Infertility Workup (Infertility Testing)

What leads to Infertility?

Infertility can be caused by various factors. In women, irregular ovulation or hormonal imbalances, such as polycystic ovary syndrome (PCOS), can hinder fertility. Structural issues like blocked fallopian tubes or uterine abnormalities can also contribute. Men may experience low sperm count or poor sperm quality, often due to factors like hormonal imbalances, genetic disorders, or lifestyle choices like smoking or excessive alcohol consumption. Other common causes include age, stress, obesity, sexually transmitted infections, and certain medical conditions like endometriosis. Understanding the underlying causes and seeking appropriate medical assistance can help couples overcome infertility challenges and pursue alternative options like fertility treatments.

How to check for infertility?

Exams and infertility tests are part of the first assessment of infertility treatment to try to determine why you and your spouse haven't conceived. Physical examinations, as well as the sexual and medical histories of both spouses, are part of a typical reproductive evaluation. Men have their sperm examined to determine sperm count, motility, and structure. Doctors first observe ovulation in women to determine whether it is taking place. This can be identified and tracked using a stimulate ovulation home test kit, ultrasound examinations of the ovaries, or hormone-detection blood tests. Treatment for Infertility can be feasible if a cause is identified.

(A) Female Fertility Assessment

A thorough history is taken prior to the Physical Examination to –

• Assess the menstrual cycle's bleeding frequency which can assist in determining whether ovulation is taking place or whether there are problems such as ovarian reserve being depleted due to aging or uterine anomalies (uterine fibroids or polyps) being present.
   
• Gather data on prior STIs, painful periods or interactions, and/or a history of abdominal surgery.
   
• Comprehend and gather data about social behaviors such as smoking, alcohol drinking etc.

Various physical examinations are conducted during female infertility testing to check for any potential hormonal issues and analyze the pelvic organs. Below are some of the female infertility tests conducted–

1. Pap Smear - 

A Pap smear may be performed on you to look for abnormal cells around the cervix. This fertility test can find sexually transmitted illnesses as well as other cervix-related issues like cervical cancer. 

2. Urine Test -

Your physician could advise you to do a luteinizing hormone, or LH, urine test at home. Just prior to ovulation, this hormone is present in high concentrations.

3. Blood Test -

Follicle-stimulating hormone level, or FSH, is a hormone that causes your ovaries to prepare an egg for release each month and may be measured in a blood test. 

4. Postcoital Testing -

Postcoital testing is a different test. After you have had intercourse, your doctor will inspect the cervical mucus. 

5. Hysterosalpingogram (HSG) -

It is also known as a "tubogram," and it consists of many X-rays of your uterus and fallopian tubes. Your doctor injects liquid dye through the vagina before taking X-rays. An alternative technique substitutes saline and air for dye and ultrasonography.

6. Hysteroscopy -

A thin, flexible tube with a camera is inserted by your doctor through the cervix and into the uterus. They can observe any issues there and, if necessary, collect tissue samples.

7. Transvaginal Ultrasound -

An ultrasound "wand" is inserted into the vagina and moved toward the pelvic organs by the physician. They will be able to examine pictures of the uterus and ovaries using sound waves to look for any issues. Your doctor may also examine the progesterone levels in your blood. An increase in progesterone indicates ovulation.

8. Biopsy -

Your doctor may also suggest an endometrial biopsy. They extract a sample of tissue from the lining of your uterus during this surgery. 

These tests might not all be necessary for you. Which ones are ideal for your individual condition can be discussed with your doctor. About 85% of couples will have some understanding of the reasons why they are having difficulty conceiving when the testing is completed.

(B) Male Fertility Assessment

The analysis and development of a thorough treatment for infertility for the infertile couple depend heavily on examining the male. A thorough medical history, physical examination, fertility drugs, and basic hormone testing are all part of the male fertility workup. Similar to female fertility assessment, a detailed Medical History is required to –

• Analyse the previous medical history which may include treatments such as surgeries and drug therapies.
   
• Recognize any birth abnormalities or infertility in the family history.
   
• Determine if a person has potentially been exposed to chemicals that might affect fertility, consider their lifestyle and employment history.

A key component of evaluating male infertility is a general physical examination and lab tests such as:

1. Urinalysis - 

To find out if there are any urinary infections present, this test is done.

2. Semen Analysis -

This checks the morphology, motility, and count. A typical count should have at least 20 million sperm per milliliter. Sperm motility, which refers to their capacity for swimming, is often stated as a percentage; around 60% of them should be able to do so. Morphology is the study of sperm morphology or how they look. There are several descriptive systems for morphology evaluation, and for each system, sperm are classified as normal or abnormal based on a set of requirements.

3. Hormonal tests - 

To assess the general hormonal system balance and the precise stage of sperm production, this test measures the levels of testosterone and FSH (follicle-stimulating hormone). Other hormonal tests, such as those for prolactin and serum luteinizing hormone, may be performed if the results of prior tests call for them.

4. Genetic Testing -

It's possible that a hereditary factor contributed to your exceedingly low sperm concentration. The presence of Y chromosomal alterations that might cause male infertility in such circumstances can be determined by a blood test, though. Numerous congenital or hereditary disorders can be diagnosed using genetic testing as well.

5. Ultrasonography -

To determine whether the testicles are blocked, an ultrasound examination of the man's scrotum is performed. This method can also check the existence of varicocele or other irregularities in the reproductive system's supporting structures.

After the diagnostic assessment is complete, a decision is taken regarding the best course of action. This decision may involve surgical correction, medicinal or endocrinologic therapy, or the choice to alter or process the patient's pre-existing sperm to conceive.

If you want to establish a family or grow your existing one, infertility problems present numerous difficulties and can be demoralizing. Your relationships and emotional well-being may be impacted. Hence, it is high time to visit the top fertility doctors if, despite your best attempts, you are not able to conceive.

These fertility experts can discuss and recommend the best treatment plans and choices for therapy. The chances of getting pregnant in most couples increase with certain lifestyle changes and medications. Moreover, there are advanced technologies like ICSI, IVF, and others to make your dream of becoming a parent come true.