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What tests should i expect?
Ideally you should start out with a consultation, fully clothed, to discuss what tests should be done in what order. An initial workup should include a consultation, physical exam, blood work, and an ultrasound.
The physical exam should includes checking your breasts, lymph nodes, and pressing on your abdomen to feel ovaries and uterus. The doctor should also look for visible signs of insulin resistance and PCOS including wasist:hip ratio, dark skin patches, acne and excess facial/body hair. An internal exam should be done to check your cervix for signs of infection and to better feel ovaries. A pap smear will be done if it's been over a year since you had one, and depending how things look, cultures may be taken (treating some possibilities, like ureaplasma, may make sense in ovulatory as it is simple antibiotics and treatment can enhance pregnancy rates. An ultrasound is a good idea -- better fertility clinics have ultrasound equipment and can check in office, but if they don't it is probably a good idea to either look elsewhere or have an ultrasound at another facility. The scan should look for cysts, ovarian enlargement, fibroids, polyps and any abnormalities which may be visble. Sometimes both an abdominal and a transvaginal ultrasound will be done.
Usually the next step is blood work. Many OB/GYNs will do all the tests at once, while REs will do specific levels on different days of the cycle. Generally all overweight women should be screen for PCOS. That bloodwork includes:
Fasting comprehensive biochemical and lipid panel
2-hour GTT with insulin levels (also called IGTT)
LH:FSH ratio
Total testosterone
DHEAS
SHBG
Androstenedione
Prolactin
TSH
Go to the Hormone Levels and Fertility Bloodwork page for more information on the hormone levels, IGTT, lipid profile, etc.
After the hormone levels comes some of the more invasive tests. An endometrial biopsy happens toward the end of you cycle. Some doctors do this in place of, or in addition to, blood progesterone levels. It's done by threading a small catheter through the cervix and up into the uterus to take a sample of the endometrium. It's usually a few days before you get the pathology report back.
Usually the next test is a hysterosalpingogram. Some people call this the dye test. Dye in injected through the cervix while the uterus is being x-rayed -- usually both as a video and as a few stills.
A hysteroscopy is done for some patients -- where a scope is inserted through the cervix to view the inside of the uterus -- but more commonly patients have a laparosopy. This gives a view of the uterus, ovaries and tubes.
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