Investigations for Women
Investigations for Women
- DAY 3 FSH and E2:
A day 3 FSH and E2 (estradiol) level gives insight into the number of eggs or “ovarian age” of the ovary. The FSH or follicle stimulating hormone is responsible for stimulating the ovary to produce an egg each cycle. If the ovary is less responsive or “older” the level will be elevated. A level of less than 10 IU/L is considered a good level and a level of over 15 is may indicate reduced ovarian reserve. The E2 or estradiol level should be under 200 pmol/L.
- ANTI-MULLERIAN HORMONE (AMH):
This test is similar to Day 3 FSH. It evaluates the number of eggs in the ovary or “Ovarian Reserve”. The normal levels are between 4.8 to 53.9 nmol/L.
A progesterone level is taken in the second half of the menstrual cycle to evaluate ovulation. A progesterone level of greater than 10 pmol/L is considered diagnostic of ovulation
An ultrasound is scheduled for early in the menstrual cycle to evaluate the pelvic anatomy – the uterus and ovaries and rule out any abnormalities. An antral follicle count gives insight into the number of eggs in the ovary. The antral follicle are small fluid filled cysts containing eggs and ideally 5 or more follicles should be seen in each ovary thus indicating a healthy number of eggs in the ovaries.
An HSG is an x-ray procedure performed to determine the shape of the uterus and whether the fallopian tubes are open. An HSG is an outpatient procedure that takes less than 5 minutes to perform. It is usually done after menstruation has ended.
HSG Specific Instructions
Your doctor has ordered an x-ray of your fallopian tubes called a hysterosalpingogram or HSG. Dye is injected into the uterus and fallopian tubes via a narrow tube inserted through the cervix. The procedure is done in the X-Ray Department located on the 4th floor of the Foothills Medical Centre.
It will be performed by an fertility specialist from the Regional Fertility Program. It will be timed in the early days of the menstrual cycle usually between days 6-10, after bleeding has stopped but before ovulation. This procedure may result in mild cramping and these may last a short while afterwards. Therefore a mild pain killer is given and an antibiotic to minimize the very slight risk of infection.
Sonohysterograms (SHG) use ultrasound and sterile water, whereas Hysterosalpingograms (HSG) uses X-ray and contrast to visualize the uterine cavity and patency of the fallopian tubes. SHG may not always be able to identify patency of tubes but gives a much clearer outline of the uterine cavity.
SHG Specific Instructions
SHG’s are done at EFW Radiology, two floors below the Regional Fertility Program on the second floor of the Cambrian Centre. They are performed Monday through Friday in the morning between 10 and 11 am and in the afternoon between 1:00 and 3:30 pm. No procedures are done on weekends or holidays. One of the physicians at the Regional Fertility Program will perform the procedure.
HSG/SHG Frequently Asked Questions
Can I eat and drink prior to and after the HSG procedure?
Yes, but try to avoid dairy products when taking the antibiotic because it can cause stomach upset.
How long does the HSG procedure take?
The procedure itself takes about 5 minutes.
Can I leave immediately after the HSG?
Is an HSG uncomfortable?
An HSG may cause mild or moderate uterine cramping for about one to two minutes. However, some women may experience cramps for several hours. The symptoms can be greatly reduced taking medications used for menstrual cramps.
How much time do I need to arrive before my HSG appointment?
Please arrive 20-30 minutes prior to your appointment to ensure adequate time to check-in.
What are the risks and complications of HSG?
An HSG is considered a very safe procedure. However, complications may very rarely happen. Please contact the RFP if these occur:
The most common serious complication with HSG is pelvic infection. This usually occurs in the presence of previous tubal disease. In rare cases, infection can damage the fallopian tubes or necessitate their removal. If you experience increasing pain or a fever within one to two days of the HSG, please contact the RFP clinic.
Light-headedness during, or shortly after, the procedure may occur on rare occasions.
The radiation exposure from an HSG is very low. There have been no demonstrated ill effects from this radiation, even if conception occurs later the same month. The HSG should not be done if pregnancy is suspected.
Since iodine is used as the contract medium in an HSG, a patient should inform her doctor if she is allergic to iodine or seafood. If a patient experiences a rash, itching, or swelling after the procedure, she should contact the RFP.
Spotting commonly occurs for one to two days after the HSG. A patient should notify her doctor if she experiences heavy bleeding after the HSG.
If I am allergic to anti-inflammatories what else can I take for pain relief?
Tylenol extra strength 2 tablets 2 hours prior to the HSG .
How soon do I get the results from the HSG?
You will generally be informed of the results at the time of the procedure. However, it is important to make a follow-up appointment with your physician at the same time as the nurse books your HSG.
Can my husband or someone else be in the room with me?
No, generally not in view of the risk of radiation exposure.
Can a HSG be done on Saturday or Sunday?
No, HSGs are only done Monday-Thursday @ 8:00 am or Fridays @ 8:30 am.
If I am still bleeding on the day of my HSG is it okay to proceed?
An HSG can’t be done if you have full flow bleeding. However, if you are just lightly spotting you can still have the HSG performed.
How soon can I have intercourse after having the procedure?
If there are no complications 3-4 days later.
Can I drive after having the HSG done?
Yes, but we recommend that someone drive you to and from the procedure given the possibility that you may experience some abdominal cramping.
Will I be able to go back to work after the procedure?
It all depends on how you feel, you may need to take a half day or a full day off work depending on how much cramping you experience after the procedure.
Do I have to pay for a HSG?
The HSG is covered under your provincial health care plan.
Does a hysterosalpingogram enhance fertility?
It is controversial whether this procedure enhances fertility. Some studies indicate a slight increase in fertility lasting about three months after a normal HSG.
Why do I need a Sonohysterogram if I have already had an HSG?
The SHG gives a clearer view of the uterine cavity and can identify abnormalities such a polyp ( small growth of the uterine lining) , a fibroid or congenital abnormalities of the cavity.
Is there a waitlist for SHG?
No, but there is high demand for these tests and limited space, so it may take 1-2 months to have the test competed.
Is the Sonohysterogram painful?
It may cause some mild cramping but you will be given a prescription for an anti-inflammatory to help with any discomfort.
When in the cycle is the SHG booked?
Usually it is booked earlier in the cycle after your period has finished but before you have ovulated.
What is my chance of getting an infection from this procedure?
You will be given a prescription for an antibiotic to start prior to the SHG to minimize any risk for infection.
Is there a cost for the SHG procedure?
No, the SHG is covered under your provincial heath plan.