Methods confirming ovulation
Basal body temperature reading (BBT)
Biphasic curve with a temperature elevation of at least 0.4°C in the second phase indicates an ovulation. Ovulation occurs in the day of temperature drop but it may vary within a two-day interval, therefore BBT is not an exact method.
Ovulation tests are used on the day, which is calculated as follows: cycle length (-) 17. Ovulation testing must be continued for 5 days. For example, if the cycle is 28 days long, then 28 (-) 17 = 13 (day of the deployment ovulation test).
Endometrial biopsy is carried out in the luteal phase, which is the time after ovulation until the beginning of menstruation. Not more than a 2-day shift between the histological response and menstrual cycle day shows ovulation, > 3-day shift suggests a luteal phase defect.
Serum progesterone level
The serum progesterone level is tested on cycle day 21-23, if a woman has a 28-30-day cycle. Level above ≥ 16-20 nmol/l indicates ovulation.
Ultrasonography in dynamics makes it possible to observe the development of the follicle. The dominating follicle grows 1.5-2 mm per day and shortly before ovulation reaches 20-22 mm. The diameter increase depending on the follicle development precisely correlates with the estradiol concentration in blood.
METHODS OF GAMETE TRANSFER AND EMBRYO IMPLANTATION DISORDER TESTING
Examination of the uterus and fallopian tubes with contrast medium or ExEm foam.
Hystero-salpingo contrast sonography (HyCoSo)
During the procedure, physiological sodium chloride solution is introduced in the uterine cavity and fallopian tube and the ultrasound method visualizes possible abnormalities.
Transvaginal hydrolaparoscopy or fertiloscopy
Fertiloscopy is a relatively new diagnostic method, which combines transvaginal laparoscopy and hysteroscopy. Fertiloscopy is an alternative to laparoscopic tubal pathology diagnostics.
Patients with a history of risk factors (pelvic inflammatory disease, endometriosis, ectopic pregnancy) and high IgG titres (> 8.5) against Chlamydia trachomatis are recommended a diagnostic laparoscopy.
During the laparoscopy, a chromatography (with methylene blue) is used to examine and treat tubal permeability – separating adhesions, salpingolysis, cautery, endometriosis heterotopy, etc.
Laparoscopy is indicated in all cases of unclear infertility and questionable HSG results.
Laparoscopy is recommended during the follicular phase.
LP is considered in patients if ultrasonography shows endometrioma > 4 cm and in patients who do not want an ART.
LP is considered in patients who prepare for an ART, if positive findings in ultrasound. In these cases, removal of the fallopian tubes increases the failure rate of the ART.
This method can detect abnormalities that are not visible in the hysterosalpingography:
During hysteroscopy treatment of uterine pathology can be performed:
Separation of adhesions;
Submucous myoma node removal, etc.;
Endometrial biopsy for histological examination.
The postcoital test (PCT) is used to determine sperm count and motility in the cervical mucus. The method is relatively simple and performed in specialized infertility centres.
The essence of the method – 6 to 8 hours after coitus and no more than 36 hours before ovulation the mucus from the cervical canal is spread on a glass slide, a cover glass is imposed and the preparation is viewed under a microscope. If in the visual field contains 5-10 moving spermatozoa, it is considered normal.