To sufficiently asses the woman's ability to become pregnant a thorough examination is neccessary.
Women will be examined on the following times:
- In the beginning of the menstrual cycle
- In the middle of the menstrual cycle
- Approximately 7 days before menstruation is expected
The menstrual cycle is the number of days between the first bleeding and the last day before the next bleeding. Blood tests will be taken along with these examinations.
ULTRASOUND SCAN IN THE BIGGINING OF THE CYCLE
Ultrasound scan is performed before the 6th cycle day when the ovaries are in a resting state and all hormones are produced in low quantities. The scan examines the shape, size and placement of the uterus along with the structure of the mucous membrane and the placement, size and folicle count of the ovaries.
Most women will have their menstruation during the time of the scanning and we know that this can cause a lot of unneccessary inconvinience; however it is a critical part of the examination.
Ultrasound scan in the middle of the cycle
The ripening of the egg cell and the general ovulation will be examined and assesed during the mid-cycle scan. In the time leading up to this scan the LH-level will be measured to map the hormonal changes leading up to the ovulation. This is done at home using an ovulation test.
Ultra sound scan approximately 7 days after ovulation
This scan will examine if the egg has been released. A blood test to determine progesteron levels will also be taken. Sometimes the egg will not have been released this is called LUF syndrome.
Water scan or xray examination of the uterine tubes (HSU/HSG)
It is necessary to asses the opening in the uterine tubes. This is done using a water scan (HSU) or an x-ray examination of the uterine tubes (HSG).
The HSU is conducted by injecting a sterile, local anesthetic in to the uterus and the uterine tubes. The examination is conducted in the clinic. The HSG is done by injecting a radiocontrast agent through the uterus and into the uterine tubes. The examination determines if there is a sufficient opening in the uterine tubes. The HSG is done at a hospital or an x-ray clinic.
The menstrual cycle is the number of days between the first day of one period to the last day before the next period. The menstrual cycle is around 28 days. Some women have a shorter cycle and others have a longer cycle. The cycle begins when hormones from the general brain center are released. These messengers make the brain increase the production of the FSH hormone. The FSH is an acronym for Follicle-Stimulating Hormone. The FSH hormone makes the follicles in the ovaries grow to have a diameter of 2 cm within 12-14 days.
The uterus prepares
In the walls of the follicle estrogen is produced. This ripens the egg in the follicle. Estrogen is released into the blood stream and circulates in the body to make the inner mucous membareane in the uterus grow so it can carry the fertilized egg. Estrogen also affects the production of slime in the cervix.
When the estrogen production is sufficiently high the ovulation hormone, LH, is released. LH makes the ripe follicle stop the estrogen production and initiate the production of progesterone.
This chemical change makes the follicle more frail and causes it to burst 24-36 hours after the LH levels have increased. This is known as ovulation.
As long as the progesterone level in the follicle and blook is sufficiently high no menstruation occurs.
If no pregnancy is begun the progesterone level will decrease about 14 days after ovulation and this will cause menstruation. The inner mucous membrane is detached and is washed out which causes bleeding. Followin the menstruation a new cycle begins.
As described earlier the woman has to go through examinations at different times during the cycle as there can be many factors that causing the missing pregnancy.