Evaluation of Women
A variety of tests are available for evaluating female infertility- it may not be necessary to have all of these tests.
Medical history — usually at the first consultation with your GP or the specialist may give a clue to the cause of infertility.
A medical history of childhood and pubertal development issues, illnesses and infections, surgeries, medications used, exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals) and any previous fertility or pregnancies may all be important in evaluating cause of infertility.
Menstrual history Amenorrhea (absent menstrual periods) usually signals an absence of ovulation, Oligomenorrhea (irregular menstrual cycles) can be a sign of irregular ovulation.
Physical examination — A physical and pelvic examination may indicate any hormone deficiency or identify abnormalities of the reproductive tract
Blood tests
Hormones are produced by the hypothalamus, the pituitary gland, and the ovaries. These hormones include follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, Thyroid stimulating hormone (TSH)play an important role in fertility.
Ovulation (the release of an egg from an ovary) is essential for fertility. Abnormalities of ovulation can often be determined from a woman's menstrual history or luteal phase (second half) progesterone levels usually performed 18 to 24 days after the first day of a menstrual period depending on menstrual cycle length.
Tests to evaluate the uterus and fallopian tubes — Uterine abnormalities that can contribute to infertility include congenital structural abnormalities, such as a uterine septum, fibroids, polyps, and structural abnormalities that can result from gynecologic procedures (Asherman’s syndrome)
Scarring and obstruction of the fallopian tubes can occur as a result of pelvic inflammatory disease, endometriosis or pelvic adhesions (scar tissue) from abdominal infection or surgery.
There are three ways of testing and the decision to choose one over the other may depend on the medical history .
1.Hysterosalpingogram — Hysterosalpingogram (HSG) is used to help identify structural abnormalities of the uterus and fallopian tubes. It involves inserting a small catheter through the cervix and into the uterus. A liquid dye is injected through the catheter, which fills the uterus and fallopian tubes. An x-ray is taken after the dye is injected, which shows the outline of the uterus and tubes The test is done while the woman is awake and lying on an x-ray table. Most women experience moderate to severe pelvic cramps when the dye is injected, but this usually improves after five to 10 minutes. The test is usually performed five to ten days after the menstrual period (before ovulation has occurred).
2.Pelvic ultrasound and Levovist— In a transvaginal ultrasound, a small ultrasound probe is inserted into the vagina this provides a clearer image of the uterus and ovaries than ultrasound that is performed through the abdomen. It does not require that the patient is sedated or anesthetised, and has few to no risks. It is used to measure the size and shape of the uterus and ovaries, and to determine if there are structural abnormalities (such as fibroids or ovarian cysts).
The tubal patency and uterine cavity can be checked using ultrasound- this procedure is called LEVOVIST. It is done without sedation and between day 5 and 10 of the menstrual cycle .This is a more commonly used procedure as there is advantage of doing ultrasound at the same time and less discomfort than the HSG.
3. Laparoscopy — During laparoscopy, a thin, lighted tube is inserted through a small incision in the abdomen, allowing the doctor to view the uterus, ovaries, and fallopian tubes. Laparoscopy is performed as a day surgery procedure, and requires that the patient receive general anesthesia.
Laparoscopy can detect damage and obstruction of the fallopian tubes, endometriosis, and other abnormalities of the pelvic structures. It is the best test for diagnosis of endometriosis or pelvic adhesions (scarring). Furthermore, endometriosis can be treated during laparoscopy, which can help to improve pregnancy rates in women with infertility who have endometriosis. laparoscopy is not routinely done during an evaluation of infertility.
Genetic tests — Genetic testing may be recommended if there is a suspicion that genetic or chromosomal abnormalities are contributing to infertility. These tests usually require a small blood sample,which is sent to a laboratory for evaluation and often takes 2-4 weeks to get results.
Evaluation of Men
Fertility in men requires normal functioning of the hypothalamus, pituitary gland, and testes. Evaluation usually begins with a medical history, physical examination, and a semen test. Other tests may be needed.
History — medical history of childhood and pubertal growth and development,sexual history, illnesses and infections, surgeries, medications, exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals),Smoking,drugs and any previous fertility (paternity).
Physical examination — A physical examination usually includes measurement of height and weight, assessment of body fat and muscle distribution, inspection of the skin and hair pattern. Special attention is given to features of testosterone deficiency, which may include loss of facial and body hair and decrease in the size of the testis.
Examination of genitalia may not be done till after a Semen analysis if the medical history is nornmal.
Semen analysis - A semen analysis (sperm count) is usually organized. This analysis provides information about the amount of semen, and the number, motility, and shape of sperm.
If the initial semen analysis is abnormal, the clinician will often request an additional sample; this is best done four weeks later.
Blood tests — Blood tests provide information about hormones that play a role in male fertility. If sperm concentration is low or the clinician suspects a hormonal problem, blood tests to measure testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (a pituitary hormone) may be ordered.
Genetic tests — If genetic or chromosomal abnormalities are suspected, specialised blood tests may be needed to check for absent or abnormal regions of the male chromosomes (Y chromosome).or testing for cystic fibrosis.
Although infertility treatments may be able to overcome genetic or chromosomal abnormalities, there is a possibility of transferring the abnormality to a child. In this case, genetic counseling is often recommended to inform a couple about the possibility of parent-to-child transmission and the possible impact of the abnormality.
Other tests —
Ultrasound-If a blockage in the reproductive tract (epididymis or vas deferens) is suspected, a transrectal ultrasound test may be ordered.
If retrograde ejaculation (movement of semen into the bladder) is suspected, a post-ejaculation urine sample is needed.
A testicular biopsy (collection of a small tissue sample) may be recommended in men with low or no sperm on the semen analysis. The biopsy can be done by fine-needle aspiration (inserting a small needle into the testis and withdrawing a sample of tissue) and a local anesthetic is used . An open biopsy is usually done in an operating room with general anesthesia .The biopsy allows to examine the microscopic structure of the testes and determine if sperm are present.
If sperm is found they can be frozen to be used for ART