Female Pre-Cycle Screening

Most women undergo fertility problems or the inability to conceive from time to time. One is usually considered to have fertility issues after trying to get pregnant for several months or even years. In such situations, the best solution is normally to consult a professional gynecologist or consider other methods of having a child. The medical procedure to solve infertility issues usually begins with pre-cycle screening and testing. 

Female pre-cycle screening involves reviewing the overall family and medical history in detail. Screening also aims at determining if you are an ideal candidate for the specific procedure you wish to undergo. Furthermore, the screening procedures and tests will give a clear insight into the chances of success through the chosen method of fertilization. 

 

Types of Female Pre-Cycle Screening Tests 

There are several types of female pre-cycle screening tests that every woman with fertility problems has to undergo. The purpose of these tests is to determine the underlying cause of infertility, the possibility of conceiving naturally, and the suitable assistive reproductive technology method. 

These forms of pre-cycle screening in women thus include the following; 

Assessment of the medical history: 

During the first consultation, the fertility doctor will inquire about your overall wellbeing and sexual background. Learning about your past is an integral aspect of how the doctor determines the cause of the infertility problem. 

For instance, the doctor may discover a previous sexually transmitted illness or infrequent ovulation and menstrual cycles as the underlying cause of infertility. Moreover, this initial consultation will provide crucial information that enables the fertility specialist to evaluate if more testing is necessary. 

HIV testing: 

The major reasons for conducting HIV test procedure includes; 

• Pregnancy can cause negative effects on the overall health of an HIV+ woman. 
• There is a chance of passing on HIV to an infant during childbirth. Hence, you need to be aware of the associated risk before getting pregnant. 
• While it’s uncommon, there is a potential possibility that frozen embryos or gametes could spread the virus to other embryos or gametes of the patients. So, in order to ensure the safety of all patients, thorough pre-cycle screening is essential prior to embryo creation. 

German measles (rubella) testing:

Screening for rubella immunity is essential for every female patient. When there is a lack of natural immunity to Rubella, vaccination must be done before treatment can begin. This reduces the risk of Rubella's symptoms and effects during the early pregnancy stage. 

Hepatitis B and C: 

Hepatitis poses equal dangers to HIV. However, hepatitis tends to be more contagious, unlike HIV, but the mortality rate is much lower. Both partners should be put to the test. These tests are also critical for freezing the gametes and embryos of the couples. 

Hormonal level:

The levels of hormones are typically assessed during the second or third day of the cycle before the treatment. This is to make sure that they are normal. These hormones include; 

Luteinizing hormone: This hormone in women is associated with the production of ovarian hormone and maturation of the egg. Luteinizing hormone measures the egg supply, ovarian reserve. It triggers the growth of follicles, maturation, and releases of the eggs for fertilization. Normally, it reaches the top level during the middle of the menstruation cycle, two days before ovulation. 

Prolactin: The pituitary gland produces the hormone prolactin, which triggers milk production. A prolactin test can be performed on women in the following ways; 

• During the assessment of the infertility problem 
• To identify why a woman isn't ovulating
• If a woman has associated symptoms, including discharge nipple

Follicle Stimulating Hormone (FSH): This helps regulate the menstruation cycle and egg production. It triggers the ovaries to generate follicles that grow, develop, and release the egg. The test is often conducted between the second and fourth day following the menstrual cycle. FSH test is also helpful in measuring the supply of eggs into the ovaries. 

Baseline ultrasound scans (sonogram): 

A vaginal ultrasound is an essential part of female pre-cycle screening. The primary purpose of ultrasound scans include; 

• Checking for any physical abnormalities, including fibroids and polyps that could be interfering with the normal cycle, as well as the existence of ovarian cysts. 
• Evaluating the ease of access to the ovaries since the eggs would be harvested with an ultrasound-guided technique 
• Giving a baseline statement that can be used as a guideline during the treatment period.
• Counting the number of tiny follicles in the ovaries and measuring the size of the ovaries. 

At times, other baseline scans can be needed before the treatment periods. A vaginal ultrasound is a comparatively painless and straightforward treatment for most women. 

Laparoscopy:  

This is a minimally invasive procedure. It involves inserting a camera and small surgical tool into the abdominal cavity via a small cut around the belly button. Endometriosis is evaluated and treated through laparoscopic surgery. This also removes ovarian cysts, scar tissue, and uterine fibroids. 

Hysterosalpingogram (HSG): 

This is a type of x-ray test used to check whether the fallopian tubes are open. It also shows if the shape of the uterine cavity is natural. HSG procedure involves implantation of a catheter via the vagina into the cervix opening. 

Through the catheter, an iodine-containing liquid (contrast) is infused. The contrast fills up the uterus and gets into the fallopian tubes. This outlines their length and spills out the ends if they are open. HSG can also help identify uterine cavity or fallopian tube obstruction, including fibroids and polyps, and detects an unusual uterus shape. 

Sonohysterography: 

This technique uses transvaginal ultrasound once the uterus fills with saline, a salt solution. Compared to transvaginal ultrasonography alone, this increases the diagnosis of intrauterine issues such as fibroids and endometrial polyps. If an abnormality is discovered, a hysteroscopy is usually performed. At times, this test is conducted in place of HSG.

Ovarian reserve blood test: 

An ovarian reserve blood test provides insight into the quantity of the remaining eggs. It’s an appropriate test, especially if you've been attempting to conceive for more than six months and need to analyze if your ovarian reserve is suitable for your age. The level of ovarian reserve can also be used to assess the drug regimen that is more effective for you. 

Hysteroscopy: 

Hysteroscopy is a surgical technique that involves passing a lighted telescope-like instrument (hysteroscope) through the cervix. This allows viewing of the interior of the uterus. Hysteroscopy can also aid in diagnosing and treating uterine disorders like fibroids, polyps, fibroids, or adhesions (scar tissue).

 

Female Pre-Cycle Screening Essential Factors

Some of the essential factors that determine female fertility test include the following; 

• Age 

The effect of aging on female fertility is well documented. In general, the age of a woman is one of the major predictors of the ability to conceive through her eggs. At around the age of 43, the odds begin to diminish as chromosome and miscarriage abnormality rates increase that egg donation is likely the best choice. 

After the age of 35, as natural fertility decreases dramatically, many women undergo what is known as age-related sub-fertility. This means that there is no clear fertility issue other than the egg being ovulated being less capable of supporting a pregnancy as one ages. 

• Ovulation 

There is no pregnancy without ovulation. Ovulation is associated with daily monthly menstrual periods. Polycystic Ovarian Syndrome, Hypothalamic Anovulation, Luteal Phase Insufficiency, and issues related to other hormones, including Prolactin or thyroid hormone, may all disrupt ovulation.

Many women usually ovulate well in their forties and even fifties, but the quality of the eggs ovulated is important. A young female who does not ovulate on a regular basis is normally stimulated to ovulate using either oral or injectable pregnancy drugs. 

• Fallopian tube status 

Fallopian tubes may become blocked, distorted, or kinked as a result of post-surgical scarring, infection, and the disease endometriosis. This stops sperm and eggs from combining, which may result in tubal or ectopic pregnancy. The HSG (hysterosalpingogram) dye examination is the only non-surgical method to assess the patency of the fallopian tubes. This means determining if the tubes are open or not. 

• Uterus and endometrial lining 

Several factors can lead to abnormality in the uterus and its lining and cause the failure of an embryo to implant. They include polyps, intra-uterine scarring from previous surgery, and fibroids. Simple ultrasonography conducted just before ovulation can also be used to diagnose any issue.

If the uterus is not completely open, a sono-hysterogram or hysteroscopy can be done. Sono-hysterogram is an ultrasound conducted by placing sterile saline fluid inside the uterus. On the other hand, hysteroscopy is a surgical procedure to see into the uterus. The majority of these issues are surgically repaired. 

 

Conclusion 

Female pre-cycle screening is an essential procedure that involves a thorough assessment of the woman’s medical and family history. It focuses on determining the potential underlying cause of fertility problems among women who are trying to conceive. Screening is also useful in evaluating a suitable assistive reproductive technology one can opt for.

Fertility specialists and gynecologists often recommend performing the less invasive techniques first to diagnose the infertility cause. The extent and speed of the evaluation procedure should depend on the preference of the woman, age, and infertility duration. Physical examination and medical history are also essential factors to consider.