HISTORY & PHYSICAL EXAMINATION
On the first visit to the clinic, a detailed history and examination of both male and female partners is carried out and on the basis of this, the most appropriate clinical procedure and essential tests are planned. Any queries regarding the treatment options are solved. A friendly patient doctor relationship is very essential for a proper result.
MALE PARTNER EVALUATION (SEMEN ANALYSIS)
Semen is produced by masturbation directly into the sterile container after 2-3 days of abstinence from intercourse. Normal semen analysis will show.
- Volume > 2 ml
- Count > 20 million sperms / ml
- Motility > 50% within 1 hour of production.
- An abnormal morphology rate of less than 30% (Normal criteria) less than 14% (Kruger’s criteria)
FEMALE PARTNER EVALUATION
General Health Test
- Complete hematogram
- Blood Sugar estimation
- Day 2 or 3 hormone analysis (FSH, LH, TSH, E, Prolactin & Thyroid hormone levels)
- Day 21 progesterone assays
In cases where surgical procedure is contemplated, further tests need to be done
- Screening for HIV-I and II antibody
- Screening for Hepatitis-B surface antigen
- VDRL test
- Anti HCI antibody
- Test for associated medical problem
The embryo is formed by the fertilization of the egg with the sperm, egg is made in the ovaries of the female, while the sperm is produced in the tests of the male. For eggs and sperms to be healthy, It is important that the reproductive system is healthy and functioning normally.
Test for Uterine Factors :
Vaginal Ultra Sonography – An ultrasound of lower abdomen is carried out to check the ovaries, uterus & pelvic.
Ultrasound During Mensturation
Best time to perform: a baseline ultrasound is during the 2nd or 3rd day of starting mensturation. Abdominal ultrasound requires to have a full urinary bladder whereas transvaginal ultrasound can be performed on a empty bladder to evaluate the following
Uterine lining (normal 2-4 mm)
Uterus (Fibroids, adencmyosis)
Fallopian Tubes (Hydrosalpinix/Water filled Tubes)
Mid cycle ultrasound : It is done to assess the following
1) Follder monitoring to see the development of dominant follicle (18-mm or above) indicating impending ovulation
2) Uterine polyyos and uterine lining (Any lining below 7mm would require further evaluation
Endometrial Factors :
Hysteroscopy : This is used to view the inside of the uterus by means of a telescope called Hysteroscope. Problems like adhesions inside the uterus, septum in the cavity, fibroid, polyps can be managed by operative hysteroscopy to increase fertility.
- Post coital test : PCT is carried out after 12-18 hours of intercourse. A sample of Cervical mucus is examined under the microscope to look for alive/dead sperm.
- Value of more than 10-12 Good
- Between 5-10 Average
- Less than 5 or No Poor
- In case of poor PCT, intrauterine insemination is good option.
- Tubal patency test : If the tubes are blocked the sperms will not meet the eggs. If they are partially blocked fertilization may occurs but the chances of ectopic (tubal) pregnancy increases. The various tests that can tell about the tubal patency are following:
- Hystero- Salpingography (HSG) : This is Contrast X-Ray of the uterus and fallopian tube. A special dye is injected into the uterine cavity through the mouth of uterus and flow of dye is seen through the tubes on X-Ray. This is an OPD procedure and can be done without anaesthesia.
- Sonosalpingography (SSG) : This checks the passage of fluid through the tubes and can be carried out while doing an ultrasound. Saline is injected into the uterus & the presence of fluid in the cul-de-sac confirms the assumption that one or both the tube is open.
- Laparoscopy : This is done under general anaesthesia. A laparoscope is introduced in the lower abdomen and all the pelvic organs are inspected. It requires half day hospital stay and is a gold standard investigation in the workup of the infertile couple. This not only detects the problems like fibroids, cysts in the ovaries, tubal problems like hydrosalpinix, tubercular adhesions and many other but also can correct them at the same time.
Ovarian Factors :
- Dysfunction of the hypothalamus-pituitary- ovarian axis – This disorder is most commonly associated with infertility. Patients with this disorder present with a history of irregular or delayed menstrual cycles that fluctuate from 35 days to five months or can sometimes be associated with prolonged periods of breakthrough bleeding.
- Premature Ovarian Failure (POF)- This term indicates reaching a menopausal stage prematurely. The eggs are depleted from the ovaries at an early age and in such cases the only option to get pregnant is by borrowing egg from other fertile women.
- Hypogonadotrophic hypogonadism- The hormones needed for eggs to grow are deficient and the treatment in such cases is to replace these hormones exogenously to make eggs.