In order to determine the proper course of treatment, we perform a number of diagnostics.
Click on each of the tests below to learn more about how it
is performed and what it determines.
History and Physical Examination
A thorough medical history is taken of both partners to enable to identify the reason
for the infertility. A physical examination is then done based on the history. A
transvaginal ultrasound is usually performed at the time of the initial examination
to evaluate the uterus, tubes, and ovaries. Only through an extensive evaluation
of a patients history and a thorough physical examination can an appropriate and
directed treatment plan be selected and implemented.
A clinical psychologist meets with the couple to help them face and cope with their
stress and anxiety. Psychological problems associated with infertility and problems
arising as a result of the existing medical conditions are dealt with.
The transducer on a transvaginal ultrasound is a long probe that is inserted into
the vagina covered with lubricant and a condom. The ultrasonographer will be able
to see the uterus, ovaries, and sometimes the fallopian tubes. The procedure is
not painful, and many women prefer it to an abdominal ultrasound for which the bladder
must be full.
It is mandatory that the male partner in all infertile couples undergo a formal
semen analysis to assess whether there is adequate sperm number and quality. The
doctor may advise the man who is scheduled for semen analysis to abstain from sex
for two to four days beforehand, but not more than seven days. The semen analysis
should include basic parameters such as sperm number, motility, and morphology (shape).
In a normal ejaculation the total volume of semen is between a half and a whole
teaspoon. As part of the semen analysis, the technician will determine the number
of sperm present in the ejaculate. A normal sperm concentration falls between 20
million/mL and 200 million/mL.
The technician looks at how well the sperm are moving and counts the total percentage
of motile sperm by figuring how many sperm per 100 are moving. At least 50% of any
given sperm population should be moving. Then the sperm movement is qualified. A
well developed sperm can propel itself up a woman's reproductive tract at a rate
of more than 2 inches an hour.
Finally, the shape or morphology of the sperm is determined. Sperm heads should
be oval-shaped without irregularities.
Female Hormone Testing: Tests of specific hormones may provide important clues about
a woman's hormonal function and reproductive system. .
- Thyroid function Test(TFT): Alterations in thyroid hormone levels are associated
with anovulatory cycles leading to lack of ovum production and subsequent infertility.
These hormone variations are treatable and can lead to a successful pregnancy outcome
- Prolactin: Alterations in this hormone level are also associated with failure
to ovulate and hence needs to be treated.
- Follicle Stimulating Hormone (FSH): Perhaps the most important hormonal test
that a woman should undergo is an FSH test if she is above 35 years. Typically performed
on day 3 of the menstrual cycle, this test can provide information about ovarian
reserve and whether hormonal stimulation is likely to improve oocyte yield for fertility
procedures. An abnormal, or high, FSH level can mean that it will be more difficult
for the woman to conceive.
- AMH or Antimullerian Hormone: testing is the new Hormonal test used to access
the ovarian capacity to produce eggs
The patency of the tubes is tested by this modality. A dye is injected into the
uterus through the cervix and an X ray is taken. If the tubes are patent, bilateral
free spill of the dye is seen.