Infertility is lack of conception after one year of trying to conceive in a couple if the woman is younger than 35 years of age, or after 6 months if the woman is older than 35 years of age.
There are 2 main contributors to infertility
- Male factor
- Female factor
The Male factor: The man is the first to be screened for infertility when a couple presents for evaluation. Semen is submitted for seminal fluid analysis to determine factors that affect sperm effectiveness in fertilizing the egg. Other tests include blood tests and testicular ultrasound. The specialist for this field is a Urologist or Reproductive endocrinologist.
The female factor: After the man has been assessed, and there is no concern for male factor causing infertility, the woman undergoes a series of tests. The specialist for female infertility is a gynecologist or reproductive endocrinologist. These tests will be listed below:
- Assessment of ovulation: Tests to determine eggs release are as follows:
- Urine test kits to measure Luteinizing hormone (LH) levels- This is a readily available urine kit to measure urine LH level. A rise in LH levels indicates that ovulation (release of egg) will occur within 12 to 36 hours. Typically women with a 28 day cycle will ovulate on days 13 to 15. Urine testing for LH surge should start 2 days before expected ovulation.
- Blood test for progesterone- A raised progesterone is seen with ovulation. Typically done one week before the anticipated onset of the next menstrual period.
- Basal body Temperature -Progesterone production starts at ovulation and increases body temperature by 0.5 degrees Fahrenheit.
2. Assessment of Ovarian reserve: Ovarian reserve is the number and quality of eggs in a woman’s ovaries. As women age, the ovarian reserve diminishes. Tests for ovarian reserve include the following tests:
- Follicle stimulating hormone (FSH)- This is a blood test. The feedback of estrogen produced by the eggs affects the FSH level. When estrogen is high, FSH is low. When estrogen is high, FSH is low. High levels of FSH indicate a reduced ovarian reserve.
- Anti-Mullerian Hormone (AMH)- This is a blood test. This hormone is produced by the follicles in the ovaries. If this level is low, it means that the eggs are in short supply and reduced ovarian reserve.
- Antral Follicle Count (AFC)-This test is obtained by a Transvaginal ultrasound. The total number of follicles are measured in the first few days of the menstrual cycle, the fewer that 10 antral follicle may indicate a reduced ovarian reserve.
3. Assessment of Tubal patency: Blocked fallopian tubes can stop the sperm from fertilizing the egg.
- Hysterosalpingogram- The test to check for any tubal blockage of called HSG (hysterosalpingogram). This is an x-ray procedure by radiologist, gynecologist or interventional radiologist. Contrast dye is injected through a small tube inserted through the cervical os, x-rays are taken to see if this dye spills out from the fallopian tubes. This test is uncomfortable and can cause cramping.
- Saline hysterosalpingogram- This is similar to the HSG mentioned above, however, for this saline is used and an ultrasound is performed to assess the uterine lining and tubal patency.
4. Assessment of Uterine cavity: Some abnormalities of the uterine lining can create distortion of the uterine lining and affect the implantation of a fertilized egg.
- Hysteroscopy- This is a minimally invasive test where a small catheter is inserted via the cervical os to look at the lining of the uterus for any adhesion, fibroids or polyps. Like the HSG above this can also cause mild to moderate discomfort. This procedure is by a gynecologist or reproductive endocrinologist.
There are many options for infertile couples, these include the use of fertility medications, intrauterine insemination (IUI) or artificial insemination (AI), or in vitro fertilization (IVF). Couples may also consider surrogacy or adoption as a way to bring a child into their lives.
Written by Dr. Onuoha
Disclaimer: This content of this post is for health education and for the purpose of improving health literacy and does not constitute any type of advice.
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