Preimplantation genetic testing (PGT) is used during in vitro fertilization (IVF) to learn more about an embryo before transfer. The testing looks at different genetic information depending on your needs.

• PGT-A checks the number of chromosomes in each embryo.

• PGT-M looks for a known single-gene condition.

• PGT-SR looks for changes in chromosome structure.

Your healthcare provider may recommend one or more tests based on your family history, genetic screening results, or past experiences. 

What is PGT-A? 

Preimplantation genetic testing for aneuploidy (PGT-A) looks at an embryo’s chromosomes. Most people have 23 pairs of chromosomes, including sex chromosomes (XX, XY). An embryo with missing or extra chromosomes may have a lower chance of developing into a healthy pregnancy. 

Why use PGT-A?

• Helps identify embryos with a normal number of chromosomes. 

• Supports single-embryo transfer and reduces the chance of twins or triplets. 

What is PGT-M? 

Preimplantation genetic testing for monogenic conditions (PGT-M) looks for a known single-gene condition. Each test is customized based on your specific gene change. A genetics lab studies a small cell sample from each embryo to learn whether the embryo is affected, a carrier, or unaffected.

Why use PGT-M?

Your care team may recommend PGT-M if: 

• You, or your partner if applicable, have a single-gene condition that can be passed directly to a child.
  This includes conditions where one gene change is enough to cause the condition (autosomal dominant) or conditions passed on through the X chromosome (X-linked). 

• You, or your partner if applicable, both carry one copy of the same gene change. 
  When both copies are passed on, the child may have the condition (autosomal recessive). 

How does PGT-M work? 

Testing begins before IVF starts. 

• You and the sperm source provide a DNA sample through blood or cheek swab. 

• Sometimes, samples from affected family members are needed. 

• The genetics lab uses these samples to create a custom test. This step, called probe creation, usually takes 6 to 10 weeks. 

Once the probe is complete, you can move forward with IVF, and embryos can be tested using this customized approach. 

What is PGT-SR? 

Preimplantation genetic testing for structural rearrangements (PGT-SR) looks for changes in chromosome structure, such as translocations or inversions. 

Key points 

• These changes can be inherited or happen on their own. 
• Balanced rearrangements are chromosome changes in which genetic material is rearranged but not missing or extra, meaning the carrier is typically healthy. 

• Most people with a balanced rearrangement are healthy and may not know they carry it. 

• Carriers of balanced rearrangements have a higher chance of embryos with missing or extra genetic material. 
• Embryos with unbalanced rearrangements usually do not result in a live birth. This is because embryos with unbalanced rearrangements have missing or extra pieces of DNA. 

• About 5% of recurrent miscarriages are linked to structural rearrangements. 

If your history suggests this may be a factor, your provider may order a blood test called a chromosome analysis (karyotype). Based on those results, PGT-SR may be recommended.

How does PGT work during IVF? 

1. You complete your IVF cycle. When embryos reach the blastocyst stage (day 5 to 7), the embryologist removes a few cells from the outer layer of each embryo. These cells would form the placenta.
2. The biopsy sample goes to a partner genetics lab for testing. The embryos stay frozen in the lab during this process.
3. The lab studies the DNA to:
   • Check chromosome number (PGT-A). 
   • Identify embryos not affected by a specific gene condition (PGT-M).
   • Screen for a structural rearrangement (PGT-SR).

Because PGT-M looks at a single gene and PGT-A looks at chromosome number, both tests are often used together. Your provider and embryologist review your results along with embryo quality before choosing an embryo for transfer. 

What happens next? 

If you have embryos available for transfer, you start a frozen embryo transfer cycle. 

• The embryologist selects the embryo based on PGT-A results and, if relevant, PGT-M or PGT-SR findings, plus embryo quality.

• Any remaining embryos stay frozen for future use or may be donated or discarded based on your consent. 

• About 2 weeks after the transfer, you take a pregnancy test to learn whether the embryo implanted.

If you have questions, Progyny is here for you. Please contact your Progyny Care Advocate for support.  

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance. 

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It can be so difficult to go through in vitro fertilization (IVF) and find that your embryo didn’t implant successfully. This happens to many people, and you are not going through this alone.

As you process the outcome of your cycle, it’s often helpful to seek comfort and understanding from others who’ve been through this experience. You always have support from your healthcare team and your Progyny Care Advocate as you think about what may be next for you.

Here are a few options you may wish to think about. It’s important to remember that there is no single timeline or pathway here — only what feels right for you. It’s OK to take the time you need.

Diagnostic testing

Diagnostic testing may help you and your healthcare team understand possible reasons the embryo didn’t implant.

Sometimes tests that were done before treatment may be repeated, or you may try new ones. Be sure to speak with your doctor about what they recommend for you. It’s always OK to ask any questions you have.

Tests may include:

• Hysterosalpingogram (HSG): An x-ray that uses contrast dye to see blockages in the fallopian tubes and look for signs of uterine fibroids, polyps, scar tissue, or other problems in the uterus
• Sonohysterogram (SIS): A transvaginal ultrasound that is done while your uterus is filled with saline solution, to better see the inside of the uterus
• Hysteroscopy: A visual exam of the inside of the uterus using a camera attached to a small, lighted tube that is inserted through the vagina and cervix into the uterus
• Other tests: Based on your personal situation and health history, your team may recommend other tests for you

Preimplantation genetic testing for aneuploidy (PGT-A)

It’s common for embryos created in an IVF cycle to have an unexpected number of chromosomes (called aneuploidy). Transferring an embryo with aneuploidy may result in an embryo that doesn’t implant, a miscarriage, or a baby born with a medical problem.

With PGT-A, genetic testing is done on the embryo before embryo transfer. This helps the team select an embryo with a higher chance of successful implantation and a higher chance of a healthy baby.

PGT-A may be helpful if you choose another IVF cycle or have remaining embryos that have not undergone PGT-A.

Lean on your support system

Everyone’s journey is different, and people need different amounts of time and support to think through what’s next for them.

Find support on a personal level

Sharing your story and hearing from other people who’ve been through fertility treatment can be validating and bring a sense of connection. Ask your fertility clinic if they recommend any support groups, or search for organizations that offer in-person or online support.

Be sure to have discussions with your partner if you have one, both about how you’re feeling and what feels right moving forward. These topics can be difficult, so it’s good to know that a professional therapist can help you share feelings and make decisions together. Here’s help finding a therapist.

Turn to your fertility team for guidance

When you’re ready, you (and your partner) can discuss possible next steps with your healthcare team. Your Progyny Care Advocate is here to help you prepare for these conversations.

Gather as much information as you need and be open about your hopes, questions, and concerns. You may wish to talk about:

• How many IVF cycles you wish to try
• Other options that may be available (such as adjusting your medicine plan, or using donor eggs, embryos, or surrogacy)
• Other paths to parenthood

Prioritize your own well-being

Throughout it all, be good to yourself. Think about what you would say or do for a close friend going through a similar experience and give yourself the same grace. Set aside time each day to:

• Use a relaxation technique like meditation or deep breathing
• Get moving with light physical activity that you enjoy
• Do a hobby that brings you comfort and takes your mind off things

Your Progyny Care Advocate is always here for support, resources, and guidance — or just a listening ear.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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Structural problems in the uterus and fallopian tubes are one possible cause of infertility. You may have tests to look for these problems as part of a routine fertility evaluation. Or testing may be done if your doctor suspects you have an issue. 

Diagnostic testing may be done to look for: 

• Blocked fallopian tubes, which make it impossible for sperm to reach an egg for fertilization. A blockage can also prevent eggs from moving from the ovary to the uterus. (If a fertilized egg can’t travel to the uterus, it can lead to a life-threatening condition called an ectopic pregnancy.) Fallopian tubes may be blocked from pelvic inflammatory disease, scar tissue, endometriosis, or fibroids. 

• Problems with the uterus, which can prevent an embryo from implanting in the endometrium (lining of the uterus). Uterine problems may include fibroids, polyps, scar tissue, and problems that can happen when the uterus is developing (the most common being a problem called uterine septum). 

There are a few tests your doctor may recommend, each with benefits and drawbacks. Be sure to discuss your options together and ask any questions you have. 

Saline infusion sonohysterogram (SIS) 

A saline infusion sonohysterogram (SIS) is a transvaginal ultrasound that is done while your uterus is filled with saline solution, to better see the inside of the uterus.  

• What it detects: Issues in the uterus and endometrium, such as endometrial polyps, fibroids, or uterine scars. 

• How it works: Saline solution is passed through the cervix to fill the uterus while a transvaginal ultrasound is done. This shows a more detailed picture of the uterus and endometrium than an ultrasound without saline. 

• Benefits: A quick procedure (less than 10 minutes) that provides important information about issues that could prevent an embryo from implanting in the uterus. 

• Drawbacks: Does not provide any information about the fallopian tubes. 

Hysterosalpingogram (HSG) 

A hysterosalpingogram is an x-ray that uses contrast dye to look at the fallopian tubes and uterus. 

• What it detects: Blockages in the fallopian tubes and some problems in the uterus, such as uterine fibroids, polyps, scar tissue, uterine septum, or other problems. 

• How it works: Contrast dye is carefully pumped into your uterus to fill the uterus. An x-ray will take pictures of the dye flowing through the uterus. If there is no fallopian tube blockage, the dye can pass through the fallopian tubes and into your body (where it’s safely absorbed). If the dye cannot pass, there is a blockage.  

• Benefits: Provides information about the fallopian tubes, including where a blockage is located in the fallopian tubes, as well as some information about the uterus. 

• Drawbacks: Involves a low dose of radiation, can be uncomfortable, and does not provide as much information about the uterus as an SIS. 

Sonohysterosalpingogram (sono-HSG) 

A sono-HSG is a newer method that does not use an x-ray. It provides information about the fallopian tubes and the uterus using saline solution and a transvaginal ultrasound.  

• What it detects: Blockages in the fallopian tubes (including an issue called hydrosalpinx, where fluid builds up and blocks the fallopian tube) and problems in the uterus, such as uterine fibroids, polyps, scar tissue, uterine septum, or other problems. 

• How it works: Saline solution, along with air, is passed through the cervix to fill the uterus. A transvaginal ultrasound will show the saline with air bubbles flowing through the uterus. If there is no fallopian blockage, the saline and air bubbles can pass through the fallopian tubes and into your body (where it is safely absorbed). If the saline and air bubbles cannot pass, there is a blockage. 

• Benefits: Unlike HSG, there is no exposure to radiation and the test can be done in your fertility doctor’s office. 

• Drawbacks: Not as well-studied as the HSG, not as widely available, and not as effective at evaluating the fallopian tubes. 

Hysteroscopy 

A hysteroscopy allows your provider to look inside the uterus. The uterus is filled with fluid to better see the inside, and a hysteroscope (a narrow, lighted camera in the shape of a tube) allows the provider to see any problems. A hysteroscopy is done to diagnose problems of the uterus, often including unusual bleeding.  

• What it detects: Issues on the inside of the uterus or the endometrium. These may include polyps, fibroids, scar tissue, or problems related to how the uterus developed. Sometimes a hysteroscopy is done with other tools to take a tissue sample (biopsy) or treat problems (such as removing polyps). Your doctor would describe why the procedure may be needed in your case — it has many uses. 

• How it works: Often, medicine is used to help you relax, or anesthesia may be used. A hysteroscope is passed through the cervix, and a liquid is sent into the uterus to help the doctor see more clearly. If needed, specialized tools can be inserted to perform surgical treatments. 

• Benefits: This is a common, safe diagnostic procedure that can be performed along with surgery if needed in a single session. 

• Drawbacks: Any procedure has risks. Hysteroscopy has a small risk of bleeding, infection, reactions to anesthesia, and other problems. Your doctor will describe these risks to you. 

If you have questions about the tests your doctor has recommended for you, it’s always OK to ask them. Your Progyny Care Advocate is also here to help you understand your options and prepare for your conversations with your doctor. 

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance. 

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When starting your family building journey, the first step is to understand your health and fertility profile. 

Your reproductive endocrinologist will talk with you about your goals with fertility treatment and ask questions about your medical and reproductive history. You’ll also discuss diagnostic testing (it may take up to a month to complete testing and get results). 

Diagnostic tests will help your team create a personalized treatment plan for both you and/or your partner. Choosing the most effective treatments for your unique needs will increase your chances of achieving your goals. 

Ovarian reserve 

During a fertility evaluation, your doctor may use blood tests and/or an ultrasound to estimate your egg supply, often called ovarian reserve. Everyone born with ovaries has all their eggs at birth, and this supply naturally decreases with age. (This is unlike sperm, which is produced continuously after puberty.)  

The estimate for how many eggs remain does NOT measure how fertile you are or guarantee your chances of pregnancy. It’s simply information to help your doctor choose the safest and most effective medicine doses if you go forward with fertility treatment.  

Bloodwork to estimate ovarian reserve may include: 

• Anti-Müllerian hormone: This can be done on any day of your cycle 

• Estradiol or follicle-stimulating hormone: Tested on the 2^nd or 3^rd day of your natural menstrual cycle (only if you’re not on the pill or hormonal support) 

• Thyroid-stimulating hormone: To screen thyroid function 

• Prolactin and testosterone: If you have irregular or absent menstrual cycles 

Ultrasound  

A transvaginal ultrasound is used to perform an antral follicle count, or how many follicles are in the ovaries. This is a rough indicator of ovarian reserve. An ultrasound may also allow your doctor to learn if you have any growths (like non-cancerous cysts) in the ovaries. 

Transvaginal ultrasounds may also be used to check the thickness of the uterine lining, as well as the shape of your uterus. Your doctor will be able to see if there are any growths (like polyps or fibroids) that might affect your fertility.  

Uterus and fallopian tubes 

It’s important to find out if there are any issues in the uterus or fallopian tubes that are making it difficult to become pregnant or maintain a pregnancy.  

Depending on your family building goals and medical history, your doctor may recommend tests including: 

• Hysterosalpingogram (HSG): An x-ray that uses contrast dye to check for blockages in the fallopian tubes and look for signs of uterine fibroids, polyps, scar tissue, or other problems in the uterus 
   

• Saline infusion sonohysterogram (SIS): A transvaginal ultrasound that is done while your uterus is filled with saline solution, to better see the inside of the uterus 
   

• Hysteroscopy: A visual exam of the inside of the uterus using a small, lighted tube inserted through the vagina 

Sperm quality 

Your doctor will also assess the fertility of a partner with sperm.  

The first step is a semen analysis, which evaluates the number, movement, and shape of the sperm.  

For additional testing, the partner producing sperm may be referred to a reproductive urologist, who specializes in male fertility. Tests may include ultrasounds or hormone tests. 

Genetic testing  

Fertility testing includes genetic testing to identify if you or your partner carries any genetic disorders or mutations. Finding potential genetic issues early can be helpful in your fertility journey.  

Moving forward after fertility testing 

Fertility tests will give you and your doctor essential insight into your fertility profile (and your partner’s fertility profile). And this will help you work together on a personalized treatment plan. Be sure to ask any questions along the way!  

You can always ask your Progyny Care Advocate for guidance, as well. 

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance. 

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What is luteinizing hormone?

Luteinizing hormone (LH) is made by your pituitary gland and plays a key role in reproduction. LH helps regulate your menstrual cycle and ovulation. A rise in LH — called the LH surge — triggers ovulation.

Why would you have your LH levels checked?

Your LH levels can be measured to determine when you are ovulating. This information can help you plan intercourse if you are trying to become pregnant.

If you are having trouble becoming pregnant, your OB-GYN or reproductive endocrinologist may order an LH test. When measured along with follicle-stimulating hormone (FSH) and estradiol, LH levels give your doctor information about your ovarian reserve.

If you are not ovulating, your LH levels can help identify the cause. For example, LH levels are often elevated in people with polycystic ovary syndrome (PCOS).

LH testing can also be used to:

• Monitor your response to ovarian stimulation.
• Predict the timing of ovulation.

If you have irregular menstrual cycles or do not get a period, your doctor may recommend LH and other hormone testing to look for possible causes.

When should you have LH levels checked?

LH levels are often checked at the beginning of the menstrual cycle — classically Day 3 — along with FSH, to evaluate ovarian function.

More commonly, LH is checked midway through your cycle, since the LH surge triggers ovulation. In a 28-day cycle, this usually happens around Day 14, but timing varies from person to person.

What does the LH test look for?

The LH test measures the amount of luteinizing hormone in your blood or urine.

• High LH levels may be normal if you are in menopause. If you are younger than 40, high LH could suggest premature menopause, PCOS, or certain genetic conditions that affect hormone production. High LH outside of the surge can interfere with ovulation and menstruation, contributing to infertility.
• Low LH levels may prevent ovulation and menstruation, making it harder to become pregnant. Low LH is more common in people with eating disorders, athletes, those experiencing high stress, or individuals with pituitary or hypothalamic disorders.

LH testing is usually done with other hormone tests such as FSH, testosterone, estradiol, and progesterone. Together, these results help determine your next steps.

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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Endometrial receptivity testing, often called an endometrial receptivity assay (ERA), is a diagnostic biopsy of the uterus. The goal is to identify the window of progesterone exposure that is most favorable for an embryo to implant.

This test is not recommended for everyone. That’s because research has not shown consistent improvements in live birth rates compared with standard embryo transfer timing. Professional organizations caution that the evidence is limited, so many reproductive endocrinologists (REIs), or fertility specialists, reserve it for select situations.

Understanding why timing matters can help explain the test’s purpose. In a natural menstrual cycle, after ovulation, your body produces the hormone progesterone. Progesterone prepares the uterus for implantation and supports early pregnancy, but the exact timing of this process can vary slightly from person to person.

Why your REI may suggest this test

Your doctor may suggest this test if:

• You’ve had unsuccessful embryo transfers in the past.
• You have a limited number of embryos.
• You are using embryos from an egg donor.

Talk with your doctor to see if this test is right for you.

How the test works

If your doctor suggests an ERA biopsy, here’s what typically happens:

• Your endometrial lining and hormone levels are monitored with ultrasound and bloodwork. This usually follows the same protocol as a frozen embryo transfer cycle and may include medications, such as progesterone.
• A mock cycle, or practice cycle, is needed to mimic how your uterus responds to hormones before the real transfer cycle.
• Once the lining is ready, your doctor performs an endometrial biopsy. A small piece of tissue is removed from the uterus and sent to the lab. The biopsy can cause some cramping, but it’s quick, doesn’t require anesthesia, and is often done in the consultation room.

At the lab, specialists analyze genes from the tissue sample to assess whether your uterine lining is receptive to an embryo.

Understanding the results

They usually fall into one of three categories:

Receptive

Your lining was within the window of implantation, meaning progesterone exposure was timed correctly. Your doctor may recommend using the same protocol for the actual transfer.

Pre-receptive

Your lining was not ready yet due to insufficient progesterone exposure. Your future transfer cycle may include additional time on progesterone — often 12 to 24 hours more than the standard six days.

Post-receptive

Your lining had already passed the ideal window. This suggests progesterone started too early. A repeat biopsy may be needed to confirm timing, and your transfer protocol may shorten progesterone exposure by 12 to 24 hours.

Occasionally, results are inconclusive. In that case, a repeat mock cycle and biopsy may be required.

Key takeaway

Hormones are generally consistent from month to month, but certain factors can influence your implantation window. This test may help fine-tune the timing of embryo transfer, but it’s not recommended for everyone. Talk with your doctor to learn more.

Progyny is here for you, too. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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Inheritable conditions

Every cell in your body contains about 3 billion base pairs of DNA, organized into 46 chromosomes (23 pairs). These chromosomes carry the genetic material that makes you unique.

You inherit half of your genetic material from the egg and half from the sperm. Genes determine features such as eye and hair color, blood type, and height. Sometimes, changes in the DNA — called mutations or variants — can cause conditions that are passed from parents to children.

If a mutation occurs in a key part of a gene and is inherited from one or both parents, it may cause a genetic condition. Examples include sickle cell disease, cystic fibrosis, and Tay-Sachs disease.

Genetic testing before pregnancy

Expanded carrier screening (ECS)

Before trying to conceive, you may choose to have this blood test. This test looks at whether you and your reproductive partner carry certain genetic changes that could be passed to your children. ECS can identify hundreds of inheritable mutations, also called variants.

If one partner tests positive for a mutation, the other partner is usually tested to confirm they do not carry the same one. Most of the genetic changes being tested only matter if both partners carry the same or similar mutation.

When both partners test positive for a mutation in the same gene, a child could inherit the related genetic condition. To lower this risk, some people choose in vitro fertilization (IVF) to make embryos that can be genetically tested for the condition. This allows you and your partner to transfer embryos that are not affected.

Karyotype testing

If you have had multiple pregnancy losses or if no sperm is found in a semen sample, your healthcare provider may recommend a karyotype test. This blood test looks at the number, structure, and arrangement of your chromosomes to find changes that may affect fertility or cause miscarriage.

During the test, cells are photographed under a microscope. It’s done to see if any chromosomes are missing, extra, or altered in a way that could cause problems with conception or pregnancy.

Genetic testing during pregnancy

If you are pregnant, genetic testing can help assess your baby’s health and identify genetic conditions before birth. Common options include:

Noninvasive prenatal testing (NIPT)

This is a blood test that screens for certain chromosomal conditions, such as Down syndrome. It can also determine the baby’s sex.

You may also hear it called noninvasive prenatal screening or cell-free DNA.

NIPT is a screening test — it is highly accurate but not 100% definitive. If results raise concerns, or if an ultrasound shows something unexpected, your provider may recommend a diagnostic test.

Chorionic villus sampling (CVS)

This test takes a small sample of cells from the placenta. It can be performed as early as 10 weeks of pregnancy.

Amniocentesis

This test takes a small sample of amniotic fluid, which surrounds the baby in the uterus. It’s usually performed starting at 15 weeks and can be done later in pregnancy if needed.

CVS and amniocentesis are diagnostic tests. Unlike screenings, they can confirm or rule out genetic conditions with a high degree of accuracy. The samples collected may be tested in different ways, such as:

• Karyotype: looks at the number and structure of chromosomes
• Microarray: checks for small duplications, deletions, or rearrangements in DNA
• Sequencing: analyzes the DNA in more detail to look for specific changes

Emotional and medical support

Genetic testing results can be complex and sometimes emotionally challenging. Talk with your provider to understand what the results mean for you and your family planning.

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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People with ovaries are born with all the eggs they’ll ever have. Each month, a group of eggs becomes available inside small fluid-filled sacs called follicles. The brain releases a hormone called follicle-stimulating hormone (FSH), which helps one follicle grow that month.

Everyone starts with a different number of eggs, and that number decreases at different rates over time. Genetics, age, medical conditions, and environmental factors all play a role.

Having fewer eggs doesn’t necessarily affect natural fertility if someone is ovulating each month. Ovarian reserve (egg quantity) matters more when fertility treatment is needed or when someone wants to preserve fertility. That’s because treatment can be more efficient when there are more eggs available to stimulate and retrieve.

The most common ovarian reserve tests are:

• Day 3 FSH
• Anti-Müllerian hormone
• Basal antral follicle count by ultrasound

In the past, another test called the clomiphene citrate challenge test (CCCT), or the Clomid challenge test, was also used. This test looks at how the ovaries and brain respond to stimulation. At one time, it was thought to help predict how the ovaries would respond during fertility treatment. But studies have shown that the CCCT is not very accurate. It does not reliably predict treatment response or outcomes. Some insurance plans may require that you take the CCCT before they approve coverage.

How hormone feedback works

The ovaries and brain (specifically, the pituitary gland) communicate through hormones using a system called negative feedback.

At the end of a menstrual cycle, after ovulation, the ovaries stop releasing estrogen and progesterone. That signals the brain to release FSH to start a new cycle. As a follicle grows, it releases estrogen. The rising estrogen level tells the brain to slow down FSH release. This process helps the body choose one dominant follicle to grow and release an egg.

How Clomid works

Clomiphene citrate (Clomid) changes the way the brain responds to estrogen. Normally, estrogen provides negative feedback, telling the brain to lower FSH levels. Clomid binds to the same receptors in the brain as estrogen but does not send that “slow down” signal. The brain doesn’t realize estrogen levels are high and keeps releasing FSH.

This boost in FSH helps follicles grow. In fertility treatment, that can encourage one or more follicles to mature and increase the chances of ovulation.

How the Clomid challenge test works

The CCCT uses this process to test ovarian reserve. People with lower ovarian reserve have fewer follicles and lower levels of certain hormones, such as inhibin. Inhibin normally helps limit FSH release. Without enough inhibin, Clomid can cause an exaggerated rise in FSH that does not come back down quickly.

Here’s how the test is done:

• FSH is measured on day 3 of your menstrual cycle.
• Clomid is taken from days 5 through 9.
• FSH is measured again on day 10.

Most people with normal ovarian reserve have FSH levels that rise and then fall by day 10. If levels stay high, that may be a sign of lower ovarian reserve and a reduced response to stimulation during treatment.

Key takeaways

The CCCT can provide some information about ovarian reserve, but it is less reliable than other tests. It does not predict someone’s ability to get pregnant naturally. Instead, it offers insight into how the ovaries might respond during stimulation.

It’s also important to remember that egg quantity is not the same as egg quality. Both decline with age, but not always at the same rate.

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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What are laparoscopy and hysteroscopy?

Laparoscopy and hysteroscopy are two types of minimally invasive surgery. They use a small camera to look inside the body to find and treat issues that may affect fertility.

In a laparoscopy, a surgeon makes a few small incisions in the abdomen — often near the belly button — and inserts a camera. This allows them to see the uterus, fallopian tubes, and ovaries. Sometimes the surgeon may use a robotic system to assist.

In a hysteroscopy, a camera is placed through the vagina and cervix to look inside the uterus. This procedure doesn’t require any cuts.

Both are done in an operating room while you’re under anesthesia. Your type of anesthesia will depend on the procedure. You may need to stop eating and drinking before surgery. These are outpatient procedures, which means you can usually go home the same day. Most people recover quickly and return to normal activities within a day or two.

These procedures usually have low risks. A member of your fertility care team will explain the risks and potential benefits before scheduling one.

Why are these procedures done?

Laparoscopy and hysteroscopy are not usually the first step in fertility treatment. Many people will not need surgery to get pregnant. But in certain cases, these procedures can help diagnose or treat conditions that may affect your chances of conceiving.

These surgeries may be used to treat or look for:

· Blocked or damaged fallopian tubes

· Uterine fibroids

· Uterine polyps

· Uterine abnormalities, such as a septum

· Endometriosis

· Ovarian cysts

· Scar tissue inside or outside the uterus

Even if you don’t have one of these conditions, your reproductive endocrinologist (REI) may recommend surgery to get a better view of your anatomy, especially if other treatments haven’t worked.

When can surgery help fertility?

Surgery may improve your chances of getting pregnant in some situations. Your REI will consider your specific case and help you decide if surgery makes sense.

There are some conditions where surgery has shown to help with pregnancy or lower the risk of miscarriage:

Hydrosalpinx

This is when a fallopian tube fills with fluid and becomes swollen. The fluid can leak into the uterus and prevent pregnancy. Removing or draining the tube can improve success rates, even if only one tube is affected. This is usually diagnosed through a special type of X-ray called a hysterosalpingogram or an ultrasound.

Fibroids inside or near the uterine cavity

Fibroids are noncancerous growths in the uterus. If they grow where a pregnancy would implant, they can reduce your chances of getting pregnant. They are found using ultrasound or a saline sonogram. Surgery to remove these fibroids may help.

Polyps

These are noncancerous growths in the lining of the uterus. They take up space where an embryo would implant, so removing them may improve fertility. The need for surgery depends on their size and location. Polyps can be seen on ultrasound or saline sonogram.

Uterine septum

A septum is a band of tissue inside the uterus that you’re born with that can sometimes lead to pregnancy loss. Removing the septum may reduce that risk. It can be diagnosed with imaging or a pelvic exam if it extends through the cervix into the vagina.

Endometriosis

This condition happens when tissue that normally lines the uterus grows outside of it, and it can cause pain and may affect fertility. Surgery is often done to reduce pain, but in some cases it may also improve pregnancy rates. Whether to operate depends on your symptoms and goals.

Most people don’t need surgery

Most people going through fertility treatment will not need surgery. Many go on to have a healthy pregnancy without it. If your REI thinks laparoscopy or hysteroscopy may help, they’ll share the details and help you decide what’s right for you.

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

The post How laparoscopy and hysteroscopy may help you get pregnant appeared first on Progyny.

What are androgens?

Androgens are often called “male” hormones, but they play an important role in the health of everyone. Common androgen hormones include testosterone, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S).

• Androgens are produced by the ovaries and adrenal glands (the glands that sit on top of the kidneys). The ovary makes testosterone and DHEA, which are converted to estrogen as it grows a follicle each month prior to ovulation.
• Androgens also play a role in sperm production, facial hair growth, libido, and bone health.
• There are conditions where people can make too few or too many androgen hormones, which can have important impacts on reproductive health.

How do androgen levels affect reproduction?

Low levels

• Testosterone is needed for proper development of the male reproductive tract when a fetus is growing. If there isn’t enough testosterone, or it doesn’t work properly, a child may be born without typical male structures. This may not be discovered until later in life.
• Testosterone is also essential to helping sperm mature. Low testosterone levels may affect sperm production, which can be seen in a semen analysis.

High levels

• Too much testosterone while a fetus is growing can also affect the appearance and function of the female genitalia after birth.
• High androgen levels later in life can stop eggs from maturing. This can cause irregular periods, unpredictable ovulation, or bleeding. The most common cause is polycystic ovarian syndrome (PCOS), but other conditions should also be checked.

What are the signs of high androgen levels?

The most common signs of high androgens:

• Excessive hair growth on the body
• Irregular periods
• A receding or thinning hair line (also known as male-pattern balding)
• Acne

Talk to your gynecologist or reproductive endocrinologist and infertility specialist if you have these symptoms. They’ll perform a history and physical exam and let you know if they recommend testing your androgen levels.

What androgen levels are tested in blood work?

The majority of testosterone is bound to proteins in the blood. Only free testosterone is active and responsible for the symptoms associated with high androgen levels, but free testosterone can be difficult to test. Because of this, it is most common for your doctor to test the total testosterone level.

Sometimes it’s helpful to test other hormones that can lead to high androgen levels. It is important to know that some hormone levels can be affected by age, medications, where someone is in their menstrual cycle, and the timing of blood draw. The results don’t always provide a specific diagnosis but using the clinical symptoms and lab results can help piece together what’s going on.

The most commonly tested androgens and precursor hormones include:

• Total testosterone
• Free testosterone
• Androstenedione
• DHEA-S
• 17-hydroxy-progesterone
• Progesterone

Depending on your symptoms and results, there may be other tests that are performed as well. Your doctor will interpret the results and review them with you.

Diagnosis and treatment

PCOS is the most common diagnosis for those with high androgen levels. For patients with PCOS who are overweight, many will have successful return of regular menstrual cycles when they lose a relatively small amount weight. Plus, improving the management of metabolic conditions, like diabetes and high cholesterol.

High androgen levels can also be caused by certain medications and other conditions, such as:

• Congenital adrenal hyperplasia
• Androgen-secreting tumors (rare)
• Cushing’s syndrome

You may need specific treatment for these conditions.

It’s also important to remember that even if you are not trying to get pregnant, there are other health consequences associated with conditions that have high androgen levels that need to be managed. Irregular periods should always be discussed with your doctor to understand your risks.

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

The post Androgen testing and estrogen: How hormones affect fertility appeared first on Progyny.