Infertility Evaluation

When should I see the doctor?

Though the women under 35 can wait till one year before going for any evaluation, it's a wise idea to see your doctor before trying to conceive as your health can be optimized before conceiving.

This includes pre conceptional Folic acid intake, weight management, reverting to healthy life style etc.

Some health issues also increase the risk of fertility problems. So women with the following issues should speak to their doctors as soon as possible:

  • irregular periods or no menstrual periods
  • very painful periods
  • endometriosis
  • pelvic inflammatory disease
  • more than one miscarriage

What's involved during the first visit?

During the first visit your doctor will take a detailed medical history and give a physical examination. There will be a counseling session with the nurse where an outline of fertile period, the process of conception is given.

The evaluation of the male's medical history includes a discussion of previous pregnancies, developmental problems, surgeries, testicular trauma or infections and environmental exposure.

What are the tests usually done?

The tests usually include

  • Basic blood tests for both the partners
  • Hormonal tests if required
  • HSG - Hysterosalpingogram, for the woman -It's a type of X Ray to see if the Uterine cavity is normal and to check whether the Fallopian tubes are patent.
  • Trans Vaginal Scan (TVS) for the woman - Is an internal pelvic scan to check the pelvic organs including uterus and Ovaries.
  • Semen Analysis for the man - to check the sperm count, motility and normal forms
  • Additional tests / laparoscopy may be advised depending on the information gained by the above tests.
  • Thyroid - an underactive thyroid can result in high prolactin levels interfering with pregnancy.

How are hormone tests interpreted?

Hormonal studies measure the levels of certain hormones produced by your body during each menstrual cycle. Hormones affect every step necessary in achieving pregnancy from stimulating the development of an egg to ovulation and implantation of a fertilized egg in the uterus. If the hormones that affect fertility are not produced in specific amounts at specific times during your cycle, your chances of conceiving a child may be greatly inhibited.

Your physician may run tests to determine the levels of the following hormones that play a role in ovulation and implantation of the egg:

  • Estradiol - stimulates the growth of the follicles and the production of cervical mucus from the cervix, and prepares the uterine lining for implantation of a fertilized egg
  • Follicle stimulating hormone (FSH) - stimulates the development of the egg
  • Luteinizing hormone (LH) - stimulates the release of the egg from the follicles
  • Progesterone - stabilizes the uterine lining for implantation of a fertilized egg and supports early pregnancy The overproduction of the following hormones can negatively affect ovulation:
  • Androgens - normally small amounts of androgens (testosterone) are produced in women; excess production can interfere with development of the follicles, ovulation and cervical mucus production
  • Prolactin - stimulates milk production; prolactin levels may be higher than normal in certain disorders or when certain medications are taken
  • Thyroid - an underactive thyroid can result in high prolactin levels

What is HSG?

A hysterosalpingogram (HSG) is an X-ray of the uterus and fallopian tubes which allows visualization of the inside of the uterus and tubes. The picture will reveal any abnormalities of the uterus as well as tubal problems such as blockage and dilation (hydrosalpinx). If sterilization reversal is planned, the point at which the tubes are blocked can be seen. This helps to plan the reconstructive procedure.

If the tubes are not blocked by scar tissue or adhesions, the dye will flow into the abdominal cavity. This is a good sign but it does not guarantee that the tubes will function normally. It does give a rough estimate of the quality of the tubal structure and the status of the tubal lining. Some cases where the tubes appear to be blocked where they join the uterus, may in fact be normal. Often blockage at this location may be due to spasm of the opening from the uterus into the tube or from accumulated debris and mucus blocking the opening. This can be managed by passing a very thin catheter into the fallopian tube either at the time of hysterosalpingogram or during a hysteroscopic procedure.

A hysterosalpingogram may also indicate endometrial polyps, submucus fibroids, intrauterine adhesions (synechia), uterine and vaginal septa uterine cavity abnormalities, or the after-effect of genital tuberculosis. The hysterosalpingogram may or may not be able to detect pelvic adhesions, mild hydrosalpinx, small polyps, endometriosis, tubal phimosis (clubbing of the fimbria at the end of the tube), or immotility of the tube. Other tests, such as hysteroscopy saline sonohysterography or laparoscopy may be necessary to accurately evaluate your uterus.

Although the purpose of the hysterosalpingogram is not therapeutic, sometimes forcing dye through the tube will dislodge any material which blocks it. A number of women have become pregnant following a hysterosalpingogram without further treatment.

Generally there is no special preparation needed for this test. However, depending upon your diagnosis, you may need to take antibiotics to guard against possible infection. To ensure that you are not pregnant, the study is done between Day 7 and 10 of your cycle. Prior to the procedure you may take an anti-inflammatory medication. A small catheter is placed into the cervix and the dye is injected. You may feel heavy cramping during, and for several hours following this procedure. Expect a sticky vaginal discharge for a few days as the dye is expelled from the uterus. Use a pad or panty liner during this time to allow fluid to escape. Any dye that remains will be absorbed without any ill effect.

NOTE: Be sure to inform the doctor of any allergies you may have to Iodine, Betadine, or Novocaine prior to the procedure.

If cramping does not subside or if you develop severe abdominal pain or fever following this test, please notify or report to Santasa Hassan.

What is Laparoscopy?

Laparoscopy is an innovative surgical procedure performed through very small incisions in the abdomen using pencil-thin instrument called a laparoscope which gives the surgeon an exceptionally clear view of the abdominal cavity on a TV monitor. Know more...

What does semen analysis involve?

When male factor infertility is suspected, the initial test performed is a semen analysis.

  • Sperm count : The normal range for sperm is between 40 and 300 million sperm per milliliter of ejaculate. A low sperm count is fewer than 20 million per milliliter of ejaculate.
  • Motility : Low sperm motility (movement) may reduce the chances of conception, especially when paired with low sperm count. In a normal semen sample, at least half of the sperm have typical movement.
  • Morphology : Sperm that do not have normal morphology (shape) are often unable to swim effectively or penetrate an egg. A normal sperm has an oval head, slender midsection and tail that move in a wave-like motion.

In order for a physician to evaluate the count, motility and morphology of sperm, a semen sample must be provided. The sample is most often collected by masturbation in a private, comfortable room in the fertility center. In some cases, the sample may be collected at home by masturbation or during intercourse with the use of a special condom provided by the physician. In some cases, the test results are not normal due to problems during sample collection and the test must be repeated. Depending on the results of the semen analysis, more tests can be ordered to diagnose specific causes of infertility. If the semen analysis shows clumping or signs of infection, a semen culture, prostate fluid culture and urinalysis may be ordered. An antisperm antibody test may also be ordered to evaluate potential immune system disorders. A fructose test can be used to evaluate structural problem or a blockage of the seminal vesicles.