What couples need to know about getting pregnant.
What is Infertility?
Approximately 80% to 85% of couples who are trying to become pregnant will successfully conceive within a year. Thus, we commonly define infertility as the inability to achieve a pregnancy within 12 months of unprotected intercourse.
Fertility potential declines significantly as a woman ages, hence couples are encouraged to seek evaluation for infertility after 6 months of no contraception if the woman is older than age 35.
What are typical causes of infertility?
The causes of infertility are wide ranging. They can be equally divided between the male and female partners in a couple.
What Tests Will the couple have to Undergo as Part of a Fertility Evaluation?
Evaluation of Female Partner
1] Assessment of ovulation:
(The growth and release of egg from the ovary)
Tests of ovulation:
· Basal body temperature: Based on progesterone rise after ovulation, reflecting rise in basal body temperature by 0.50C.
· LH surge detection: Identifies mid cycle LH surge which precedes ovulation by 1-2 days. Urine testing kits are available for home use.
· Transvaginal scan: TVS helps monitoring egg growth and confirming rupture
· Serum progesterone: Blood test on day 21 of menses >10ng/mL suggests ovulation
Transvaginal ultrasound allows the physician to assess the appearance of the uterus and the ovaries. During this examination, the physician may discover uterine abnormalities such as fibroids (benign growths of the muscle of the uterus) or uterine polyps (benign growths of the lining of the uterus) also presence of ovarian cysts.
2] Ovarian reserve tests:
Ovarian reserve is a function of number and quality of oocytes. Women with decreased ovarian reserve (DOR) may have regular or scanty menses and response to stimulation is decreased when compared to other woman of the same age.
· Day 2-4 values of FSH >10 IU/L predicts poor response
· Anti-mullerian Hormone : AMH is a simple blood test which tells you about the number of small eggs in the ovary. Serum values of less than 1 ng/ml are associated with poor ovarian response
· Antral follicle count : measured by a transvaginal sonography and defined as total number of small eggs in the ovaries. Less than 3 -4 eggs per ovary is a poor responder.
3] Tubal testing:
Tubal testing can be done by hysterosalpingography which is a X ray of the womb done on day 6 of menses.
Endoscopy, laparoscopy or key hole surgery is the other best technique for checking the tubes alongwith any other problems in the uterus or ovaries.
EVALUATION OF MALE PARTNER:
· Semen Analysis:
Routine testing of the male partner of an infertile couple includes a basic semen analysis evaluating the volume of semen, the concentration of sperm (sperm count), the percentage of moving sperm (sperm motility), and the percentage of normally shaped sperm (sperm morphology). Sometimes there may be a need to do hormone evaluation, genetic tests or a biopsy of the testes if no sperms are there in the semen sample
· Complete hormonal profile: In severely altered semen parameters, hormonal assays like FSH, testosterone, and TSH and prolactin may be done.
What is Laparoscopy?
A laparoscopy or key hole surgery is usually performed under general anaesthesia.
During a laparoscopy, the physician inserts a small fiberoptic telescope into the abdominal cavity through an incision made in the patient’s umbilical area (belly button). Using the laparoscope, a gynecologic surgeon can inspect the uterus, fallopian tubes, and ovaries. During a laparoscopy, the physician typically introduces a blue dye into the uterine cavity while directly visualizing the fallopian tubes. If abnormal ovarian cysts such as endometriomas or fibroids are present, then the physician may remove them during the course of the laparoscopy.
What is Hysteroscopy
A hysteroscopy is a simple surgical procedure that is performed either to diagnose or to treat a problem within the uterine cavity. During hysteroscopy, the physician inserts a small fiber-optic telescope through the cervix and into the uterus. Liquid can be used to distend the uterus and allow the physician to directly visualize the uterine cavity. The physician may also introduce small instruments into the uterus to cut scar tissue or remove polyps or fibroids.
Hysterosalpingogram (HSG). In this a radiopaque fluid is introduced into the uterine cavity under fluoroscopy (X ray), the dye is observed as it fills the uterine cavity and then passes out into the fallopian tubes and ultimately spills out of the ends of the tubes and into the pelvis. The HSG can be used to diagnose polyps and fibroids. This imaging procedure also provides information on the status of the fallopian tubes. However, this is a painful procedure as it is usually done without anaesthesia.
