There are several paths to parenthood; determining the right one for you is largely dependent on the cause of your infertility. One of our first steps in creating a detailed, personalized treatment plan for you is a diagnosis of your infertility issues.

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Dr. Nancy Klein from Seattle Reproductive Medicine breaks down the techniques for testing and diagnosing infertility with her patient.

Ovarian Reserve Assessment

Women are born with all the eggs they will ever have. When a woman enters puberty—around age 12—she has approximately 200,000 eggs. No eggs remain by the time she reaches menopause, around age 50. If ovulation were not interrupted—with birth control pills or pregnancy—a woman could expect to ovulate about 500 eggs from puberty to menopause.

The eggs that are not ovulated (from the initial 200,000) all die naturally. Currently, there are no treatments to improve ovarian reserve or restore egg numbers. A woman’s ovarian reserve is primarily determined by genetics, however some external factors accelerate egg loss. These include prior ovarian surgery, some chemotherapy agents, radiation to the pelvis, and smoking cigarettes.

Ovarian Reserve Assessment is commonly performed as part of the infertility evaluation. It consists of four general tests: a blood draw on days 2–4 of your cycle to check for follicle stimulating hormone (FSH) and estradiol (E2); an ultrasound to check your antral follicle count; and a test for antimullerian hormone (AMH).


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Procedures to determine the cause of infertility