When To See A Doctor & Diagnosing Infertility

When to consult ?

Normally, infertility is defined as no pregnancy after 1 year of unprotected regular sexual intercourse. Though the time period may be relaxed to 6 months and 3 months for females above 35 years and 40 years of age, respectively.
You might also want to see a senior specialist for a second opinion or when basic treatments for infertility like Clomiphene, IUI etc are not working.

Whom to consult ?

You and your partner should consult a gynaecologist who is specialising in Infertility and Assisted Reproductive Technology (ART).

What will the infertility specialist do? Your doctor will normally run through the following:

  • A detailed medical history along with following tests for the female partner
  • Ovarian reserve testing with blood tests – to check your capacity to produce enough eggs by measuring – Follicle-stimulating hormone (FSH), estradiol, and anti-Müllerian hormone (AMH)levels
  • A transvaginal ultrasound performed on the second, third, or fourth day of the menstrual cycle to count the number of follicles (egg sacs) in each ovary
  • Hysterosalpingogram (HSG) – an X-Ray to evaluate if the Fallopian tubes are open
  • Hysteroscopy / Laparoscopy / Both – if required, to actually see inside your uterus and abdomen
  • Male Evaluation – A detailed medical history and Semen analysis. And if need be, then certain blood tests to see hormones levels in the male partner.

Diagnosing infertility

involves looking at the reproductive health of both the male and female partner. Testing both partners is an important step as the causes of infertility are evenly divided between men and women.

TESTING THE FEMALE PARTNER

Your doctor can evaluate the female partner with following few the tests:

  • Hormone evaluation
  • Transvaginal and 3D Ultrasound
  • Hysterosalpingography
  • Hysteroscopy – Laparoscopy
  • Hormonal Evaluation

Generally, we will order these tests for day 2, 3, or 4 of your periods.
Testing Hormones Indicate Ovarian Reserve, We will test the following hormones:

  • E2 (estrogen): stimulates the growth of the follicles and the production of fertile mucus from the cervix; also prepares the uterine lining for implantation of a fertilized egg
  • FSH (follicle-stimulating hormone): stimulates the development of the egg
  • AMH (anti-Müllerian hormone): secreted by the small antral follicles found in the ovaries at the start of the cycle indicates the size of the ovarian reserve

Testing Hormones that Control Ovulation and Fertilized Egg Implantation, We will test the following hormones:

  • LH (luteinizing hormone): stimulates the release of the egg from the follicles (ovulation)
  • Progesterone: stabilizes the uterine lining for implantation of a fertilized egg and supports early pregnancy

Testing Additional Hormones that Can Interfere with Ovulation, We will test the following hormones:

  • Androgens: small amounts of androgens—testosterone and DHEAS (dihydroepiandrosterone sulfate)—are normally produced in women. Excess production may interfere with development of the follicles, ovulation, and cervical mucus production.
  • Prolactin: stimulates milk production; blood levels may be higher than normal with certain disorders or if you are taking certain medications
  • Thyroid: an underactive thyroid (hypothyroidism) can result in high prolactin levels
  • Transvaginal and 3D Ultrasound – Sonography of the pelvis to assess the reproductive structures like the uterus, ovaries, follicles and tubes along with scanning for any other abnormalities.
  • Hysterosalpingogram (HSG)

The HSG requires the assistance of a special type of x-ray called a fluoroscopy, or “real time x-ray.”

The actual HSG procedure generally takes approximately 10 minutes. During the procedure, the doctor will place a speculum into your vagina in the same manner as if you were undergoing a Pap smear. He or she will cleanse the cervix with an antiseptic solution before placing a small, flexible catheter approximately 1 inch into the cervical canal, where it rests against the cervix. The clinician will pass a small amount of dye through the catheter, filling the uterine cavity and then filling the Fallopian tubes. The tubes are considered open when the dye “spills” at the ends of the tubes (this is visible on the fluoroscopy). If your tubes are open, they should be able to “pick up” your ovulated egg. This part of the process generally takes less than 1 minute.

TESTING THE MALE PARTNER

A physician can evaluate the male partner’s reproductive system with one simple test:

Semen analysis
Some of the parameters we check for in a semen analysis include:

  • Sperm count (concentration)
  • Volume
  • pH (level of acidity)
  • Motility (movement)
  • Progression (motion and forward progression)
  • Semen viscosity (consistency)
  • Morphology (shape and appearance)
  • The presence or absence of white, red blood cells, or immature sperm

Low testosterone, also called low T, occurs when a man has testosterone levels that are below normal levels. The condition—defined as a combination of sexual symptoms and measured testosterone level—is actually quite rare (affecting only 0.1 percent of men in their 40s, 0.6 percent in their 50s, 3.2 percent in their 60s, and 5.1 percent of men in their 70s, according to the British Medical Journal’s European Male Ageing Study).

BEFORE THE SEMEN ANALYSIS
You should abstain from sex or masturbation for at least 3 days before the analysis, but not longer than 1 week.

DURING THE SEMEN ANALYSIS
In order to perform the semen analysis, your doctor will want you to provide a semen sample. You may collect the sample by masturbation. One of our clinicians will ask you to collect your semen in a sterile specimen cup. Another option is to collect your semen at home by masturbation or during intercourse in a special condom that you can get from your doctor. You must deliver your sample to our office within 60 to 90 minutes of collecting it (please check for specific drop-off office availability). Speak with your doctor about instructions for transporting the sample to the office. In some cases, you will need to repeat testing (e.g., small sample size, abnormal test result). Because test results often vary, you may need to repeat testing more than once.
Semen analysis results are generally available within a few hours. If test results are abnormal, your physician may diagnose one or more of the following conditions:

LOW SPERM COUNT
A low sperm count is fewer than 15 million sperm per milliliter ejaculated. The normal range is between 40 million and 300 million sperm per milliliter of ejaculation. Certain medications or a medical problem such as a blocked duct, a low testosterone level, or a condition in which sperm back up into the bladder may cause a low sperm count. Fever can also reduce sperm count.

LOW MOTILITY
Motility describes the movement of the sperm. Some men may have enough sperm, but their sperm may not swim well enough to reach the egg. Low motility may reduce your chances to conceive, especially if your sperm count is also low. In a normal semen sample, at least 40 percent of the sperm have appropriate movement.

ABNORMAL MORPHOLOGY
A normal sperm has an oval head, slender midsection, and a tail that moves in a wave-like motion. Sperm that do not have this normal shape may not be able to swim effectively or penetrate the egg.

FURTHER TREATMENT
In the event that severe male factor infertility is present, intracytoplasmic sperm injection (ICSI) has made it possible for patients to conceive using their own sperm.
If the analysis is abnormal, your doctor may also want to check for a hormonal imbalance by measuring the following hormone levels as well as checking for genetic defects:

Testosterone: a male hormone that is vital for healthy sperm
Follicle-stimulating hormone (FSH): a male and female hormone; in males, FSH helps maintain sperm production
Luteinizing hormone (LH): a male and female hormone; in males, LH stimulates the production of testosterone
Thyroid-stimulating hormone (TSH): a male and female hormone; in males, TSH helps maintain sperm quality and motility
Prolactin: a male and female hormone; in males, prolactin also helps maintain sperm quality and motility
The male partner will also undergo infectious disease testing, similar to the female partner, in order to check for hepatitis B surface antigens, hepatitis C antibodies, human immunodeficiency virus (HIV), and other infectious diseases.

TREATING INFERTILITY
Once your physician has determined the cause of your infertility, the next step is to determine the best treatment options. This decision is one made in conjunction with your physician that both satisfies the desired outcome and the desires of the couple. Generally we take a stepped-care approach to treatment starting with the least invasive and cost effective options first and move to more advanced options, such as in vitro fertilization (IVF) only when necessary. Common treatment options include:

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