Diagnostic methods for women:
Detailed gynecological and ultrasound examination of women
It is ideal to perform this before ovulation to assess endometrial pathology. An ultrasound determines the shape of the uterus and uterine cavity, the quality of the endometrium, the position of the ovaries, ovarian reserve, and any pathological changes that may exist. A gynecological examination assesses the condition of the cervix, the position of the uterus, its size, shape, as well as the presence of tumors and inflammatory changes of an acute or chronic nature in the adnexa.
Hormonal analyses
These are done on the third day of the cycle (the first day of menstruation is considered day one): FSH, LH, AMH, estradiol, prolactin, TSH. Depending on the patient's phenotype and the presence of other symptoms, additional hormones may be added.
HyCoSy
Checking the patency of the fallopian tubes, a new method that has almost replaced the earlier HSG. It is performed under ultrasound control, where a thin, painless catheter, similar to that used for embryo transfer, is inserted into the patient who is in a position similar to that for a gynecological examination. A small balloon at the tip of the catheter is inflated to prevent it from falling out, and contrast that is visible on ultrasound is gently injected. The flow of the fallopian tubes is monitored with a transvaginal ultrasound probe to see if the contrast spills around the ovaries and into the abdominal cavity.
Hysteroscopy
This is an endoscopic method performed on an outpatient basis, similar to gastro or colonoscopy in terms of execution—there is equipment used to enter the uterine cavity, allowing visualization of the inside of the uterus, the quality of the endometrium, and the shape of the uterine cavity, whether the ostia of the fallopian tubes are open, and whether there is patency of the fallopian tubes, i.e., the flow of fluid in them and beyond; any diagnosed pathology in the uterus and cervix is removed, providing a complete insight into the condition of the uterus. It is important for patients who have a thin endometrium, repeated IVF failures where implantation did not occur, or where there is a significant hormonal imbalance, especially in those patients who have had interventions in the uterus such as curettage or revision.
Folliculometry
After ovulation, progesterone is secreted from the corpus luteum formed from the ruptured follicle, as a hormone that should support pregnancy, and based on its measurement, ovulation can be established. However, in a certain number of cases, it is necessary to visually monitor whether the follicle ruptures, as there is a condition known as LUF syndrome where everything is hormonally normal, but the follicle does not rupture and the egg cell is not released to enter the fallopian tube, thus preventing fertilization. A serial transvaginal ultrasound examination is performed until it is diagnosed whether the follicle ruptures or not.