inserted to capture a proper view of the inner surface of the uterus. The HSG test makes it easier to look inside uterus and fallopian tubes closely. The complete procedure is also accompanied by fluoroscopic x-ray, which provides mobile images of fallopian tubes with high resolution. In the absence of blockage, the dye smoothly goes inside and moves freely in the organ. In case the blockage of the fallopian tubes hinders the movement of the instrument inside, it concludes that the passage of the fallopian tube is clogged. Significantly, when an obstruction is present inside the fallopian tube, a laparoscopy or other surgeries are required to operate such blockage. If it becomes challenging to treat such cases, then a doctor may suggest for an In Vitro Fertilization (IVF) treatment straight-away without the case going for any second opinion. In IVF procedure, experts perform a surgery to remove the obstruction and provide with successful results. HSG is strictly conducted after menstrual periods end, but prior to ovulation. (2) HSG test procedure: The test is usually performed in a radiology department of the hospital. Under the surveillance of a medical specialist, the complete HSG test should be performed. One must keep herself relax during the procedure and assist the doctor while performing the procedure. Below is the step by step HSG procedure: (5) Step 1: The patient will be asked to lie down on the table present below the x-ray machine. Further, the patient will be asked to relax and place her feet into the stirrups which are similar to a pelvic examination. A tool known as the speculum is then placed into the vagina to progress the procedure. Speculum helps in holding the walls of the vagina apart to view clearly inside the uterus and accurately inject the cannula. Subsequently, the cervix present in the patient is cleaned thoroughly to avoid any infection. Step 2: There are two methods of performing the HSG test. The first method includes injecting the dye into the vagina. A device grips the cervix intact so that it does not move in the insertion process. An instrument known as a cannula is entered into the cervix to monitor shape, structure, and presence of blockage inside the uterus. Whereas, the second method involves a thin plastic flexible tube to be inserted inside through the cervical opening in the patient. The plastic tube has a small inflated balloon at the end. The balloon helps in keeping the tube intact to give a proper view of the targeted area in the patient. Step 3: The tenderly holding specula is gently removed from the cervix, while one is resting under the X-ray machine. The fluid is then gradually inserted into the uterus and fallopian tubes through a cannula or a tube. During the dynamic process of insertion, one may further feel cramps and mild pain because the fluid will gently stretch the tubes if they are found blocked in the resultant x-ray images. Step 4: When the contrast medium fills the uterus and fallopian tubes with liquid, the X-ray machines previews the images formed. In such a scenario, a doctor may also ask the patient to change her position as per the requirement of the test. In case the fallopian tubes are free of potential obstruction, the liquid will spill and move slowly towards the end of the tubes. When the liquid is spilled completely, the body will efficiently absorb the liquid. Once the clear images are captured, and a doctor is confirmed about the completion of the procedure, then the cannula is removed from the patient. One may be given with an injection to relieve the pain. However, the patient will feel slight pain and cramps afterward, but these are handled carefully through appropriate medication and taking rest for the entire day after the procedure gets completed. Preparing for the test: One must keep the below-mentioned points in the notice before going for the HSG procedure. (3) One must only consider an Infertility specialist for HSG test: Usually, a test is performed in a hospital, clinic, health care provider’s office (OB/ GYN's office) or at the radiology department of a clinic or hospital. However, it is better to get an appointment with the gynecologist to accompany throughout the process and to get the root cause of the problem efficiently. It is beneficial to check if any insurance covers such a test: HSG being a diagnostic test can be covered under insurance, irrespective of infertility treatment. Therefore, one must check with their insurance provider for compensation. Although this option varies to a great extent depending on the location or clinic. Specific days in which HSG procedure should be performed: It is crucial to note that the HSG test should only be performed between 5th to 10th day of the patient's menus cycle. One must be assured first that she is not pregnant before planning to go for the HSG test. If one does not have a regular menstruation cycle and she is not sure about her ovulation time, then a qualified doctor will perform a pregnancy test before commencing with HSG test. Inform the doctor about the known allergies, which might be caused due to Iodine, Betadine, or Novocaine: Usually, it's rare that a patient will evolve allergies due to the dye instrument while performing the HSG test, but there is always an exception to the case. Therefore, if a patient has any poor earlier experience with such a test, then she must inform the doctor about it to avoid such severe circumstances again. On the day of the performing the test, one must take an anti-inflammatory tablet like Advil or Motrin an hour before the procedure: It is very common that a patient might feel terrible cramps and pain in her abdominal due to insertion of the instruments. It will be helpful if one takes other medicines as well along with antibiotics as per the guidance of the medical specialist to avoid such pains. It is also advised to confirm with the doctor first, which tablet or medicine will be suitable for the procedure: In certain cases, a doctor provides with an effective course of medication to avoid infection. In those cases, women should only follow the regime of medicine prescribed by a doctor timely. It is essential to bring a pad along: It is normal for the patient to bleed for some time after the HSG test is performed. A patient's uterus will further leak the contrast dye, which was utilized while performing the test. Therefore, carrying a pad will become helpful for the rest of the day to avoid staining on the clothes. Comfortable clothing will help during the procedure: Soft and comfortable clothes will help a patient to bear soreness after the procedure, as the body becomes tender after the HSG test. One should get somebody along for the procedure: A person taken along for the test might help in providing moral support. They might also help you drive home and recollect patient consciousness after the test. It is also advisable to take a leave from work for the specific day to relax: HSG test is not a major test, but due to an inference of medical instrument in the vagina, one may evolve nausea and dizziness. Therefore, going office right after the test in the condition of spotting and cramping is not considerable. (1) How does the patient experience during the HSG test? A patient suffers considerable discomfort during the HSG test procedure. When a speculum is inserted inside the vagina, one may start feeling cramps and develop mild to severe pain. If a patient feels extreme discomfort and feels severe pain during the test, then mild anesthesia will be given to her to complete the test. Even after the test is successfully performed, a patient may exhibit mild pain with cramping similar to the periods for the whole day. If the fallopian tube is blocked, then certain kind of discomfort will generate each time the contrast dye liquid leaks from the vagina. (4) Many women with a blockage in fallopian tubes feel a severe painful sting when the dye is being injected deep inside. Women having blocked fallopian tubes might suffer extreme throbbing than other patients. Normal drug store medicines may help in relieving such pains in a longer run. However, it is helpful to discuss with a doctor at least an hour or two back prior to the HSG test about the consumption of the medicine. Pregnancy after HSG Test: After the test is completed, one will have a sticky fluid dropping out of her vagina. This fluid is a liquid of dye used in the HSG test. At times, the fluid will drip along with some blood spots. Therefore, a pad is essential to bring in these types of vaginal tests. It is also advised to avoid using tampon after this process. One may also feel the following symptoms after having the HSG test done: (5) Scanty vaginal bleeding Cramps Feeling weak, dizzy, or ill to your stomach After the HSG test procedure, one is expected to get recovered by the next day and resume back with the normal routine. If one still feels severe HSG test side effects, then she must visit a doctor immediately. After the HSG test procedure, one should not suffer heavy bleeding, fever, or severe pain. Therefore, contacting a doctor becomes prominent in such an instance. It has been observed in many cases, which after going through the HSG test, women tend to conceive shortly. Pregnancy after HSG test happens because of dislodged dye insertion inside the uterus and fallopian tube, which ultimately releases the minor blockage like endometriosis lesion by emptying the fallopian tubes for conventional operation. (1) Is Radiation of HSG test safe? In a usual X-ray test, a woman's pelvic area is covered first by an attendant. Particularly in HSG test, the aim of the radiation is directly on the pelvic area of the patient. Therefore, doctors use a minor range of radiation, so that it does not create any problem to a woman's uterus. Due to the involvement of radiation, doctors avoid using the HSG test while one is pregnant. Therefore, if one knows that she is pregnant, she must speak out to the doctor to try an alternate method. (6) What does the equipment look like? The types of equipment utilized for the HSG test examination include a radiographic table, one or a couple of x-ray tubes plus a television-like monitor, which is located inside the examining cabin. Fluoroscopy device converts x-rays in video images for ease of vision. It is also used in watching and guiding the course of the procedure. The video is generated by the x-ray machine and a detector that is suspended above a table on which the patient reclines. (10) HSG test side effects: There are very minimal chances of any risk or complication, almost one percent. The HSG test procedure is a very safe and secure test to check blockage in inside the fallopian tubes. However, below are a few complications, risks, and HSG test side effects which found to develop after the procedure: (7) Infection: This is the primary side effect of an HSG test. This only happens in a woman having a history of tubal or the presence of major uterine infections like Chlamydia. The infection rarely causes due to a dye used in HSG test. The infection damages the fallopian tubes. Sometimes, a condition occurs where removing the fallopian tubes becomes essential. So, it is advised to discuss the HSG test side effects, risks, and complications with a doctor. If a patient experiences severe pain and high fever within the subsequent 1-2 days, then one must visit a doctor immediately. Unconsciousness: Some women feel severe discomfort during the procedure and evolves a condition of fainting out, which occurs to be natural and normal after sedation. Radiation Exposure: The HSG test uses mild radiation, which is not harmful. It is very less in terms of kidneys and bowel radiation tests. In fact, the HSG test does not show any side effects if a patient conceived within a month of an HSG test. To avoid severe problems, one must not take the test in pregnancy. Iodine allergy: It is very rare that a woman possesses allergy with iodine contrasts used in the HSG test. Therefore, pre-discussion on allergy substances with iodine usage is significant for a patient, and a doctor both. A patient must inform the doctor about having allergies with seafood, and intravenous contrast dyes. In such cases, the test will be performed with an alternative contrast not containing any compound of iodine. If a patient suffers any rashes, swelling, and itching, then one must inform the doctor immediately. Spotting: It is common to have blood spots for subsequent 1-2 after the HSG test. In case a patient feels heavy bleeding, she must inform the same to the doctor. A few other risks associated with HSG tests are: (5) Foul-smelling vaginal discharge Vomiting Fainting Severe abdominal pain or cramping Heavy vaginal bleeding Fever or chills Results of the HSG test: When the HSG test results are released, the radiologist will send these results to the concerned doctor. The doctor will then discuss all the problems and complexities with the patient. If the report results positive, then it will confirm that fallopian tubes are blocked and another test of laparoscopy will be required. A doctor may also direct a patient for IVF directly to perform bypass surgery. It is observed in many cases that after performing HSG test, chances of conception increases for about 25 percent. Therefore, it becomes quite necessary for a patient to become pregnant successfully with three months of performing the HSG test. There are no confined studies, which prove why HSG test enhances the chances of pregnancy. Whereas, one theory suggests that dye injection works as a blast cleaned with a hosepipe. The procedure helps in tubal flushing with oil-based contrast media, whereas, water-based contrast media is not effective in comparison. (8) HSG test cost: The average of HSG test cost between Rs. 2500 to Rs. 3000. In other countries, the same test costs about 500 to 700 dollars. HSG test is now the first choice for many before considering themselves under the category of infertile couples. An HSG test does wonder with its oil-based flushing of the fallopian tubes that have proved to increase the fertility chances above 50 % then water base substance. IVF is a difficult and prolonged journey. In IVF the cost is high chances to get pregnant remains low in a woman with obstructed fallopian tubes. Therefore, choosing an excellent HSG test can save a huge amount of money and also provides a woman with a chance to carry a natural pregnancy. Around the world, the average cost of cleaning the fallopian tubes is 600 dollars, which not even a fraction of IVF cost. An IVF internationally costs for about 10,000 dollars per IVF cycle. (9) HSG test not only provides with a clear image of the internal fallopian tubes blockage, but it helps in releasing such obstruction in many cases. The positive effects of this test remain for three months, also an appropriate time to try for pregnancy. Using oil-based contrast while performing the test helps in removing any unwanted obstruct from the fallopian tubes. Removal of the obstruction ensures the free movement of the eggs, and sperms to fertilize. Whereas, water-based contrast is not much help, but only provides a view of the inside part of the organ.  If you want to know more about pregnancy and infertility tests, then please visit our website elawoman.com. You can also find some interesting, useful, and informative blogs on our website under the blog section. To find a solution to your infertility issues or receive guidance with your pregnancy care, you can also contact us on +918929020600.

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Fertility Basics

Estradiol Test – Uses, Indications, Risks, and Results

posted on June 10, 2019, 4:42 p.m.
4.5/ 5 (1 Votes)

Estradiol blood tests help in measuring the levels of estrogen hormones. These hormones are uniquely responsible for the growth and development of women’s sexual characteristics and reproduction. Estrogen is one of the most commonly known and discussed of all hormones in the human body. The term "estrogen" includes a group of chemically similar hormones namely Estrone, Estradiol (the most abundant in women of reproductive age) and Estriol. Overall, the estrogen hormone is produced in the ovaries, fat tissues, and adrenal glands. Levels of this crucial hormone in women’s reproductive age fluctuate from 10–300 pg/mL, depending on the timing of the monthly cycle. For ovarian reserve testing, specialized doctors usually assess E2 levels at their early in the monthly cycle, at days 2 or 3 of the same. (1) More particularly, estradiol and estrone forms are produced primarily in the ovaries in premenopausal women, while estriol hormone is produced by the placenta during pregnancy. In women, estrogen hormone helps in circulating in the bloodstream and binding to estrogen receptors on cells in targeted tissues. It thereby affects not only the breasts and uterus, but also the liver, heart, brain, bone, and other tissues. Estrogen helps in controlling the growth of endometrial lining during the first phase of the menstrual cycle, thus causing changes in the breasts during adolescence and pregnancy. This also helps in regulating several other metabolic processes, including cholesterol levels and overall health of the individual including that of bones. This article gives detailed information about: What is Estradiol blood test? What is the role of Estradiol in fertility levels? What is the significance of Estradiol in pregnancy? What are the uses of Estradiol blood test? What are the indications for Estradiol hormone test? How Estradiol test is performed? How to prepare for Estradiol test? What are the risks associated with Estradiol test? Frequently Asked Questions about Estradiol Hormone Blood Test What is Estradiol blood test? An estradiol blood test is helpful in measuring the amount of estradiol hormone in the blood. Estradiol hormone test is called as an 'E2 test'. Estradiol test is a simple blood test. E2 or estradiol hormone is one of the four major types of the hormone estrogen that is chiefly produced by the ovaries. It is the form of estrogen hormone which is scientifically known as 17 beta-estradiol. Hormone estradiol is made by adrenal glands, testes, ovaries, and breasts. When a woman is pregnant, the Estradiol hormone is also made by the placenta. The right estrogen levels are crucial for the reproductive health of both men and women. Imbalance in the hormonal levels of Estradiol can lead to certain medical and reproductive health problems, like urinary tract infections, weak bones, and even depression. Doctors may recommend an estradiol test if they are concerned about a woman's fertility, puberty, or menopause phase. (2) Role of Estradiol in Fertility Levels: Estrogen hormones are a group of steroids that are responsible for the development and proper functioning of reproductive organs. These hormones also manage the formation of secondary sexual characteristics in females. Estradiol, along with another hormone, progesterone, helps in regulating the menstrual cycle. These hormones are also involved in the growth of breasts and the uterus and help in maintaining a healthy pregnancy until the delivery of the baby. In females, estradiol hormone acts majorly as an effective growth hormone for the reproductive system including fallopian tubes, vagina, endometrium, and cervical glands. Estradiol hormone helps in enhancing the growth of the womb’s muscle layer, the myometrium. In addition, the hormone also helps in maintaining oocytes (eggs in the ovary) and triggering a series of events that lead to ovulation. (3) Estradiol hormones are considered as potent sex hormones for women as they assist in the proper functioning of the reproductive system. They are also found in men and play a vital role in bone metabolism and growth in both sexes. Estrogen blood tests help in measuring the three components of this hormone: Estrone (E1), Estradiol (E2), or Estriol (E3) in the blood or urine. Estrone (E1) is either directly converted from androstenedione (from the adrenal gland) or indirectly from other androgens. E1 is also produced by the ovaries, testicles, placenta, and adipose (fat) tissues. E2 and E1 can be easily converted into each other as and when needed which makes estrogen a useful hormone for the body. E1 is an important endogenous primary estrogen. It is significantly present both in men and postmenopausal women. Estradiol (E2) is primarily produced in the ovaries under stimulation of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) in pre-menopausal women and in the testicles in men. E2 is converted from E1 in post-menopausal females. It is the most effective estrogen and the one that is present in the highest concentration in non-pregnant and pre-menopausal women. E2 hormone levels vary depending on a woman's age and reproductive system. These hormones are a good marker of ovarian function in women. Estriol (E3) hormone is produced by the placenta, with concentrations elevating throughout a woman's pregnancy. These increasing levels of E3 hormones are an indication of the health of developing a baby. Estriol is one of the most important parts of the second-trimester maternal serum screening as suggested by the top fertility doctors. This screening test is performed to analyze fetal risk due to certain chromosomal defects. Comparatively lower levels of E3 are present in non-pregnant women or men. Estrogen in Girls and Women: The types and amounts of estrogen normally present in a woman's blood vary throughout her lifetime. Levels of this hormone vary during each monthly cycle and during pregnancy. Secondary sexual characteristics in women such as public and armpit hair also begin to grow when the levels of estrogen hormone rise. Many organ systems, including the cardiovascular and musculoskeletal systems and the brain, are affected with the functioning of the hormone estrogen. (4) At Birth: Levels of Estradiol (E2) and Estrone (E1) hormones are usually high at this time but fall within a few days. Concentration levels are normal during early childhood. After the birth of a baby, oxytocin hormone that plays a vital role in labor continues to contract the womb. This restricts the blood flow to the womb and prevents bleeding. Oxytocin hormone is often called the ‘love hormone’, which is associated with feelings of motherhood and bonding between mother and baby. (5) At Puberty: Concentrations of E2 and E1 begin to rise as a child reaches his or her puberty. These estrogens are responsible for the development of uterine growth, breasts, and (with other hormones) the onset and regulation of menstruation cycle. A moderate amount of E1 hormone is present from the time of puberty to menopause. This concentration varies during the day but is otherwise relatively constant. During Menstruation: The menstrual cycle of a woman is approximately 28 days long when the average days are taken into consideration. The cycle usually consists of two phases, follicular phase (day 1-14) and luteal phase (day 15-28). During each cycle, Estradiol (E2) hormone and several other hormones normally increase and then fall in a particular sequence. During Pregnancy: Estriol (E3) is the main estrogen present in a woman’s body during pregnancy. It is produced by the placenta, begins to rise in the 8th week of pregnancy, and continues to rise throughout the period of pregnancy. A sharp increase of E3 hormone happens approximately 4 weeks prior to the onset of labor. Estriol circulating in a pregnant woman’s blood is quickly cleared out of the body. Each measurement of estriol hormone describes the current status of placenta and fetus. Also, there is a natural daily variation in estriol concentrations. E1 hormones also rise during pregnancy, increasing as much as 10-fold between weeks 24 and 40 of pregnancy. Post delivery, E1 falls and E3 again becomes significantly undetectable. This hormone regulates progesterone, which helps in protecting pregnancy. It also encourages one of the major processes of fetal maturation. Without it, a fetus’s organs and tissues cannot mature. (6) During Menopause: Estrone (E1) is the key estrogen present during menopause. E2 concentrations significantly decline as ovarian production diminishes and eventually stabilize at a low level. Estrogen in Boys and Men: The term "estrogen" actually refers to any of a group of hormones which are chemically associated with the estrogen hormone; estrogenic hormones are sometimes wrongly interpreted to as exclusively female hormones when in fact the hormone is produced in both men and women. Estrogen plays an important role in sexual function and testosterone is the primary hormone. Significance of Estradiol in Pregnancy: During a woman’s reproductive years, the pituitary gland in the brain generates hormones that allow a new egg to be released from its follicle each month. As the follicle develops, it produces estrogen, which causes the thickening of the endometrial lining of the uterus. Progesterone hormone production rises after ovulation in the middle of a woman's cycle for preparing the lining to receive and nourish a fertilized egg so it can successfully develop into a fetus. If fertilization does not occur, estrogen and progesterone levels drop sharply which results in the lining of the uterus breaks down and menstruation occurs in the woman. Estradiol hormone levels obtained on the 4th day of gonadotropin therapy were highly predictive of successful ovulation induction and pregnancy outcome in monthly cycles using the luteal phase. (7) If fertilization happens, estrogen and progesterone hormones work together to prevent the occurrence of regular ovulation during pregnancy. Birth control pills (oral contraceptives) take advantage of this effect as they start regulating hormone levels. This also results in the production of a very thin endometrial lining, which is unreceptive to a fertilized egg. Plus, they are responsible for thickening cervical mucus in order to prevent sperm from entering the cervix and fertilizing an egg. Oral contraceptives containing estrogen hormone also relieve menstrual cramps and some perimenopausal symptoms and regulate menstrual cycles in women with Polycystic Ovarian Syndrome (PCOS). Furthermore, various research studies indicate that contraceptive pills have the potential to reduce the risk of ovarian, uterine, and colorectal cancer. Uses of Estradiol hormone Test: Estradiol blood tests are used to evaluate a deficiency or excess in a woman. This helps diagnose a variety of medical conditions related to this imbalance. They may also be used to help to ascertain the timing of a woman's ovulation. These tests are also recommended to monitor the health status of the developing baby and placenta during pregnancy. In a man, estradiol testing is performed to detect a hormonal increase and reasons for its increase. The three components of hormone estrogen: Estrone (E1), Estradiol (E2), and Estriol (E3) have their unique uses. Below are explained different uses of estradiol test: Diagnosing early onset-puberty or delayed puberty Investigating menstrual abnormalities such as amenorrhea, abnormal vaginal bleeding, and infertility Monitoring follicle development prior to In Vitro Fertilization (IVF) treatment Monitoring menopausal hormone replacement therapy (HRT) which is given to reduce symptoms related to estrogen deficiency Detecting estrogen-producing tumors Indications for Estradiol Hormone Test: A fertility doctor may order an estradiol test if female or male sex characteristics are not developing at the desired rate. In cases where estradiol is higher than normal, the situation indicates that puberty has happened earlier than usual. This condition is known as 'precocious puberty'. Presence of lower levels of estradiol hormone indicates a condition of late occurrence of puberty. In Girls and Women Estradiol (E2) and/or Estrone (E1) hormone blood testing in girls and women is recommended in the following cases: A girl's sex organs develop earlier or later than usual A woman having symptoms such as abnormal or lack of menstrual cycles and abnormal vaginal bleeding after menopause Female factor infertility; a series of estradiol test over the course of a woman's monthly cycle are performed to monitor follicle development prior to ART procedure (timed with a surge in estradiol). A woman experiencing symptoms of menopause, including night sweats, insomnia, hot flashes, and/or irregular or lack of menstrual periods. A menopausal woman undergoing hormone replacement therapy (HRT) is also recommended periodically to get her estrone levels monitored. Estriol (E3) testing in women is recommended in the following cases: During pregnancy, a fertility doctor recommends serial estriol samples to look for a certain rise or fall in the estriol level over time. Unconjugated estriol hormone is often measured during 15th to 20th week of gestation as part of the triple/quad screening. In Boys and Men: Estradiol (E2) and/or Estrone (E1) testing in boys and men is recommended in the following cases: A boy has delayed puberty, characterized by delayed growth of muscle mass, slow or delayed growth of testicles and penis and lack of deepening of the voice or growth of body hair. A man experiencing signs of feminization, like enlarged breasts. (8) How Estradiol test is performed? Estrogen hormone tests can be performed in blood, urine, or saliva. Blood or urine test is usually performed at the doctor’s office or lab. Saliva tests can be performed even at home after following the advice of the doctor. For a blood test: A health care professional takes a blood sample from a vein in the patient’s arm, using a small needle. After the needle is inserted, a small amount of blood is collected into a test tube or vial to be sent for further tests. A patient may feel a little sting when the needle goes in or out. This procedure takes usually less than five minutes which proves to be time-saving for the patients. For a urine test: For this test, the health care provider asks patients to collect a certain amount of urine passed in a 24-hour period. This is called a '24-hour urine sample test'. For a urine test, the laboratory professional hands over a container to collect urine and patient need to follow instructions on how to collect and store the samples for further process. (9) How to Prepare for the Test? While some hormone blood tests require the patient to avoid eating or drinking beforehand, people undergoing an estradiol test do not need to make any such specific preparation. Women, who are taking any medication, like hormone therapy medication or birth control or, they must let their doctor know before undergoing the test. Certain forms of medication could have a significant impact on the results of the estradiol test. Other tests associated with Estradiol Test: Depending on the patient’s unique medical condition, the doctor may also recommend other tests. These tests may include: Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), for menopausal issues and treatment FSH and LH, for early puberty FSH, thyroid-stimulating hormone/free thyroxine (TSH/FT4), and prolactin, a hormone required for breast milk production, in cases of absent periods TSH, FSH, prolactin, and LH, for both female and male factor infertility issues Risks associated with Estradiol Test: An estradiol test is a simple blood test, and the risks associated with this test are low. However, any test involving a needle carries certain risks, such as: Bleeding Blood building up under the skin Infection Pain and soreness at the site afterward Feeling dizzy, fainting or lightheaded Multiple punctures if a doctor is unable to find a suitable vein Hematoma (blood accumulated under the skin causing a bruise or lump) (10) Estradiol hormone test range: Normal estrogen results depend majorly upon the gender and age of the person being tested. With women, it also depends upon their monthly cycle or whether they are pregnant. The reference range varies somewhat between laboratories, both in normal values listed and in units used. Both rising and falling levels of estrogen are carefully observed in several medical conditions. Expert guidance must be used in the interpretation of hormones Estrone, Estradiol, and Estriol results as there is a variation in levels on a day-to-day basis and throughout a woman's menstruation cycle. A healthcare provider who is monitoring a woman's hormones will look at trends in the levels, increasing or decreasing over time in conjunction with the monthly cycle or pregnancy rather than examining single values. According to some reputed medical laboratories, a normal level of hormone Estradiol (E2) for menstruating women ranges from 15 to 350 picograms per milliliter (pg/mL). For postmenopausal women, these levels should be lower than 10 pg/mL. Estradiol level that is higher than normal indicates the presence of early puberty. Estradiol Normal Range: Male: 10 - 50 pg/mL Female (premenopausal): 30 - 400 pg/mL Female (postmenopausal): 0 - 30 pg/mL (11) What does abnormal Estradiol Test Result mean? Lower levels of estradiol test result indicate the following conditions: Low estrogen levels due to sudden and rapid weight loss Low levels of pituitary hormones Ovarian failure Menopause Failed pregnancy Turner syndrome, a chromosomal defect that can lead to infertility Higher levels of estradiol test results indicate the following conditions: Hyperthyroidism Gynecomastia Tumors in the adrenal glands, ovaries or testicles Liver damage Frequently Asked Questions about Estradiol Hormone Blood Test: Q. What does estradiol mean in a blood test? An estradiol test is a simple blood test which measures the amount of hormone estradiol in the concerned patient's blood. Estradiol hormone is also known as 'E2'. It is one of the four types of estrogen which is produced by the ovaries.   Q. Is fasting required for Estradiol test? In both men and women, low levels of estradiol are related to osteoporosis. Fasting is not required for this estradiol blood test. Take medications as prescribed by the medical specialist. For those patients who are supplementing with any hormones, doctors suggest taking them approximately 2-3 hours prior to having the blood drawn. An estrogen hormone is considered critical in different aspects of overall health. The estradiol hormone test will often be the first step towards assessing solutions to improve several different aspects of a person's well-being. Today, an appreciating percentage of all babies are born with assisted reproductive technology. These statistics are expected to rise in the near future as mean maternal age continues to rise. While the workup for infertility can be extensive, advanced medical laboratory tests can prove to be helpful in determining a primary diagnosis and assess associated ovarian reserve. Most importantly, the results of these tests give a predictive framework for evaluating and treating infertility. As there is a progression in the advancement in technology, laboratory testing will undoubtedly become a more accurate and trustworthy predictor of response to medical conditions. This will make the treatment of infertility safer and more efficient for women. Estradiol blood test helps a fertility doctor to evaluate and diagnose fertility issues or menopause status in the patient. For a woman, a fertility specialist may suggest several blood samples drawn over the course of her monthly cycle. This is done to efficiently check for a woman's estradiol levels. For more information about an estradiol blood test or any other information related to infertility or IVF treatments, visit elawoman.com or talk to the best fertility experts at +918929020600.

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Fertility Basics

All You Need to Know About Hormone Blood Tests

posted on June 11, 2019, 10:06 a.m.
4.5/ 5 (1 Votes)

The process of testing hormone levels is medically multifaceted and the question of which testing method is advanced over another is highly-debated. It is considered to be the best step towards better health. Testing hormone levels is a good idea for an improved working of the human body. Hormone blood testing is particularly essential while using bio-identical (natural) hormone therapy. It is used in natural hormone therapy in order to avoid imbalances that may not be seen even if the symptoms in patients are tracked over time. This may lead to adverse symptoms or conditions with long term hormone use. Testing of hormones can prove to be helpful in providing information about the hormonal status of the patient. It can also help to guide the respective health care professional in choosing the most appropriate hormone therapy based on the unique medical conditions of the patient. There are numerous types of tests for a doctor to choose from in order to detect the particular cause for hormonal imbalance. Patient symptoms will surely assist the doctor in the right direction. A blood test is considered to be the most common and effective methods to conduct hormone tests. A hormone blood test is performed to detect estrogen, cortisol, testosterone, and thyroid levels in the human body. A simple saliva test can help in detecting several types of hormones as well. With these tests, doctors can look at the patients’ estradiol, progesterone, and testosterone levels. In cases where there is an issue with a specific gland in the body, an ultrasound scan can prove to be a great option and is often recommended by the doctor. This generally happens in the case of thoroughly testing the ovaries, pituitary gland, testicles, uterus, and thyroid in the concerned individual. Depending on the results of these medical tests, certain additional tests may be recommended by the doctor in order to obtain a better diagnosis of the current status of the patients. This article gives detailed information about: What is a hormone? What is hormone imbalance? What are the causes of hormonal imbalance? What is the significance of hormones infertility? What is the role of hormones in pregnancy? Frequently Asked Questions related to a hormone blood test 1. What is a hormone? Hormones are chemical substances signaling molecules produced by the endocrine glands in multicellular organisms. These chemical substances are transported by the circulatory system to target distant organs to regulate physiology and functioning of the concerned organs. (1) Hormones travel to different parts of the body where they help in controlling the working of organs and cells. For instance, insulin hormone is made by the beta cells in the pancreas. (2) They are responsible for controlling a variety of functions like common basic needs like hunger to complex systems such as reproduction, and even the mood and emotions. Understanding these major hormones and their role in the body will help patients bring effective changes in their lifestyle in order to improve their health. (3) Hormones are those impactful messengers of the body that work slowly, over time, and affect several different processes, including: Reproduction: Reproduction is a dynamic biological process in which two kinds of reproductive cells are involved. These cells are also popularly known as gametes. It is a fundamental part of the functioning of the body. Sperm, the male gamete and egg or ovum, the female gamete meet and combine in the woman’s reproductive system of a woman which leads to pregnancy. Growth and development: Human development is a lifelong process of physical, cognitive, behavioral, and emotional growth and change. During the early stages of life—from babyhood to childhood, childhood to adolescence, and adolescence to adulthood—tremendous changes take place. (4) Sexual function: Sexual function is the manner in which the body reacts in various stages of the sexual response cycle, or even in cases where the male individual faces sexual dysfunction. The different aspects of sexual function defined as being relevant to the assessment include erection, sexual desire, ejaculation, and orgasm. Metabolism: Metabolism is the procedure by which the human body converts the items they eat and drink into energy. It is a set of life-sustaining chemical processes in organisms. During this complex biochemical process, calories in food and beverages are combined with oxygen to release the energy for the proper functioning of the body. Mood: Mood is considered to be an emotional state in psychology. Moods are usually defined as emotional changes which can be seen in an individual based on certain life or health situations. In all these cases, a comprehensive hormone blood test is performed to find out a detailed understanding of the hormones impacting menstrual cycle and fertility levels of a woman. (5) 2. What is hormone imbalance? Hormone blood tests are beneficial and trustworthy ways to examine and evaluate the possible reasons for hormonal imbalance in the body. These tests are performed when hormones in the body are not produced properly and this leads to a deficiency of the respective hormone. Hormones get out of balance due to two obvious reasons. Sometimes there is a deficiency observed in the given hormone and there are times when there is a steep rise in hormonal levels in the body. The hormone blood test results play a vital role in determining suitable treatment for each of the patients undergoing the suggested medical tests. Due to the variations in the functionalities of hormones, it is challenging to find a single way to detect any related medical condition for chromosomal abnormality. This is one of the reasons why a patient’s best bet is to get his or her hormone blood test done without thinking a lot over the same. Hormonal imbalance in women include the changes in progesterone, estrogen, and other hormone levels. Hormones are produced in the endocrine glands serving as messengers. They are also responsible for coordinating and controlling functioning throughout the body. Hormonal balance is very crucial for pregnancy, carrying a baby to pregnancy term, and having a successful healthy baby delivery. (6) Hormones are the powerful chemicals which travel around the bloodstream informing and guiding tissues and organs their respective function. They help control certain crucial processes of the body, including the proper working of metabolism and reproduction. When someone has a hormonal imbalance, they have too much or too little of a certain specific hormone. Women undergo several periods of hormonal imbalance during their lifetime. Most importantly, these transitions are observed by a woman during puberty, menstruation, pregnancy, and at the time of menopause. Even a little shift in the working of hormones can have substantial effects throughout the system of the human body. Some hormone levels fluctuate throughout the lifetime of humans and can be the result of natural aging. Other changes in hormone levels occur when their endocrine glands get the working system wrong. Women may experience hormone imbalances in cortisol, insulin, androgens, and thyroxine levels. Depending on a patient’s unique symptoms and medical conditions, the doctor will suggest the appropriate hormone imbalance test. Hormone blood tests are done to effectively detect estrogen, testosterone, insulin, progesterone, thyroxin, cortisol, and TTH levels in the blood. A pelvic exam is performed to check for any cysts or lumps present in the respective patient. (7) Symptoms of a hormone imbalance specific to women include: Heavy or irregular periods, including missed periods, absent period, or frequent period Hirsutism, or excessive growth of hair on the face, chin, or other parts of the body Acne on face, chest, or upper back Thinning hair or hair loss Sudden weight gain or trouble losing weight Darkening of skin, especially along neck creases, underneath breasts, in the groin, and skin tags Vaginal dryness Vaginal atrophy Pain during sex Night Sweats 3. Causes of hormonal imbalance: The possible causes of hormonal imbalance are: Hyperfunctioning Thyroid Nodules Hormone Therapy Tumors (Benign or Cancerous) Congenital Adrenal Hyperplasia Unhealthy eating habits Medications Stress Adrenal Insufficiency Pituitary Tumor Injury or Trauma Cancer Treatments Diabetes Hypothyroidism, Or Underactive Thyroid Hyperthyroidism, Or Overactive Thyroid Hypogonadism Cushing Syndrome Thyroiditis 4. Significance of hormones in Fertility Hormones help in controlling each of the crucial functions in the human body from their appetites to their moods to their fertility. When humans experience a sudden drastic difference in their appetite or moods, it’s easy to determine something is wrong in their system. However, changes in fertility levels are difficult to track unless women know the physical signs they’re looking for. There are four major hormones which are responsible for a successful pregnancy: estrogen, progesterone, Luteinizing Hormone (LH), and Follicle Stimulating Hormone (FSH). An imbalance of even one of these hormones will bring the rhythm of systematic reproduction off-track and this won’t allow the pregnancy to happen. Hormones play an important role when it comes to fertility levels in women. High levels of Follicle-Stimulating Hormone (FSH) in a woman’s body could minimize the chances of conceiving in such women. Abnormal levels of estradiol, which is an important form of estrogen, decreases chances of In Vitro Fertilization (IVF) success. Insufficient levels of Luteinizing Hormone (LH), which stimulates ovaries to release an egg and start producing progesterone, can also be a cause of fertility problems among women. Normal levels of progesterone, which are responsible for preparing the uterus for a fertilized egg arrival, must be present in order to allow a woman to get pregnant. The clinical definition of female infertility defines it as an inability to conceive a child after 12 months of regular unprotected intercourse. The term 'female infertility' is often used as a general term to describe a situation where a woman is unable to become pregnant. Infertility can be a very stressful and poignant issue for couples. It is important that advice and professional counseling is sought for dealing with the respective case in an effective manner. Some causes of infertility in women are highly treatable with the advent of Assisted Reproductive Technology procedures such as In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI). The most common hormone-related causes of female infertility usually involve the following scenarios: Polycystic Ovarian Syndrome (PCOS): PCOS affects between 6-15 percent of women during their reproductive age. PCOS is a common cause of ovulation problems, weight complications, and miscarriages. Once PCOS is recognized and treated, a good percentage of women are successfully able to become pregnant. Low Egg Reserve Declining egg production is the primary reason for age-related infertility in women. A low egg reserve can also be caused due to premature ovarian failure. 5. Role of hormones in Pregnancy: Many hormone levels are affected in the body during pregnancy, with various hormones playing significant roles during pregnancy. The hormone blood test panel offers a broad scope of detecting hormone levels in the body. It helps in determining factors related to aging and fertility issues in women. The role of hormones is explained in detail. Human Chorionic Gonadotropin hormone (hCG): Human Chorionic Gonadotropin (hCG) hormone blood test is performed to detect the hormone hCG in blood or urine. Some hCG tests are performed to measure the exact amount while others may be done to check the presence and existence of the hormone. HCG hormone is produced by the placenta during pregnancy. (8) The test can be used to detect if a woman is pregnant. This hormone is produced only during pregnancy almost exclusively in the placenta. hCG hormone levels which are found in maternal blood and urine rise dramatically during the first trimester. These hormones may also contribute to causing nausea and vomiting often linked with pregnancy as pregnancy symptoms. hCG hormone blood test is usually done between 15 and 20 weeks of pregnancy to detect the levels of three or four substances in a pregnant woman's blood. The triple screen detects hCG, alpha-fetoprotein (AFP), and a type of estrogen (unconjugated estriol, or uE3). (9) The average range of hCG hormone levels in a pregnant woman’s blood is mentioned as follows: - Non-pregnant women: less than 10 U/L - Borderline pregnancy: 10-25 U/L - Positive pregnancy test: more than 25 U/L   Human Placental Lactogen (hPL): Human placental lactogen (hPL) hormone test is usually performed for measuring the amount of hPL in the blood. (10) Human placental lactogen (hPL) hormone is produced by the placenta. This hormone is helpful in the process of providing nutrition to the fetus. hPL also plays an important role in stimulating milk glands in the breasts in anticipation of breastfeeding. hPL is present in a woman’s body only during pregnancy, with maternal serum levels increase in relation to the growth of the fetus and placenta. Maximum levels are reached near term and that point of time usually reaches to 5–7 mg/L. Higher levels are noted in women with multiple gestations. Little hPL enters the fetal circulation. Its biological half-life is about 15 minutes. hPL hormone blood test is considered as an important indicator of fetal growth and required well-being. It is one of the reliable sources for determining the growth and development of the fetus.   Follicle-stimulating hormone (FSH): Follicle Stimulating Hormone (FSH) is responsible for controlling the menstrual cycle and egg productions in a woman. FSH levels are tested on day 2 or 3 of a woman’s monthly cycle to determine her ovarian function and evaluate egg quality. In general, women with elevated FSH levels found in their blood on day 2 or 3 of the monthly cycle have reduced chances of live birth, as compared to women of the same age. This happens even in cases where IVF and ovulation induction are taken into consideration. Currently, several laboratory methods are used to measure FSH blood levels, and measurement of these levels may vary considerably depending on the laboratory and method used. Therefore, it is difficult to compare blood levels that are measured at different medical laboratories. As women get older, FSH levels increase, until they reach a level of 40 mIU/mL or higher than this during the menopause phase of a woman. Sometimes, increased Follicle Stimulating Hormone (FSH) levels are measured by FSH hormone blood test to confirm the presence of menopause. When a woman's FSH blood level is constantly elevated to 30 mIU/mL or higher, and she did not have a menstrual period for each of the months for a year or more, it is usually accepted by doctors that she has reached menopause. (11)   Estrogen: Estrogen hormone is responsible for the growth and development of female sexual characteristics. Normally formed in the ovaries, this hormone is also produced by the placenta during pregnancy to help in maintaining a healthy pregnancy. Estrogen hormone blood test is done to detect any hormonal imbalance in the body. Conditions under which estrogen hormone test is done are abnormal vaginal bleeding, unusual sex organ development, or lack of menstrual periods. In estrogen hormone blood test, a woman’s blood sample is correlated with her monthly cycle. In cases related to pregnancy, the gestational age of the baby is considered as a dominant factor. There are many factors responsible for affecting the test results such as age, sex, and unique medical history. The three types of major naturally occurring estrogen hormones are present in significant quantities in the blood. These are namely Estradiol (E2), Estrone (E1) and Estriol (E3). The expanded female hormone panel blood test includes Total Estrogens, Cortisol A.M., Sex Hormone Binding Globulin, DHEA-s, Progesterone, and Testosterone tests. Estradiol hormone levels are measured in picograms per milliliter (pg/ml). In premenopausal women, normal estradiol levels are 30-400 pg/ml. (12)   Progesterone: During pregnancy, progesterone hormone is produced by the ovaries and by the placenta. This hormone stimulates the thickening of the endometrial lining in anticipation of implantation of a fertilized egg. (13) A progesterone hormone blood test helps in measuring the amount of the hormone progesterone present in a blood sample. Progesterone is a female hormone produced by the ovaries when ovulation takes place. Progesterone hormone is largely produced by the corpus luteum until around ten weeks of gestation. When the pregnancy reaches term gestation, progesterone hormone levels range from 100-200 ng/ml and the placenta produces over 250 mg/day. Most of the progesterone hormone which is produced by placenta enters the placenta. This does not happen in the case of estrogen. (14) Progesterone hormone level is measured in nanograms per milliliter (ng/mL). In general, progesterone hormone test results fall in the following ranges: men, postmenopausal women, and women at the starting of their monthly cycle: 1 ng/mL or below. Women in the middle of their monthly cycle: 5 to 20 ng/mL. Pregnant females in their first trimester have a progesterone level of 11.2 to 90 ng/mL. Frequently Asked Questions (FAQ's) related to Hormone Blood Test: How early can a blood test detect pregnancy hormone? Pregnancy blood tests are a reliable source to detect pregnancy at much lower ranges of circulating pregnancy hormone in the blood. These tests can, therefore, catch a pregnancy in its very early stages. However, in urine tests, the levels of pregnancy hormone need to be much higher to be detected in a urine or home pregnancy test. Hormone blood tests are considered to have nearly 99 percent accuracy rate and they are almost always accurate.   Do you need to fast for a hormone blood test? Fasting is needed before commonly ordered tests for glucose (blood sugar) and triglycerides (part of the cholesterol, or lipid, panel) in order to obtain accurate results. The tests which are usually not affected by fasting are measurements of the liver, kidney, blood counts, and thyroid.   What does FSH mean in a hormone blood test? Follicle Stimulating Hormone (FSH) hormone blood test assists in measuring the level of FSH in blood. It is a hormone released by the pituitary gland, present on the underside of the brain. The FSH test, along with others, is often considered as a great way to check for egg quality to get a complete picture of a woman’s fertility. If you have any concerns related to hormone levels or wish to know more about the hormone blood test, Elawoman can help you out. Medical tests play an important role in the effective execution of the required medical treatment. For further information about hormone blood tests or any other information related to infertility or IVF treatments, visit elawoman.com or talk to the best fertility experts at +918929020600.

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