Lecture 1: Home Fertility Testing

How does endocrine control menstrual cycle?

• Complex interplay of hormones

• Hypothalamus

• Initiates cycle w/ release of GNRH

• Pituitary gland releases FSH & LH

• Ultimately influences ovaries & uterine lining

• Produces estrogen & progesterone

What are the stages in the ovary?

• Developing follicle

• Mature follicle

• Ovulation

• Early corpus luteum

• Regressing corpus luteum

• Corpus albicans

What are the stages in the hormones?

• FSH before ovulation, then quick spike in LH

• Estrogen before ovulation, progesterone after

What are the stages in the uterus?

• Menstration

• Follicular phase

• Ovulation

• Luteal phase

What do progesterone levels do throughout the menstrual cycle?

Fluctuate to prepare body for implantation if conception occurs

What is progesterone before ovulation?

• 1st half of period

• Low levels

• Produced by adrenal cortex

What is progesterone after ovulation?

• 2nd half of period

• Initial steady rise in levels

  • Conception → levels remain high

  • No conception → levels drop

• Production shifts to ovaries

What are the days associated w/ each phase of cycle?

• 1-5: menstruation

• 6-11: follicular phase

• 12-16: ovulation- day 14 (most fertile)

• 17-28: luteal phase

What are options for fertility testing?

• At-home semen analysis

• Follicle stimulating hormone (FSH) tests

• Ovulation predictor kits

• Variety of tests range greatly on price & accuracy & there is no “one size fits all” at-home fertility test. If infertility issues are suspected, both partners need to be tested

What is semen analysis?

• Cost ranges from $30-60

• At-home convenience

• Takes 30 mins per test

• >90% accuracy

• Available from pharmacies, Amazon

• (Representative test)

• Numerous tests available

• Sperm count analysis most common

• 95% of normal males produce sperm in >20 mil per mL range

What is the typical test produce for a semen analysis?

• Semen sample is obtained

• Sample is mixed w/ test solution(s)

• Sample mix is added to test device

• Result is read in a few minutes

What are semen analysis fully?

• Volume- 1.5 mL- how much fluid there is measured in mL (approx ½ tsp)

• Concentration sperm- 16 mil per mL- how many sperm are in each mL

• Total motility- 42%- total proportion of sperm that are moving (grade A, B, C)

• Grade A rapidly moving Grade B slowly Grade C non-progressive Grade D immotile- A & B: 30%, D: 20%- A: quickly progressing forward, B: slowly progressing forward, C: moving but not going forward, D: not moving- may or may not be dead

• Normal morphology- 4%- proportion of sperm w/ normal head & tail shape

What are FSH tests?

• Not 1st line in fertility testing in women

• Requires blood draw on day 2-3 of cycle

• Used in conjunction w/ other tests

• OTC tests used to assess menopause status in women

• OTC tests not approved for fertility testing

• Assesses status of ova in ovaries

What are ovulation predictor tests?

• (Representative test)

• Clearblue (digital ovulation test)

• Identify most fertile day(s) during cycle

• Identifies LH surge

• 98% accurate

• Priced from $18-35

• Contain test strips for 2 months of testing (most kits)

What is important for ovulation predictor tests?

• Timing is important!

• Woman needs to accurately determine day 1 of her cycle (first day of period)

• Testing should being on day 12 & continue for 4 days or until a positive result is obtained

What does a positive ovulation predict test indicate?

• LH surge & if all is normal, ovulation

• Intercourse during this “window” has greatest chance for conception (12-16, esp. 14)

What are the basics for home pregnancy testing?

• All tests identify presence of human chorionic gonadotropin (hCG)

• hCG is produced by placenta after fertilization

• hCG production begins 5-6 days after conception

• Cost ranges from $6-20, each kit w/ multiple tests

What is the testing procedure for most home pregnancy tests?

• Urine is directly applied to test strip & results are available w/in mins

• Some tests involve a finger stick (generally not popular)

What are the line meanings for pregnancy tests?

• 1 line: not pregnant

• 2 lines: pregnant

What is the meaning of a faint line?

• hCG is present

• You can’t be “just a little pregnant”

• May need a clean white background to see a very faint line

What are the causes of a faint line be?

• Early pregnancy:

  • hCG levels are too low early in PG leading to faint line

• Testing too soon

  • Testing before next period is anticipated may detected only a low level of hCG

• Diluted urine

  • Hydration can dilute hCG

What is the recommendation w/ a faint line?

• Wait a few days & retest

• Cut back on fluids before testing again

What are the retest recommendations?

• hCG test will report positive as early as 10-12 days after ovulation

  • Generally a few days before next period

• Best time to retest is at time of next period & preferably a few days after a missed period

What is a faint line even mean?

Positive test