Services

Our clinics are here to help you build your family.

Whether you are dealing with infertility for the first time or have had fertility treatment and advice elsewhere, we have the expertise to help you. Our highly qualified team will listen, understand your situation and advise the correct tests to provide you with information on all your fertility treatment options.

Find out more about taking the first steps in our centre.

Need to hold on to your fertility for the future?

We can do that for you as well. We have a high quality cryopreservation unit offering all fertility preservation treatments ensuring you have the best chance of a family in the future. Whatever the reason, we can quickly provide advice and treatments for sperm, egg and embryo freezing.

Women will need a range of basic tests to assess your current fertility levels, prepare you for pregnancy and help you choose the most successful fertility treatment. If you have done any of these tests before make sure and provide us with copies of your test results so that we can avoid you repeating tests.

Blood tests

For women starting their journey, these are the basic blood tests to find out why you are not getting pregnant. These blood tests check;

  • your egg levels (AMH),
  • the levels of hormones that control the menstrual cycle (e.g. Prolactin hormone),
  • your general health with a full blood count (CBC)
  • your thyroid gland (TSH)
  • if you are protected against the virus German measles (also known as Rubella).

A detailed fertility ultrasound scan of the pelvis.

This test is essential before any fertility treatment. One of our experienced fertility doctors examines you and assesses your ovaries, looks for PCOS, fibroids, uterine polyps, endometriosis and uterine lining abnormalities, checks for scar tissue and adhesions and rules out other rare abnormalities in the pelvis, womb, tubes and ovaries.

This ultrasound ensures you are choosing the fertility treatment with the greatest chance of being safe and successful. It also can diagnose some preventable causes of miscarriages.

Will I need other tests?

Many women will also need an assessment of the health and status of the fallopian tubes. This is often done by an X-ray of the fallopian tubes – called a hysterosalpingogram (HSG). It can also be done with a procedure called a HyCoSy (or hystero-salpingo contrast sonography).

If you have had treatment elsewhere that was unsuccessful or ended in a pregnancy loss, then we will be likely to need some more specialised tests to assess you situation and give you the highest chance of a live birth in your next pregnancy.

What other tests do you offer for women?

Sometimes you will require other tests to find out more about your fertility issues or causes of pregnancy loss. These more specialised tests include:

  • other blood tests to look for causes of infertility & miscarriage
  • vaginal and cervical swabs to check for infection
  • a saline scan of the pelvis where fluid is passed into the womb to outline the inside cavity and look for abnormal areas that might affect an embryo being able to implant and grow
  • a laparoscopy – where a small camera is passed through a ‘keyhole’ into your abdomen to check for cysts, endometriosis or blockages
  • a hysteroscopy – where a thin telescope is passed through the vagina and cervix and up into the womb to look for issues inside the lining of the womb and near the entrance of the tubes into the womb
  • genetic blood tests to look for causes of miscarriage
  • genetic tests to see if you and your partner carry genetic conditions
  • genetic testing of the uterine lining to look for causes of both miscarriage and failed IVF cycles

What is next after testing?

Once you have done the required fertility tests you will have an appointment with one of experienced fertility doctors. We will go through your results and what we know so far about the causes of your fertility problems. We will also explain all the fertility treatment options you have for becoming parents.

Go to our fertility treatments page.

Find out more about your appointment with the doctor.

Rubella Virus
A blood test will show whether a woman is immune to the virus Rubella. If a woman is not immune she can catch the Rubella virus. Rubella is the German measles virus, and if caught during pregnancy there is a serious risk of the baby being infected and damaged. If the blood test shows that a woman is not immune to the Rubella virus, then the MMR vaccine should be given. This is available in all our clinics and also at health centres throughout Trinidad and Tobago. Once the vaccine has been given it is essential that 28 days is allowed to elapse before pregnancy occurs, because rubella is a live vaccine, which can damage an unborn child.
Ovulation Testing
There are a variety of tests to try and work out if a woman is releasing eggs (ovulating). Unfortunately there is not one test that can tell for sure if ovulation will or has happened.
  • Ultrasound scan of the ovaries. This type of scan is called a follicle-tracking scan because it measures the bubble of fluid called the follicle in which the egg grows. Human eggs are microscopic and cannot be seen with the human eye. If a follicle is seen to be growing in size from one scan to the next, then it is likely to contain an egg. Once this follicle reaches 18-25mm in diameter then it usually will contain a mature egg. A scan in the next 24-48 hours will show that the follicle has ruptured and changed in appearance if ovulation has happened.
  • Urine testing for ovulation hormone (LH). Once a mature egg is ready to ovulate the body usually releases a “surge” or large amount of LH hormone to cause ovulation to occur. This LH hormone can be easily detected in the urine using a commercially available urine ovulation kit.
  • Basal body temperature monitoring. Once ovulation has happened the body temperature rises by 0.5 degrees Farenheit. Often a small dip in temperature is seen just before this rise. Both of these slight temperature changes can be detected with a sensitive thermometer, used to measure your morning resting temperature before you get out of bed (basal body temperature).
  • Progesterone blood test. When ovulation takes place, levels of the hormone progesterone rise. The amount of hormone present can be detected in the blood. This rise can be found on a blood test that is done seven days before your period starts. If you have a 28-day menstrual cycle the test is performed on day 21. If your cycle is longer or shorter the day of the test will be altered. The doctor will calculate which is the correct day for you according to your menstrual cycle.
Most fertility clinics now advise ultrasound scanning or LH urine testing, as they have the advantage of picking up signs before the egg releases, at a time when sexual intercourse is recommended to maximise the chance of pregnancy. Both progesterone blood testing and basal body temperature testing only show signs after ovulation has already happened, at a time when sexual intercourse is less likely to result in a pregnancy. Maximum pregnancy rates are actually seen when sexual intercourse takes place in the 24 hours before the egg releases. This ensures that sperm are ready and waiting for the egg inside the fallopian tube. The sperms are capable of living for several days inside the womb & tubes, however the egg probably lasts 12 hours at most. This is why the most up-to-date advice for timing sexual intercourse is to be sexually active in the 24 hours before ovulation.
Ultrasound Scanning
We provide expert ultrasound practitioners within all our clinics. This test for women is a vital way of assessing your fertility problem and also an essential way of monitoring all treatments in the clinic.

What is ultrasound?

An ultrasound test uses high frequency sound waves to look at various organs and soft tissues within the body. Ultrasound can be used to look at the internal organs within the abdomen (lower tummy area) and pelvis (at the lower end of the spine), to look for fluid within the chest or to look at soft tissues in any part of the body, including the eye and muscles within the limbs. It is also used to look at an unborn baby in the womb. Ultrasound scans are used widely in fertility medicine to evaluate your womb, ovaries and pelvic area. Every fertility treatment will generally require at least one ultrasound scan to monitor your egg production or the growth in the lining of your womb as your body prepares for pregnancy.

How is it done?

Ultrasound is a painless procedure. When looking at the organs in a woman’s pelvis by ultrasound, often the ultrasound probe is placed in the vagina (a trans-vaginal ultrasound scan). The reason for this is that the probe can get closer to the womb and ovaries giving much more information and detail. This is the way most early pregnancy ultrasounds are done. The ultrasound probe transmits and collects the sound waves which make up the ultrasound picture. The doctor will see the picture (which is black and white) at the same time on a TV screen.

Why are ultrasounds done?

Ultrasound is used as part of the investigation into the cause of a your fertility problem, to show if you have any problems that might reduce your chance of a pregnancy or increase the chance of a miscarriage. It can be used to view the body’s internal structures to see if they are structurally normal. It is also used to monitor the growth of egg-containing follicles in the ovary and the increase in thickness of the lining of the womb during fertility treatments such as IUI and IVF. Abnormalities such as fibroids, cysts, swollen tubes, uterine polyps, excess fluid and abnormal growths can be seen using this technique. It is also used to confirm a healthy pregnancy and analyses the development of unborn babies to check for normal growth and any abnormalities.

Benefits and risks

Benefits

Ultrasound is a very safe procedure and does not involve any radiation. It is also easy to perform and is painless.

Risks

There are no serious risks associated with the ultrasound.

Do I have other choices?

There are alternative diagnostic tests that you might have instead. These include:
  • X-rays.
  • CT scans – this method looks at the structures of the body using computer-generated images (computed tomography). It is a painless procedure and the person is conscious, but must lie quite still while they rest inside the scanning device, so that accurate images of the brain can be taken (rather like having a photograph taken). The technique is 100 times more sensitive than conventional radiography.
  • MRI scans – this is a special imaging technique used to see internal parts of the body, particularly the soft tissues. These scans may be used for detecting some cancers and other diseases or for following their progress.
The possible alternative tests depend on the person’s symptoms. Doctors differ in whether or not they perform the procedure – some will use ultrasound first as it is painless and easy to perform. Others will use another diagnostic test – which will depend on the problem.
HyCoSy
This is another type of test to assess if the fallopian tubes are open. Some units offer this rather than HSG. A HyCoSy is similar to a HSG except that ultrasound, instead of X-ray is used to look at the tubes. The contrast medium contains galactose particles and is injected through the cervix as with the HSG. Again you are awake for this procedure.
Laparoscopy and Dye Test
This may be done instead of the HSG. It requires a short-lasting anaesthetic, which means that you will be put to sleep. It is a form of keyhole surgery. A small camera is placed into your abdomen through the belly button, giving a good view inside the pelvis. Any cysts, adhesions or endometriosis can then be identified and treated (if mild or moderate in severity). A dye is injected through the cervix. If the tubes are open the dye is seen passing through the tubes and into the pelvis. If the tubes are blocked, the extent of the blockage may be identified. Other abnormalities of the tubes can also be identified and sometimes treated.
Vaginal and Cervical Swabs
These might be taken to check for infection. These swabs are taken during a speculum examination, which is similar to a smear test. Having the swabs taken should not hurt, and you will probably find it easier than a smear test.
Hysterosalpingogram (HSG)
This is a test to assess whether the fallopian tubes are open or blocked. It also assesses the inside cavity of the womb. During this procedure a radio opaque dye (a dye which can be seen on an X-ray) is injected through the neck of the womb (cervix). The dye will pass up through the womb and if the tubes are open, will pass through the tubes into the pelvis. This will be seen on the X-ray. For this test you will need to visit a specialised x-ray centre. Our staff can advise you on recommended units for this test in Trinidad and Tobago. This procedure is performed while you are awake. It is quite safe but a small number of people may be allergic to the dye. A doctor is present in case of this. Some patients complain of discomfort during the procedure, so it is advisable to take some simple painkillers such as Paracetamol beforehand.
Blood Hormone Testing

(AMH, LH, FSH, Oestradiol & Prolactin)

All the female hormones involved in egg growth and release can be measured. The time of the menstrual cycle is important when measuring FSH, LH and Oestradiol.
  1. AMH (anti-mullerian homone) is the most accurate test to estimate how many eggs a woman has in her ovaries. It can be done at any point in the menstrual cycle and is also not affected by hormone or drug medications.
  2.  FSH, LH and Oestradiol levels are performed between days two and five of your menstrual cycle. This test is an estimate of the number of eggs in the ovary and also the balance between the hormones. It can pick up a variety of medical conditions, such as low FSH and LH (hypogonadotrophic hypogonadism), PCOS and premature ovarian failure. Because the levels of these hormones fluctuate during the menstrual cycle, this test is not very helpful when done after day five of the menstrual cycle.
  3. Prolactin hormone is usually produced in large amounts during breast-feeding. It can become high in other situations and may then cause problems for egg release. It can be measured at any point during the menstrual cycle.
Ruling out medical conditions that can affect fertility
  • Thyroid disease (TSH levels). This screening thyroid test is done to check whether these hormones, which affect the menstrual cycle, are present at normal levels.
  • Diabetes screening. Blood testing to screen for diabetes may be suggested. Women with un-diagnosed diabetes are less likely to get pregnant, and are also at increased risk for miscarriage and abnormal babies.
Pregnancy Test
If you’re not having periods it might be because you are already pregnant. A urine pregnancy test looks for the pregnancy hormone (HCG) and is a very accurate test whether done at home or in a clinic. Pregnancy hormone can also be measured in the blood by a simple blood test (beta HCG) and this gives a more detailed level of the amount of pregnancy hormone that is present. Blood tests are usually done after fertility treatment.
Saline Contrast Scan
This is a specialised vaginal ultrasound scan that gives more detail of the inside lining of the womb (endometrium). It is commonly used to diagnose uterine polyps and fibroids inside the womb. The procedure is performed while you are awake, and is safe and painless. A small volume of saline fluid is injected through the neck of the womb while the ultrasound scan is being done.
Egg Count

What tests can tell me how many eggs I have?

There are a variety of tests that help your doctor work out how many eggs might be left in your ovaries. However there is still not one test that will tell you for certain. The tests currently available are:

  1. AMH blood test (done at anytime in your cycle)
  2. FSH and LH blood test (done in the first three days of your period)
  3. Oestradiol test (done in the first three days of your period)
  4. Inhibin B blood test (done at any time in your cycle)
  5. Ultrasound scan to measure the volume of your ovaries
  6. Ultrasound scan to count the antral follicles in your ovaries

What we do know is that a woman is born with all the eggs she will ever have, and slowly loses them, as she gets older.The number of eggs starts dropping from before birth. When there are no eggs left then the periods stop completely and this is called the menopause. Men are very different and are capable of growing new sperm most of the time.

What is the best test to tell me how many eggs I have?

From research around the world it seems like the AMH blood test is most accurate test to measure the number of eggs left in the ovaries.

AMH levels tell us whether a woman is likely to have more or less eggs than her age alone suggests. It is a good measure of a woman’s fertility potential. The blood AMH levels remain relatively stable (20–25 pmol/L) from 18 to 29 years of age. By 30 years of age, AMH levels start to drop rapidly, reaching an average of only 10 pmol/L by 37 years.

Other blood tests are less accurate at picking up this drop in egg levels, for example the older blood test FSH. Despite the 50% fall in AMH levels between 29 and 37 years of age, minimal changes in FSH levels will be picked up on testing.

What is AMH?

AMH (anti-mullerian hormone or Mullerian inhibiting substance (MIS)) is a hormone produced by special cells that surround the eggs in the ovaries – the granulosa cells.

We introduced AMH into clinical practice in 2010, and have seen very accurate results, with AMH levels consistently predicting women with low egg levels and lower chances of pregnancy – often despite a young age and normal FSH levels. AMH can be done at any point in the menstrual cycle and is also not affected by hormone or drug medications.

How can I get an AMH blood test done?

All new patients are offered an AMH blood test in our fertility clinic. It is a simple blood test that does not require any special preparation (such as fasting or a certain time in your menstrual cycle). The results are available within a week.

For men a semen analysis (sperm test) is always advised.

In fact for a proper assessment at least two sperm tests are essential.

To be accurate sperm testing must be done in a laboratory with specialised equipment, good identification and control of samples and by properly trained andrology laboratory technicians. As many sperm tests are not done to this level of accuracy in or region, we require all patients to do a sperm test in one of our clinic laboratories.  We can rely on these results to help you choose the correct treatment.

What does a sperm test tell you?

A sperm test will tell you:

  • the number of sperm (sperm count)
  • how many sperm are swimming and the type of swimming (sperm motility
  • how normal the sperm look in their structure and shape (sperm morphology)
  • if there are antibodies on the sperm (anti-sperm antibodies)
  • if the sperm are stuck together (sperm agglutination)
  • the semen volume and quality, including how sticky the semen is (viscosity) and how quickly it turns from a jelly to a liquid (semen liquification)

Many people who visit our clinic have very little idea about how sperm make a baby, or options fertility clinics have available to help. This is the reason we offer all patients new to the clinic, a free appointment with one of our expert fertility nurses. It is a great opportunity to find out more about fertility tests and treatments, ask questions about how things work, what you go through, the different costs and how successful treatments might be.

Did you know that a sperm test can be entirely normal and yet the sperm can still be the problem?

We also offer more detailed sperm tests that look at the quality of the sperm. These tests, including sperm DNA fragmentation testing, can reveal previously hidden causes of infertility on the man’s side.

These sperm quality tests will also suggest men where the sperm might cause a miscarriage and men with extremely low chances of having a baby with fertility treatments.

What other tests might I need?

For men with low sperm numbers, we advise a blood test to review the male reproductive hormone levels. It is actually very rare to find a hormonal imbalance in men causing sperm problems, but for a very few men this blood test reveals a treatable condition, like a high oestrogen or prolactin level that might respond to tablets.

More often this blood test will show a high FSH and low testosterone blood level, which diagnoses testicular failure. Men with this problem need fertility treatments like insemination (IUI) and IVF with ICSI (in-vitro fertilisation and sperm injection) to try and get a baby with the sperm they are still able to make. Some of these men do not have much time left, and will soon stop making sperm altogether, so for those with worrying blood test results we recommend sperm freezing.

Genetic tests for men

We also offer a variety of genetic tests for men with very low sperm counts or who have no sperm at all in their ejaculate (azoospermia).

For men whose partner has had recurrent miscarriages, there are some specialised genetic tests. We also offer genetic tests to see if you carry a heritable medical conditions and might risk your baby having a serious medical problem.

What if there are no sperm on my sperm test?

One in every 15 to 20 men doing a sperm test have no sperm. These men need expert testing to diagnose the cause before choosing a treatment. If there is a blockage to sperm release, then a simple procedure will usually find sperm in the testes that we can use to make a baby with IVF and ICSI (Sperm injection). Amazingly, we only need a couple of live sperm these days as sperm injection techniques are so advanced.

If the problem is sperm production, then we have all the treatments that are required. If there are no sperm because of testicular failure, then we have a range of donor sperm options available from our cryostorage donor sperm bank.

Sperm Test

Semen analysis is also called a sperm test.

For this test a sample of semen is required. This is usually produced by masturbation into a sterile pot. Special semen collection condoms (available from the clinic) can also be used for collecting a sample. Normal condoms should not be used as they contain chemicals to kill sperm. Semen is the fluid ejaculated from the penis when a man has an orgasm. It normally contains both fluid (semen) and sperm. The semen needs to be analysed in the laboratory within one hour of production, otherwise the sperm will begin to die. A sperm test will make sure that sperm are present and will provide details on the swimming ability and structure of the sperm. Sperm tests should be done in specialised laboratories that contain trained staff using the correct equipment. We will require you to undertake a sperm test in one of our accredited fertility laboratories, as other laboratories cannot provide a complete and accurate assessment. We use the WHO 2010 guidelines to grade the results of the sperm tests as normal or abnormal. A semen analysis reports on
  • the volume of semen ejaculated. The volume should be between 1.5-6mls. Low volumes are associated with infertility, while high volumes are seen when there are problems with the prostate gland or seminal vesicles.
  • the colour and consistency of the semen. Semen that is very thick (viscous) will often result in lower pregnancy rates. Sometimes many white cells can be seen, suggesting an infection.
  • time to liquefy of the semen. The ejaculated semen is thick, and will turn into a liquid within 10-30 minutes of being produced. If the semen does not liquefy, then the sperm will have difficulty in swimming into the womb.
  • Number of sperm. Both the total number of sperm in the ejaculate, and the concentration of sperm (ie number of sperms per ml of semen) are reported. The lower the numbers of sperm the lower the chance of pregnancy occurring naturally. When no sperm are seen, despite detailed searching, this is called azoospermia. A normal sperm concentration is 20 million sperm/ml of semen or more.
  • the sperm’s ability to swim (motility).  The sperm test result will give you the percentages of sperm that cannot swim, those that can swim around in circles but not move forwards, and those that can move forwards. At least 50% of the sperm should be able to swim in a fast forward direction. When the sperm cannot swim well, fertility rates are low.
  • Morphology or the normal appearing structure and size of sperm is important for healthy sperm to get inside the egg. Specialised miscroscopes are needed to assess this properly. Sperm abnormalities can be seen in the head, mid-piece or tail of the sperm. A large proportion of human sperm are abnormal and a normal result is that 5% or more of the sperm should have normal morphology
  • Sperm antibody testing. This test is performed on sperm to see if they have higher than normal levels of small molecules called antibodies that might block the sperm from being able to get inside an egg.
A blood test to look for genetic causes of sperm problems is also available. This blood test, called a “male reproductive genetic profile” currently reveals a genetic cause for around 5% (1 in 20) men with very low numbers of sperm or absent sperm production. It is believed by researchers around the world that as science discovers more and more about our genetic make-up, a higher proportion of sperm problems will be found to have a genetic cause.
Sperm DNA Fragmentation Test
This test is performed on the sperm to see how damaged the genetic material is inside the sperm. It is recommended by the fertility doctor in certain cases of sperm problems or unexplained infertility.
Sperm Aneuploidy Testing
This test is also performed on the sperm to see if the genetic material inside a large proportion of sperm is not normal. Again it is a test recommended by the fertility doctor in certain rare cases of male infertility or after a couple have a number of miscarriages.