What should be included in the initial infertility evaluation?

The doctor will ask questions about your past to try to get clues as to the cause of your infertility. These questions will be regarding your medical, surgical, gynecological, and obstetric history, as well as some "lifestyle" questions. A review of fertility-related records from other doctors that you have seen is also important.

Physical exam

A directed physical exam that may include a pelvic ultrasound should be performed. Ultrasound can help us discover abnormalities with the uterus, fallopian tubes and/or ovaries. We can sometimes see evidence of pelvic scarring, such as when an ovary appears to be stuck to the uterus. We can also get some information regarding the woman's potential for adequate ovarian stimulation for infertility treatment cycles by counting antral follicles.

Assessment of ovarian reserve

This is a very important assessment of a woman's remaining egg storage. It is generally done with day 3 FSH and estradiol testing and a vaginal ultrasound assessment of ovarian volume and antral follicle counts

Assessment of adequate ovulation

This can be done in a variety of ways. About 25% of all infertility is caused by an ovulation disorder. One type of ovulation problem, polycystic ovarian syndrome, is usually quite amenable to treatment with medications.

Semen analysis

The semen analysis is a very important test and should be done early in the evaluation process. If a severe sperm defect is discovered, the testing on the female partner might be modified, and therapy can be immediately directed to the sperm problem.

About 25% of all infertility is caused by a sperm defect and 40-50% of infertility cases have a sperm defect as the main cause, or a contributing cause.

Blood tests

Depending on the individual couple's situation, various blood tests on either the female or the male may be needed. Blood tests that might be needed include day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone (T), estradiol (E2), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating hormone (TSH).

If there is a history of recurrent miscarriages (2 or more) a lupus anticoagulant (LAC) and anti-cardiolipin antibody (ACL) are often done, as well as other tests.

Immunological testing has not been proven to have any value in infertility patients without a history of 2 or more miscarriages.

Testing for tubal patency and normalcy of the uterine cavity with a hysterosalpingogram

The hysterosalpingogram, or HSG is done in order to assess the anatomy of the endometrial cavity of the uterus and the fallopian tubes. The HSG is usually scheduled to be done between days 6 and 13 of the cycle - this also depends on the specifics of the woman's normal cycle.

This test is usually performed in the radiology department of a hospital or free standing radiology clinic.

About 25% of all infertility is due to a tubal factor.

Role of Endoscopy:

• Diagnosis & treatment simultaneously.
• No scar / stitches on abdomen & cosmetically superior.
• Short hospital stay & faster recovery.
• Early resumption of daily activity.

Hsteroscopy

• Endoscopic visualization of the uterine cavity.
• Diagnostic & therapeutic for uterine septum, polyps, sub-mucus fibroids,asherman's syndrome, foreign body etc.

Laparoscopy

• It is endoscopic visualization of abdominal cavity through small hole.
• Diagnostic & therapeutic for uterine fibroids, tubal pathologies, ovarian pathologies, PCOD, endometriosis, adhesions, etc.

Salpingoscopy

• Endoscopic visualization of the inner part of the fallopian tube up to the ampullary portion of the tube.
• It shows the functional capacity of the tube so that, we can decide whether to offer IUI & IVF-ET.

Investigations & Diagnosis for Male Partner

• Detailed history (counseling) & examination.
• Routine blood and urine investigations.
• Semen analysis after 4 days of abstinence.
• Hormonal assay: FSH, LH, TSH, Testosterone, Prolactine
• Optional tests : semen culture
• Kruger sperm morphology
• Sonography & Colour Doppler study of scrotum.
• Testicular biopsy.
• Sperm antibodies: Immunobead & MAR test
• Scrotal Doppler to rule out varicocele