The most common cause of infertility in women is blocked
fallopian tubes (50% of the cases) followed by hormonal
problems (one third of the cases). The most common
cause for male infertility is some problem or the
other with the sperm. After the routine questions
on health, frequency of intercourse, medical history,
menstrual cycle and the like, you and your partner
may be referred to a specialist for special tests
if nothing concrete has been found during the primary
round of tests. To determine the underlying cause
of infertility both the male and the female have to
undergo a number of medical procedures and investigations
to establish the cause(s).
The
Specialist Tests..
Semen Analysis:
A check on the sperm count in terms of volume, number
of sperm; a close examination of the sperm formation,
its activity level, its normality, its shape, a
check on infection, level of white blood cells and
the presence of antibodies that may be attacking
the sperm
Blood Profile:
To measure levels of hormones viz oestrogen, LH,
progesterone and prolactin; insufficient oestrogen
or progesterone or excess testosterone may affect
ovulation frequency or obstruct the proper formation
of the uterus lining required for the fertilized
egg
Hysterosalpingogram (HSG):
This method should be done in the early part of
the menstrual cycle when there is minimum chance
of pregnancy, to prevent harm to the fetus. It is
an uncomfortable procedure but can detect about
70% of tubal blockages. It is an x-ray technique
in which dye is injected into the vagina to pass
through the uterus using a catheter. The fluid's
progress up through the fallopian tubes will be
monitored on an X-ray machine. If it does not, one
or both of the tubes may be blocked. No anesthesia
is required.
Laparoscopy:
A small incision will be made near the navel about
12mm long, then a tube like endoscope will be inserted.
The light from the laparoscope will guide the surgeon
on the overall condition of the ovaries, uterus
and fallopian tubes. The aim of this minor operation
is to detect ovarian cysts, endometriosis and blockages
of the tubes. Dye is passed through the neck of
the uterus into the tubes to detect blockages. Abnormal
growths can also be viewed. Laparoscopy done in
the second half of the menstrual cycle can also
reveal if ovulation has taken place. It's a day
procedure involving the use of general or local
anesthetic.
Hysteroscopy:
A procedure similar to laparoscopy but without the
cut, it uses the hysteroscope to check for adhesions
and other problems. This special endoscope is passed
through the neck of the uterus.
Post-coital Test:
A test to examine the cervical mucus within few
hours of intercourse to check on sperm activity.
It is a good test to check on male's fertility and
female's ovulation.
Ultrasound Scan:
This scan will closely examine the ovaries, check
on the development of the ovarian follicles and
confirm ovulation
Human Zona penetration Test:
Also known as the Acrosome Reaction Test, this test
checks to see if the sperm is able to penetrate
the shell of the egg or zona. The acrosome found
in the head of the sperm contains enzymes that break
down the egg and allow fertilization to happen.
This test primarily checks on the strength of the
sperm. In cases of infertility, none of the sperm
are strong enough to penetrate the zona or there
just isn't enough sperm to allow penetration.
Biopsy:
A tiny sample of the endometrium will be removed
with or without a local anesthetic in the second
half of the menstrual cycle. The sample will be
checked in the lab to see if it thickens enough
after ovulation and for any other changes effected
by the hormone progesterone.
Following these tests, if no medical problems are
found or identified, psychotherapy may be recommended.
Sometimes there is no apparent problem with the
reproductive system of either partner that is causing
the infertility. Unexplained infertility cases will
require some assistance in conception in the form
of treatments. The good news is about 30-40% of
couples go on to conceive within 2 years after specialist
investigations.