Author Name: Dr. Ganeswar Barik || Mentor Name: Dr. Shubhdeep Bhattacharya on April 10, 2020

Diagnosis of female infertility

For diagnosis of female infertility following things comes to mind of infertility specialist like is female partner ovulating, is her ovary has sufficient eggs , is her fallopian tubes are normal, is her uterus is normal, is her hormones are normal. History and physical examination of female partner with emphasis on secondary sexual characters and thyroid swelling will guide what tests are to be done for diagnosis of female infertility .

1. Tests to assess ovulatory function:

If any women is menstruating every month then it indicates that she is ovulating. Apart from this following tests are to find out if women is ovulating or not .

A- Commercially available urinary luteinizing hormone (LH) kit- it detects ovulation by identifying mid cycle surge of LH hormone. LH kit helps in determining fertile period and it may be useful for couples not staying together.

B- Basal body temperature measurement method(BBT)- in this method serial basal body temperature measurement provides idea of ovulation.female partner have to record temperature daily to predict ovulation and impove chance of pregnancy during this period.

C- Ultrasound- it helps in confirmation of ovulation. Detection of corpus luteum in ovary confirms ovulation. But this method is time consuming and costly.

D- Mid Luteal serum progesterone – it is done between day 21 – 28 of menstrual cycle
and serum progesterone value more than 3ng/ml suggest ovulation .

E- less common tests of ovulation are endometrial biopsy and histological dating.

2. Tests for ovarian reserve assessment:

A- Antral follicle count(AFC)- it is done on day 2 of menstrual cycle by transvaginal ultrasound..AFC is calculated by counting follicles of size 2-10mm in both the ovaries..AFC is a direct marker of ovarian reserve and most commonly used test for diagnosis of female infertility

B- Anti- Mullerain hormone(AMH) –AMH is second most common test done for female infertility.AMH is a glycoprotein secreted from ovary…one benefit of AMH test is that it can be done at any days of menstrual cycle..

C- Less commonly done test for ovarian reserve are , Day 3 serum FSH and E2 level, serum inhibit B level, clomiphene citrate challenge test.

3. Tests for tubal patency:

A- Hysterosalpingography (HSG)-
It is first line test to evaluate status of fallopian tubes in female… HSG is a radiographic evaluation of fallopian tubes by injecting radiocontrast dye into uterus via cervix. It is done between 7 – 12 days of menstrual period…it can diagnose many fallopian problems like tubal block, fluid in tubes (hydrosalpinx) and it can detect few uterine pathology also.

B- Hysterosalpingo- contrast sonography (HyCoSy)- in HyCoSy contrast media is injected to uterus via cervix and tubal status is assessed using ultrasound unlike xray in HSG..

C- Sonohyterography- this is similar to Hycosy but instead of contrast media normal saline is used to assess tubal status.

4. Tests for uterus:

A- Ultrasound- this is most common method used for diagnosis of uterine pathology in female infertility …ultrasound can be trans abdominal or transvaginal and later is more preferable for infertility work up. Ultrasound usually detects normal and abnormal uterine morphology and endometrium thickness..Uterine causes of infertility like fibroid uterus, polyp, adenomyosis are diagnosed by ultrasound…In recent time 3D ultrasound is used for diagnosis of Mullerain anomalies like septate uterus and unicornuate uterus.

B- Hysteroscopy- for evaluation of uterine cavity hysteroscopy is gold standard. Hysteroscopy is done under anesthesia and a small diameter scope is introduced via cervix to evaluate uterine pathology. All Hysteroscopic procedures are done as day care basis.

C-MRI- MRI is less commonly used for diagnosis of female infertility..MRI is gold standard for diagnosis of adenomyosis in female and mapping of fibroids.

D-Laparoscopy – it is a invasive method used for diagnosis of female infertility.Laparoscopy can identify both tubal and uterine pathology .By Laparoscopy we can diagnose and treat conditions like fibroid uterus, tubal patency, hydrosalpinx, adenomyosis , endometriosis and ovarian cysts.

5. Hormonal evaluation of female infertility:

A- Thyroid profile – thyroid disorders are most common causes of infertility and abortion. So every female partner should have investigated for thyroid disorders and proper treatment should have started before starting advanced infertility treatment.

B- Serum prolactin level- hyperprolactinemia is cause of infertility and menstrual irregularity in female patients. Measurement of serum prolactin level should be done in female patients.

C- Other less common hormonal test done are serum testosterone level, serum 17 hydroxyprogesterone level to rule out adrenal pathology.

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