What To Expect In An Infertility Workup

1.COMMON TESTS IN INFERTILITY

Sperm Motility

A motility rate of atleast 50% is normal

Sperm Count

A count below 20 millions say indicate decreased fertility

Sperm Shape

Normal sperm has oval shape and long tail enabling them to penetrate the egg.

2. HORMONAL TESTING :

Among the tests which will be advised to the couple seeking treatment will be a set of hormonal tests which would be ideally done by the female on day 2/3 of her periods.These are follicle stimulating hormone ( FSH ), luteinizing hormone (LH), prolactin( PRL ), thyroid stimulating hormone( TSH ), which could give an idea about any hormonal imbalances within the body, which in turn may cause an ovulation, leading to the difficulty to conceive. Besides these there may be other tests which may have to be studied in certain cases.

The male may also require to get these hormone levels done in case his semen report shows some problem of sperm production.

3. FOLLICULAR STUDIES :

Follicular studies has become the cornerstone of all fertility treatment around the world and has made detection for ovulation much easier. The female is called for serial sonography from the eighth day of her periods and the size of the follicle and the thickness of the endometrium (thickness of the uterine lining ) is measured at each session. The sequential study provides the doctor with detailed information about the growth of the eggs and any problems thereof which can be corrected by medicines if necessary. At the appropriate time when the growth of the eggs is adequate, injections may be given to ensure rupture of the eggs .Also it is ensured that sperms are present during this period within the female's genital tract which may improve the chances of fertilization of the eggs and therefore lead to a pregnancy. The couple may be asked to have planned intercourse more frequently during the time of anticipated rupture or an intrauterine insemination may be done if required.

Before the advent of sonography, ovulation was documented by studying the cervical mucus of the female or by keeping a record of basal body temperature and documenting the changes which ovulation brought about in these parameters but nowadays these tests are hardly used. Cervical mucus studies may be done by the doctors to do a “post coital test”.

4. POST COITAL TEST :

This test is usually done around the time of ovulation in the female partner. The couple is asked to report to the clinic within 5 hours of having unprotected vaginal intercourse. The vagina is inspected and a small sample of cervical mucus and vaginal fluid is collected on a slide and inspected under a microscope. If the mucus is favorable, the sample should show a good amount of sperm swimming rapidly in the fluid. Sometimes however if the cervical mucus is hostile to the sperm or if there antisperm antibodies, the mucus may show only dead sperm ,in which case it may be interpreted as a negative PCT report. Such couples may require intrauterine insemination for achieving a pregnancy.

5. DIAGNOSTIC HYSTEROLAPAROSCOPY :

Hysterolaparoscopy is one of the most important tools for investigating the female. It gives us a eye witness picture of the internal genital organs, thereby allowing accurate diagnosis of any anatomical problems, and also allows testing for the continuity within the genital tract.

The procedure basically involves introducing a fiber optic endoscope within the uterine cavity (hysteroscopy) and the abdominal cavity(laparoscopy) and visualizing the structures within. This is done under general anesthesia and takes about 30 min, and requires an indoor stay for half a day, followed by rest at home for 2 days.Hysteroscopy tells us about the lining of the uterus (endometrium), the opening of the tubes in the uterus( ostia), as also about any pathology within the uterus which otherwise is very difficult to detect (septum , polyps , adhesions etc ).Our centre is fully equipped to do any corrective surgery if any of the above mentioned problems are encountered during the scopy , thereby saving the patient time , money and the stress of another surgery subsequently.

A curettage (scraping of the lining of the uterus) done at the end is sent for histopathological testing to the lab for study.
The second part of the procedure involves laparoscopy, wherein a small incision is made below the umbilicus (navel) and the endoscope is introduced into the abdominal cavity. The abdomen is inflated using carbon dioxide to allow proper visualization of the pelvic organs. The uterus, ovaries, fallopian tubes are inspected for any anatomical defects or pathology and then patency of the tubes is checked by pushing methylene blue dye through the vaginal end of the uterus. Tuberculosis and endometriosis is also looked for during the procedure. Various surgical procedures can also be carried out if indicated during the same session if required (adhesiolysis, fibroid removal, ovarian cysts, tubo ovarian masses..).

6. ENDOMETRIOSIS :

This is one of the most painful and most chronic conditions to afflict women. Basically it is believed that the cause of endomtriosis is a partial backflow of menstrual blood through the fallopian tubes into the abdominal cavity.This blood is highly irritant and leads to all the genital and other abdominal organs getting adherent to each other over a periods of time. Also the lining of uterus(endometrium) is deposited outside the uterus and the menstrual blood gets collected as cysts into which further bleeding occurs during each menstrual cycle leading to severe painful menses (dysmenorrheal ) as also fertility problems. Although now many good drugs are available for treating this condition there is no complete cure for this condition except permanent stoppage of menstruation ( natural or induced ).Even fertility treatment for this condition gives very poor results and severe endometriosis usually requires extensive surgical intervention (laparoscopic adhesiolysis ideally ) followed by IVF .Even with these treatments results can be disappointing. It is usually better to go in for aggressive treatment of endometriosis for enhancing fertility treatment results.

7. OVULATION INDUCTION :

Almost invariably, the female partner is given stimulation by means of drugs to enhance ovulation and to increase the number of eggs available for fertilization. The commonest drug used and which remains the gold standard for all infertility treatment worldwide is Clomiphene citrate which is given in dosages varying from 50 – 100 mg , depending on the requirement of that particular patient. Most patients would show follicular growth with this drug. At the appropriate size of the follicle , as measured by sonography, an injection (HCG) may be given to induce rupture of the follicle .
In some cases, besides clomiphene citrate, other drugs may be given additionally, like injections of FSH / LH etc, either to improve the response of the ovaries or to induce superovulation (if needed) .

IVF (in vitro fertilization) is the most common form of ART (Assisted Reproductive Technology). If the fallopian tubes are damaged or the sperm is poor, it is obviously the only acceptable treatment. It is also usually the most effective treatment for most other types of infertility as well. The eggs are fertilized in our laboratory, and the resulting embryos then are placed into the uterus 2 to 5 days later.

This procedure achieves remarkable pregnancies even in women with hopelessly damaged fallopian tubes, seemingly sterile husbands, and even “unexplained” infertility. Problems with the husband’s sperm are never a serious issue, since we can fertilize the eggs with ICSI. In fact, in our program we routinely use ICSI in most cases to guarantee against any risk of failed fertilization. Our IVF pregnancy rate is over 40%% per attempt, regardless of diagnosis, and we accept all of the most difficult cases. 

Extra embryos are frozen and saved for a later, much less expensive future pregnancy. Our very special Vitrification freezing technique essentially assures no damage to viable embryos. The cost for subsequent frozen IVF cycles is one quarter the cost of the original cycle.

How Does IVF Work?