Diagnostic Panels

The diagnostic panels are important information to help the physician to decide which tests to perform according to the clinical symptom of the woman before or during pregnancy. 

Ovarian Reserve Panel

Ovarian Reserve describes the ovary’s capacity to respond to gonadotropin stimulation by producing a sufficient number of good quality eggs capable of generating normal embryos. Inhibin-B serum concentration provides a new measure of ovarian reserve to accompany the measurement of day 3 Follicle Stimulating Hormone (FSH), luteinizing hormone (LH), and Estradiol (E2) concentrations.  Since Inhibin-B is secreted by granulosa cells and controls FSH secretion from the pituitary gland, it is a more direct measurement of assessing follicular function than FSH. Inhibin B serum concentrations drawn on day 3 have also been shown to predict response of ovaries to gonadotropin stimulation in IVF cycles.

Women who had less than 45 pg/ml Inhibin-B on cycle day 3 had a 70% reduction in pregnancy rate than women with day 3 Inhibin concentrations greater than 45pg/ml. Women with antiovarian antibodies are less likely to become pregnant after IVF/ET than women without antiovarian antibodies. The predictive value of a positive antiovarian antibody for poor pregnancy outcome after IVF/ET is 82%.

Tests included:

  • Inhibin-B
  • Antiovarian Antibodies (AOA)
  • FSH
  • LH
  • E2

Premature Ovarian Failure

Premature Ovarian Failure is the cessation of ovarian function prior to 40 years of age. It is associated with autoimmunity in a significant population of women. Autoantibodies frequently associated with premature ovarian failure include Anti -Phosphohpid Antibodies (APA), Anti-Nuclear Antibodies (ANA), Anti-Thyroid Antibodies (ATA), and Anti-Ovarian Antibodies (AOA). To ensure cessation of ovarian function, Inhibin B is added to the panel to aid in the diagnosis of premature ovarian failure.

Panel Tests included:

  • Anti -Phospholipid Antibodies (APA)
  • Anti-Nuclear Antibodies (ANA)
  • Anti-Thyroid Antibodies (ATA)
  • Anti-Ovarian Antibodies (AOA)
  • Inhibin B

Male Factor Infertility Panel

Male factor comprises half or 50% of causes of infertility.  Until recently, diagnosis of male factor infertility include results of a standard semen analysis, namely sperm count, motility and morphology.  Abnormalities in these parameters manifest as clinically as infertility.  Results of more contemporary research indicate that sperm not only contributes to causes of infertility but also to early embryogenesis and pregnancy loss.  Problems with early embryogenesis are the result of defects with the sperm nucleus.  Nuclear contributions to male factor infertility can be measured as percentage of fragmented DNA and high DNA stainability.

Panel Tests included:

  •  Sperm DNA Integrity assay (SDIa)
  •  Standard semen analyses

Endometriosis Panel

Endometriosis is a common gynecologic disease characterized by endometrial tissue outside of the uterus.  It affects approximately 10% of women in the United States and 20% to 40% of women seeking infertility evaluation.  There is increasing evidence that immunologic mechanisms play a role in the pathogenesis and path physiology of endometriosis. The immunologic manifestations in patients with endometriosis are associated with exaggerated B,T and NK cell responses. Alterations in B cell responses  can be measured as elevated serum levels of autoantibodies including antiphospholipid (APA) and antinuclear (ANA)antibodies;  alterations in T cells by the embryotoxicity assay (ETA);  and  NK cell response as elevated Natural Killer cell cytotoxicity assay (NKa).   CA125 has also been used as a marker of endometriosis.

Panel Tests included:

  • Anti-Phospholipid Antibodies (APA)
  • Activated Reproductive Immunophenotype (aRIP)
  • Anti-Nuclear Antibodies (ANA)
  • Embryotoxicity assay (ETA)
  • Natural Killer cell Activity (NKa)
  • CA125

IVF Screening Panel

Women undergoing in vitro fertilization (IVF) for treatment of infertility not due solely to male factor have an increased prevalence of immunologic risk factors. Thus, women with a female factor or unexplained infertility are screened prior to starting an IVF cycle to rule out a treatable cause of potential implantation failure.  Women with endometriosis, pelvic adhesions, unexplained infertility, secondary infertility after a history of recurrent spontaneous miscarriages and family history of autoimmune disease should be screened with a minimum of the routine screening tests. However, depending upon the patient history, immunologic testing should be individualized.  Some patients may require additional testing. Women who have had a cumulative 8 or more embryos transferred or 4 or more blast cysts transferred without successful pregnancy should have evaluation with the Implantation Failure Panel (below).

Panel Tests included:

  • Anti- Phospholipid Antibodies (APA)
  • Anti-Thyroid Antibodies (ATA)
  • NK Activation Assay (NKa)
  • Reproductive Immunophenotype (RIP)

Implantation Failure Panel

Implantation is the pivotal event in achieving pregnancy. Most pregnancy failures occur around the time of implantation. The diagnosis of implantation failure is usually considered if either no obvious cause for a couple’s infertility can be detected or if repeated IVF attempts have failed despite the successful transfer of an adequate number of morphologically normal embryos.  Implantation failure can occur due to problems with embryos or with the endometrium. Endometrial problems can be hormonal or immunologic in nature. Both lend themselves to therapeutic intervention. The Implantation Failure Panel is useful in the diagnosis of immunologic factors contributing to implantation failure.

Panel Tests included:

  • Anti- Phospholipid Antibodies (APA)
  • Anti-Nuclear Antibodies (ANA)
  • Anti-Thyroid Antibodies (ATA)
  • Immunoglobulin Panel
  • Embryotoxicity Assay (ETA)
  • Reproductive Immune-Phenotype (RIP)
  • NK Activation Assay (NKa)

Pregnancy Loss Panel

Recurrent Pregnancy Loss (RPL) has been defined as the loss of two or more first trimester pregnancies or the loss of any second or third trimester pregnancy. While the putative causes of recurrent pregnancy loss have included anatomic abnormalities of the uterus and hormonal insufficiencies, the major causes are chromosomal anomalies and immunologic factors. The Pregnancy Loss Panel helps to identify those patients who have an immunologic factor contributing to the recurrent pregnancy loss.

Panel Tests included:

  • Anti- Phospholipid Antibodies (APA)
  • Anti-Nuclear Antibodies (ANA)
  • Anti-Thyroid Antibodies (ATA)
  • Immunoglobulin Panel
  • Embryotoxicity Assay (ETA)
  • Reproductive Immuno-Phenotype (RIP)
  • NK activation assay (NKa)
  • Lupus Anti-Coagulant (LAC)
  • Activated PTT
  • Prothrombin Time (PT)

Coagulation Panel

Recurrent pregnancy loss may be associated with circulating anticoagulants (lupus-like anticoagulants). The presence of a circulating lupus-like anticoagulant will prolong the activated partial thromboplastin time (APTT). APTT is also sensitive to lowered concentrations of Fletcher and Fitzgerald factors and coagulation Factors I, II, V, VIII, IX, X, XI and XII. The lupus anticoagulant (LAC) test should be performed on plasma specimens with a prolonged APTT to distinguish between a factor deficiency and lupus inhibitor. APTT and Prothrombin time (PT) are also used to monitor the clotting ability of individuals using anticoagulant therapy.

Panel Tests included:

  • Lupus Anti-Coagulant (LAC)
  • Activated PTT
  •  Prothrombin Time (PT)

Early Pregnancy Failure Monitoring

When a patient has a history of previous pregnancy losses, the prognosis for the current pregnancy is most important.  In addition to transvaginal ultrasound examination, current methods for detection of early pregnancy failure include serum βhCG and inhibin-A concentrations.

Panel Tests included:

  • β-hCG
  • Inhibin-A

Pregnancy Monitoring Panel

When a diagnosis of immunologic factor contributing to reproductive failure is made, subsequent pregnancies are monitored to ensure appropriate treatment. Depending on specific immunotherapy, pregnancy monitoring includes Anti-Phospholipid Antibodies (APA) and Reproductive Immuno-Phenotype (RIP) as well as APTT and Platelets, if heparin is being used.

Panel Tests included:

  • Anti- Phospholipid Antibodies (APA)
  • Reproductive Immuno-Phenotype (RIP)
  • APTT (if the patient is on heparin)
  • Platelets (if the patient is on heparin)