Adelay in conception, is an indication, that there is a problem of infertility.
Problems in infertility occur at any time in the process of conception, and these may include
• the development or the release of the egg or sperm,
• in fertilisation or transport of the fertilised egg from the fallopian tube to the uterus,
• in implantation of the embryo in the uterine lining,
• the endometrium ,
• even in the timing of intercourse or
• physical conditions after conception.
In the female, the reproductive system consists of the – vagina, cervix, uterus, fallopian tubes, ovaries, and vulva.
The male genital organs include the testicles, vas deferens, seminal vesicles, prostate gland, and penis.
Hormones produced by the hypothalamus, pituitary, and thyroid glands as well as the ovaries and testes, controlling reproduction and metabolism also play an important role.
The male genital organs include the testicles, vas deferens, seminal vesicles, prostate gland, and penis.
Hormones produced by the hypothalamus, pituitary, and thyroid glands as well as the ovaries and testes, controlling reproduction and metabolism also play an important role.
The source of infertility problem may be in either partner. Age plays an important role especially in women, and also in men.
Endometriosis and the effects of sexually transmitted diseases may be factors in infertility; so is the presence of some other diseases and infection.
Endometriosis and the effects of sexually transmitted diseases may be factors in infertility; so is the presence of some other diseases and infection.
Nutritional health, lifestyle choices, and environmental factors, also
have an effect. The most common defects are sperm disorders in men, and
damaged or blocked tubes in women.
Infertility testing can be complex, expensive and time consuming; with both partners expected to undergo extensive physical examinations, blood tests, evaluation of lifestyles and or ultrasound testing to determine the source of the problem. The normal mode of testing is,
Infertility testing can be complex, expensive and time consuming; with both partners expected to undergo extensive physical examinations, blood tests, evaluation of lifestyles and or ultrasound testing to determine the source of the problem. The normal mode of testing is,
• check the Rubella status, Chlamydia and Gonorrhea infections
• Semen analysis
• Followed by presumptive documentation of ovulation, usually by charting, Sonography, and HSG, before other more complex imaging.
• Semen analysis
• Followed by presumptive documentation of ovulation, usually by charting, Sonography, and HSG, before other more complex imaging.
Typical tests for Females
Common causes of female infertility include blocked tubes, polycystic ovaries [PCO], which interferes with egg release, fibroids, endometriosis, autoimmune disorders, producing antibodies against fetal tissue, diabetes, hyperthyroidism, eating disorders, excessive smoking and alcohol intake, and gluten intolerance.
Common causes of female infertility include blocked tubes, polycystic ovaries [PCO], which interferes with egg release, fibroids, endometriosis, autoimmune disorders, producing antibodies against fetal tissue, diabetes, hyperthyroidism, eating disorders, excessive smoking and alcohol intake, and gluten intolerance.
The causes may also include fluctuating or diminished hormones levels,
inconsistent ovulation, or a poor reproductive environment, that does
not support proper fertilisation of the egg, interferes with the sperm’s
transport, or hinders retention of a fertilised egg.
The initial investigations may include some blood tests, such as measuring the levels of hormones involved in reproduction ; luteinising hormone [ LH ] follicle stimulating hormones [ FSH ], Prolactin [PRL ], Oestradiol, and progesterone; other assays that may help include, thyroid function tests [ TSH and T4 ] , steroids such as testosterone and dhea-s, used in creating androgens and Oestrogens.
The initial investigations may include some blood tests, such as measuring the levels of hormones involved in reproduction ; luteinising hormone [ LH ] follicle stimulating hormones [ FSH ], Prolactin [PRL ], Oestradiol, and progesterone; other assays that may help include, thyroid function tests [ TSH and T4 ] , steroids such as testosterone and dhea-s, used in creating androgens and Oestrogens.
These tests help test the health of the pituitary and adenoid glands
which can themselves affect the menstrual cycle and ovulation. Other
specialised tests include imaging like ultra sound scan, to look at
reproductive organs.
Tests routes, include
• presumptive tests of ovulation- this gives an idea of when you could be ovulating.
• basal body temperature charting- this is the internal body temperature in a woman, in rhythm to the temperature changes with ovulation in line.
• mid luteal phase serum progesterone concentration- the time after the period that you would have taken in, and needing support for the developing pregnancy.
• urinary LH tests kits- the LH spill into the urine, speaks a lot about the activity of this very important hormone.
• serial ovarian ultrasonography- it gives a serial picture of your ovarian response in size, before, during and after conception.
• endometrial biopsy- the actual state of the womb, can be assessed with this test.
The serum progesterone levels of 4mg obtained between days 19 and 23, is presumptive of ovulation. Urinary LG surge or rise indicates a trigger in the events leading to ovulation about 40 hours after the start of the surge.
• presumptive tests of ovulation- this gives an idea of when you could be ovulating.
• basal body temperature charting- this is the internal body temperature in a woman, in rhythm to the temperature changes with ovulation in line.
• mid luteal phase serum progesterone concentration- the time after the period that you would have taken in, and needing support for the developing pregnancy.
• urinary LH tests kits- the LH spill into the urine, speaks a lot about the activity of this very important hormone.
• serial ovarian ultrasonography- it gives a serial picture of your ovarian response in size, before, during and after conception.
• endometrial biopsy- the actual state of the womb, can be assessed with this test.
The serum progesterone levels of 4mg obtained between days 19 and 23, is presumptive of ovulation. Urinary LG surge or rise indicates a trigger in the events leading to ovulation about 40 hours after the start of the surge.
Typical tests for men
A man’s fertility can be affected by factors like low sperm count, poor sperm motility, clumped sperm, unable to swim to an egg, abnormal shaped sperm, enlarged veins around the testes, varicocoel, obstruction that prevents sperm from being released during ejaculation, and genetic or congenital conditions that impair the reproductive environment.
Also, a history of mumps, testicular injury, exposure to chemical or toxins, acute illnesses, prolonged fever, drug or alcohol abuse, ingestion of anabolic steroids, can all impair male fertility.
A man’s fertility can be affected by factors like low sperm count, poor sperm motility, clumped sperm, unable to swim to an egg, abnormal shaped sperm, enlarged veins around the testes, varicocoel, obstruction that prevents sperm from being released during ejaculation, and genetic or congenital conditions that impair the reproductive environment.
Also, a history of mumps, testicular injury, exposure to chemical or toxins, acute illnesses, prolonged fever, drug or alcohol abuse, ingestion of anabolic steroids, can all impair male fertility.
Temperature affects sperm efficiency.
Age related problems, include reduction in testosterone production, decline sperm motility or production, prostate, erectile, or ejaculation problems and excessive alcohol use.
Semen analysis ---: this is the main test done on males, and it should be the first line of treatment and assessment, before more elaborate and expensive tests are done on the female. Collection and prompt evaluation of an ejaculate can quickly determine and abnormalities in the number of sperms, their shape, and ability to swim towards and egg. At least two samples should be examined at least several weeks apart since there can be considerable variability in quality.
The presence of a particular sperm abnormality, would require the full evaluation of the male reproductive system.
Abnormal results must be sent to an Urologist, for proper interpretation and treatment.
It is important to know that while the individual parameters of the semen analysis are not particularly sensitive predictors of infertility, the overall semen quality, does have predictive value.
Age related problems, include reduction in testosterone production, decline sperm motility or production, prostate, erectile, or ejaculation problems and excessive alcohol use.
Semen analysis ---: this is the main test done on males, and it should be the first line of treatment and assessment, before more elaborate and expensive tests are done on the female. Collection and prompt evaluation of an ejaculate can quickly determine and abnormalities in the number of sperms, their shape, and ability to swim towards and egg. At least two samples should be examined at least several weeks apart since there can be considerable variability in quality.
The presence of a particular sperm abnormality, would require the full evaluation of the male reproductive system.
Abnormal results must be sent to an Urologist, for proper interpretation and treatment.
It is important to know that while the individual parameters of the semen analysis are not particularly sensitive predictors of infertility, the overall semen quality, does have predictive value.
Minimum normal values are –
* Sperm concentration - > 20million per ml
• Total count > 60 million,
• Ejaculate volume - >1.5 mls
• Total motile count > 30 million,
• Viable sperm >50 %
•Normal shapes >60%[WHO, INDICES]
specialised sperm function tests includes,
• anti sperm antibody assay
• hamster egg penetration test ; to predict fertilising capability of sperm
• hypo osmotic swelling test ; to asses sperm membrane function
* Sperm concentration - > 20million per ml
• Total count > 60 million,
• Ejaculate volume - >1.5 mls
• Total motile count > 30 million,
• Viable sperm >50 %
•Normal shapes >60%[WHO, INDICES]
specialised sperm function tests includes,
• anti sperm antibody assay
• hamster egg penetration test ; to predict fertilising capability of sperm
• hypo osmotic swelling test ; to asses sperm membrane function
Blood test- ; the measurement of some hormones may help to determine
their effect on male fertility; e.g. testosterone, LH, FHS, and
Prolactin. In some cases, testicular biopsy may help identify the
problem.
Chlamydia and rubella status – the diagnosis of genital infections is very much laboratory based, and cannot be made on the clinical examination alone.
Chlamydia and rubella status – the diagnosis of genital infections is very much laboratory based, and cannot be made on the clinical examination alone.
Genital Chlamydia Trachomatis infection, is the most common sexually transmitted infection .
Chlamydia and Gonorrhea culture, rubella immunity status, are generally pursued in the first visit.
FSH, LH and testosterone should be measured in cases of severe Oligospermia, Azospermia.
An elevated FSH/ LH suggests primary gonadal failure, whereas a reduced FSH/LH plus a low testosterone suggests hypothalamic or pituitary disease.
Chlamydia and Gonorrhea culture, rubella immunity status, are generally pursued in the first visit.
FSH, LH and testosterone should be measured in cases of severe Oligospermia, Azospermia.
An elevated FSH/ LH suggests primary gonadal failure, whereas a reduced FSH/LH plus a low testosterone suggests hypothalamic or pituitary disease.
Chromosomal analysis can be included, where available, to exclude
testicular failure; a testicular biopsy is recommended in case of
azospermia.
Women with regular menstrual cycles need not measure for thyroid function, but this test is necessary in Amenorrhea.
Women with PCO’s should have LH, FSH and testosterone assay done, while Oestradiol can be done for Amenorrhea. It is also good for women with PCO, who become pregnant to be screened for gestational diabetes, in early pregnancy.{ advanced fertility clinic]
Women with regular menstrual cycles need not measure for thyroid function, but this test is necessary in Amenorrhea.
Women with PCO’s should have LH, FSH and testosterone assay done, while Oestradiol can be done for Amenorrhea. It is also good for women with PCO, who become pregnant to be screened for gestational diabetes, in early pregnancy.{ advanced fertility clinic]
Finally, it is essential that the laboratory tests carried out to
assess male and female infertility, utilise reference ranges,
conditions for sample collection, preservation, to be effective in
clinical application. Also it is essential that you discuss with your
doctor, that the most appropriate laboratory investigations are
performed.
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