AMH - Anti-Müllerian Hormone

Fifty years after the invention of the birth control pill, a new test promises to revolutionize the behavior of future generations of women. The Anti-Müllerian Hormone (AMH), which is produced by the ovarian cells, can indirectly assess whether the quantity of ova available is higher, average or lower than expected for a certain age. This helps predict reproductive longevity. This new test has become an important tool for human reproduction professionals all over the world, and it is already a routine practice at the Center.

Immunological Research

At present, there are tests that can diagnose the problems that cause countless couples to have miscarriages or issues with getting pregnant. Many miscarriages can be explained by immunological issues. Many cases classified as "unexplained infertility" or "with no apparent cause" are actually caused by undiagnosed immunological issues that can be treated. These complications can cause not only miscarriages, but repeated failures in attempts at in vitro fertilization (IVF). Tests for the NK (natural killer) cells, thrombophilia, cross-matching, Factor V Leiden, and HLA-G compatibility, among others, may be necessary. Analysis of cervical mucus and post-coital test: during the fertile period, the quality and quantity of the mucus produced can be analyzed. When done a few hours after sexual relations, this evaluation can also be used to study the sperm in the mucus.

Hysteroscopy

Through placing a thin device in the cervix, we can verify the integrity of the uterine cavity and if it is able to withstand a pregnancy. In addition to the diagnosis, the hysteroscopy can be surgical, in order to correct uterine development issues (malformations) or segmental resection of uterine fibroids, polyps (endometrial or cervical) and Asherman's syndrome (scars inside the uterus).

Transvaginal Ultrasonography or Ultrasound

This test is routinely requested to analyze the functioning of the female reproductive system, with an emphasis on studying the uterus and ovaries. In addition to identifying problems such as ovarian cysts, polycystic (or micropolysistic) ovaries, uterine fibroids, endometrial polyps and endometriosis, the serial transvaginal ultrasonography helps monitor the menstrual cycle and determine ovulation (or lack thereof) and the best period to get pregnant (fertile period). This is one of the tests that can identify the ovarian response to medication. When done right after menstruation, the ovarian volume and follicle number can predict the ovarian reserve. That is, if an ovary is producing quality ova in the right quantity. New resources made possible through ultrasonography are being examined as options to improve fertility studies for couples.

Interview (medical history) and Physical Exam

Though many tests can contribute to the diagnosis, some of which are very sophisticated, in the area of human reproduction, a specific and detailed interview is crucial to finding the correct diagnosis and choosing the best treatment.

Blood assays (hormones or antibodies)

A small blood sample can be used to evaluate a series of hormones that are responsible for female fertility. Hormones such as FSH (follicle-stimulating hormone), LH (luteinizing hormone), estradiol, progesterone, prolactin, testosterine, inhibin B and AMH (Anti-Müllerian hormone) can indicate a woman's capacity to ovulate. Some, as is the case with the Anti-Müllerian hormone, are used to evaluate the ovarian reserve; they reflect the amount of follicles and ova that are still available. For example, an altered dosage of FSH and/or Anti-Müllerian hormone can reveal that the number of ova available is decreasing at a higher rate than expected for a woman's age. Some substances known as markers, such as CA 125, can also be administered. Though it might not be as precise and can be implicated in a series of issues, CA 125 is also used to study endometriosis. Some antibodies can be studied in the bloodstream. The specifics for chlamydia, the main germ that causes changes in the Fallopian tubes, can reveal an older problem (IgG) or a recent one (IgM).

Videolaparoscopy

This is a test done in a hospital to analyze the abdominal cavity. Though it is done under general anesthesia, there is no need for an extended hospital stay. The patient will only be at the hospital for a few hours, which is why it is classified as an outpatient procedure. This test allows us to accurately visualize the organs in the female reproductive system (uterus, Fallopian tubes and ovaries). It consists of the main test used to diagnose endometriosis and pelvic adhesions (scars that can affect organs such as the Fallopian tubes and the ovaries). Videolaparoscopies can be requested for diagnostic purposes or to correct problems that have been detected (surgical).

Hysterosonography

The transvaginal ultrasonography can be accompanied by the introduction of a small amount of liquid in the uterus to more easily verify the existence (or not) of certain issues.

Hysterosalpingography

X-ray exam used to demonstrate the permeability of the female reproductive system. It is one of the few tests that can evaluate the Fallopian tubes. The Fallopian tubes are delicate organs that are essential for a pregnancy. They can be easily damaged, especially by inflammations/infections, surgeries or endometriosis. 

Nuclear Magnetic Resonance

This allows us to assess uterine malformations, such as defects in the size and shape of the uterine cavity, the presence of adenomyosis (a disease that impedes pregnancy). It can also show the presence of uterine fibroids.