To estimate the rate of potentially successful pregnancy and if there are any hormonal imbalanaces that causes infertility.
3 indexs of ovarian function:

1. Prolactin (PRL)

   Secreted by pituitary gland, PRL is considering as antagonist of hormone regarding the growth of follicles. Therefore, higher PRL level would inhibit the ovulation, and leads to infertility.

2. Thyroid-stimulating hormone (TSH)

   Secreted by anterior pituitary, higher TSH is usually associated with hypothyroidism. Since the structure of TSH is similar to ovulation related hormone such as LH and FSH, higher TSH would also affect the function of ovarian.

3. Testosterone

   Excessive androgenic hormone due to PCOS or congenital adrenal hyperplasia would lead to female infertility.

The number of oocytes of a female is fixed after birth. There are about a million of primary oocytes on both sides of the ovaries. As getting older, the number of oocytes would decrease gradually. By taking a blood draw, ovarian reserve examination allows us to realize the ovarian function, which also can be interpreted as a reference for the following treatment.

2 Major Index of Ovarian Reserve：

1. Anti-Mullerian hormone (AMH)

   AMH, secreted by follicles, is the most important index of the ovarian function. AMH level would be lower as the number of follicles decline.

   AMH (ng/ml)	<0.8	0.8-3	>3
   Ovarian Reserve	Hugely Declined	Declined	Adequate
   Number of Oocytes of each IVF cycle	<2	2-8	>8

   The correlation between AMH and age：

   Age		25↓	35y	38y	40y	43↑
   AMH	International Facilities	>6	4	3	2	1
   	Stork Fertility Center	>6	2.2	1.3	0.9	0.7

    
2. Follicle Stimulating Hormone (FSH)

   FSH is one of the hormone that stimulate the maturation of follicles. Secreted by pituitary gland, FSH is also an ovarian reserve index. To rule out the fluctuation, FSH is suggested to test on day 1-3 of the period and repeated for 2-3 times. When FSH>10 mIU/mL, the ovarian function is considered as hugely decline. (Note：For patients who have done the ovarian surgery or endometriosis, FSH would not be able to represent the ovarian function)/p>

   FSH mIU/ml	<8	8~10	10~12	12~25	>25
   Ovarian Reserve	Abundant	Slightly	Decline	Hugely decline	Nearly menopause
   Number of Oocytes of each IVF cycle	>10	10±2	<8	<5	0~1

AFC is examined on day 1-3 of the period by ultrasound.

Fallopian tube is the spot where the sperm meet the oocyte. Therefore, the patency of the fallopian tubes is important for the following treatment. Intrauterine Insemination(IUI) and Timed Sexual Intercourse(TSI) are both applicable if the fallopian tubes are patent. However, if there are obstruction or hydrosalpinx in the fallopian tubes, the chances of ectopic pregnancy would increase. Also, the embedding of the embryo would be affected because the inflammatory fluid may flow into the uterus. The best solution of patients with blocked fallopian tubes is to undergo a Salpingectomy and IVF.

HSG is an X-Ray test to examine the condition of the fallopian tubes and uterus to determine if there are any blocked tubes, abnormal uterine structures or growths. It’s recognized as a simple, convenient and with 80%-90% accuracy.

HSG must be conducted after menstrual period and before ovulation. If cycle is regular (28 days), it is best to conduct the HSG on the 7th -11th day of the cycle. If doing the HSG after day 11 is inevitable, contraception measures must be fulfilled throughout the cycle in case of pregnancy.

The test is usually done in 5-10 minutes, and the doctor will explain the result on the same day.