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I am planning to get a copper IUD in about a month. I am wondering if having this non-hormonal IUD will skew the results of any fertility tests I take once it is in place, and if so, whether I should get my fertility tested before I get the IUD? I also wonder how stress levels affect the results of fertility testing? I’ve been under a lot stress and am wondering how long I should wait after things settle down, before taking the fertility test?

Written by our medical expert Dr. Stephen Hudson, Director of the Victoria Fertility Centre in British Columbia, Canada.

In order to answer your question appropriately I would really require more details. Specifically I would need to know whether or not you have tried to conceive before, how heavy, uncomfortable, and regular your menstrual periods are, and whether or not you have any history of pain, previous pelvic infections, or surgery.

I will try and help you by discussing some of the testing which is done to evaluate women with infertility or alternatively just to get an idea of what their fertility may be, with the understanding that we can never guarantee what will happen until someone tries to conceive.

I am going to assume from your question that you may be interested in exploring your egg reserve (medically this is referred to as ovarian reserve).

All women are born with a finite number of eggs. Although women only release 1 egg per month (this is ovulation) thousands actually die during the process. The average female is born with about 2 million eggs, and by the time she reaches her teens there are about 300,000 eggs left, and by age 37, the average woman has somewhere around 25,000 to 50,000 eggs. Unfortunately some women start running out of eggs earlier than others – and this impacts their fertility. As the number of eggs declines, so does the percentage of good quality eggs. This is why older women have more trouble conceiving and have higher miscarriage rates.

We can assess ovarian reserve in a number of ways.

  1. Ultrasound to measure the antral follicle count.
  2. Blood tests done on cycle day 3 to measure FSH (follicle stimulating hormone), LH (luteinizing hormone) and estradiol.
  3. Another and more accurate way to check ovarian reserve is by measuring the anti-mullerian hormone level (AMH). This can be done at any time during the cycle and is regarded as most accurate.

Neither the FSH nor the anti-müllerian hormone level will be affected by wearing a non hormone releasing IUD such as a copper IUD. An IUD will not affect your ovarian reserve.

As far as stress is concerned, severe stress can stop a woman’s periods (this is called amenorrhea) and may affect her FSH and estradiol levels, but will usually not affect her AMH levels. Although you are under stress, if your periods remain regular, these fertility related tests are unlikely to be affected. The other hormones which are important in reproduction are prolactin and thyroid function. Prolactin can be affected by stress.

If you do have a history of infertility then the other test we always like to do is to check your fallopian tubes by doing a hysterosalpingogram. It is best not to have an IUD in place when doing this test.

I would suggest that you speak with your OB/GYN or fertility specialist before going ahead and having the IUD inserted. Specifically the things that need to be considered are your age, whether or not you have had difficulty conceiving before, how heavy or painful your periods are, and what other alternatives there are for effective contraception. It might turn out that a copper IUD is just fine for you, but these are the questions I think you should ask.

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