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Antral follicle count

What it is: The antral follicle count (AFC) is a measure of the number of antral (or “resting”) follicles in each ovary. The AFC is performed during a pelvic ultrasound, which usually takes about 5 minutes.

How it helps: Each antral follicle contains an immature egg. Counting them allows us to estimate the number of eggs we might retrieve with ovarian stimulation. The appearance of those follicles and range of sizes also helps us determine the best protocol for you.

Hormone Testing

Hormone tests are simple blood tests that help us understand your ovarian reserve and how hard your body is working to send signals to your ovaries to produce eggs.

Some of the reproductive hormones involved in your menstrual cycle include:

  • Follicle stimulating hormone (FSH) is made in the pituitary, and stimulates follicle and egg development in the ovary.
  • Estradiol is the most common type of estrogen and is tested to see how your ovaries are responding to medication. Estradiol acts at many areas in your body and helps prepare the uterine lining to receive the embryo (along with progesterone).
  • Luteinizing hormone (LH) stimulates ovulation, which is the release of the egg from the follicles.
  • Progesterone is the hormone that prepares the uterus and uterine lining to support a pregnancy.
  • Androgens are typically thought of as male hormones, but they play a role in women as well. In women, androgens are needed in order to produce estrogen, however, excess production can cause problems with ovulation.
  • Thyroid stimulating hormone (TSH) is a measure of thyroid function. When the thyroid is not working well, women can stop ovulating and also suffer miscarriage.
  • Prolactin is commonly known as the hormone that produces breast milk and is important to pregnancy. A high level, however, can interfere with ovulation.

We will check for these as part of our personalized evaluation and treatment plan. The most common hormones we test include:


What it is: A blood test done at any time during your menstrual cycle. Anti-Mullerian Hormone (AMH) is produced by the cells surrounding the follicles. It correlates well with the AFC and also with the number of eggs your body will produce with ovarian stimulation.

How it helps: The AMH level helps us determine your ovarian reserve (how many eggs you can make), and the appropriate dose of your medications. Spring Fertility offers the AMH test on site so we can deliver results in one day, as part of our Same Day 360° Evaluation and Action Plan, a comprehensive fertility consultation for both partners.


What it is: A hormone produced in the brain by the pituitary gland, Follicle Stimulating Hormone (FSH) stimulates development of your antral follicles (hence its name). FSH is determined through a blood test that is performed on the second or third day of your menstrual cycle. We always test the level of another hormone, Estradiol, to tell us if the reading is accurate.

How it helps: The FSH levels at the beginning of a menstrual cycle tell us how hard your body is working to send signals to your ovaries. When levels are high, it suggests that the ovaries are not responding well to the pituitary gland’s signals sent from the brain. This is sometimes called diminished ovarian reserve (although a better description might be “diminished ovarian responsiveness”).

HSG (The Dye Test)

What it is: The Hysterosalpingogram is a low dose x-ray of your pelvis to determine if your fallopian tubes are open. A radio-opaque contrast or “dye” is gently instilled into the uterus so that we can see the outline of your uterine cavity and fallopian tubes. The procedure takes only a few minutes and can be performed onsite at Spring, by our fertility specialists.

How it helps: The HSG tells us if the fallopian tubes are open or blocked. If they are blocked, then we will need to do In vitro fertilization (IVF) in order to bypass the tubes and help the egg and sperm to meet. If they are open, we may be able to try treatments like Intrauterine insemination (IUI).


Semen Analysis

What it is: A test of the sperm in a man’s ejaculate. The semen analysis tells us the concentration of sperm, how many are moving, how fast they are moving forward, and how many have a normal appearance.

How it helps: Just because a man’s ejaculate appears normal does not mean he is fertile. 30–40% of infertility cases are caused by problems with the man’s semen. Fertile men typically have over 20 million swimming (“motile”) sperm per ejaculate. Abnormal semen analysis results may lead us to different types of treatments, either to improve the motile sperm count or to optimize their performance by Intrauterine insemination (IUI) or Intracytoplasmic sperm injection (ICSI).


Pelvic ultrasound

What it is: Also known as a “transvaginal ultrasound”, this test allows us to view the uterus, ovaries, cervix, and fallopian tubes (which we only see if they are swollen with fluid). A small handheld transducer is gently introduced two to three inches into the vaginal canal, using a warmed gel. This typically takes about 5 minutes.

How it helps: This ultrasound may reveal fibroids, polyps, or cysts that can be treated to optimize your fertility.

Saline sonogram

What it is: A pelvic ultrasound is performed while sterile saline is gently instilled through the cervix and into the uterus. The saline neatly outlines the inside lining of the uterus The procedure takes about 10 minutes.

How it helps: Seeing the outline of the uterus allows us to detect any obstacles that could prevent a good embryo from implanting. Sometimes we find small abnormalities, like polyps, fibroids or scars that can be corrected before treatment.


What it is: A minimally invasive procedure in which a thin camera is inserted into the vagina, to examine the cervix and inside of the uterus. For minor cases, patients have the option to be awake and observe the procedure on screen.

How it helps: Hysteroscopy is useful in finding as well as fixing any fibroids, polyps, and/or scars, as we can pass small instruments through the hysteroscope.

Endometrial biopsy

What it is: A soft, thin tube (called a “pipelle”) is inserted through the cervix and takes a small biopsy or scratch of tissue from the lining of the uterus (the endometrium). The tissue is then examined under the microscope for any signs of inflammation or infection.

How it helps: Examining the tiny sample of tissue captured by the endometrial biopsy helps us determine if the uterus is a good environment for an embryo, and to make sure there are not abnormalities like chronic infection that might prevent a good embryo from implanting.

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