Female Infertility Tests

Female Infertility Tests

Female Infertility Tests

Infertility Consultation

During the first session the following information is discussed;

  • Medical histories, including any chronic illnesses or surgeries
  • Use of prescribed medication
  • Use of caffeine, alcohol, cigarettes, and drugs
  • Possible exposure to chemicals, toxins, or radiation at home or at work
  • Frequency of sexual intercourse
  • Use of the birth control pill
  • Any history of sexually transmitted diseases
  • Any problems with sexual intercourse

A more thorough gynecological record will follow on;

  • Previous pregnancies achieved (biochemical, miscarried or term)
  • Menstrual cycle patterns (e.g. regular 28 days, irregular? etc)
  • Abnormal bleeding between menstrual cycles
  • Volume of blood discharge observed, duration of bleeding, painful menstruations and whether pain is experienced with sexual intercourse, any noted changes in blood flow or appearance of large blood clots
  • Methods of contraception used in the past and duration
  • Any previous clinical monitoring at alternative establishments inclusive of interventions which might had been undertaken

Hormonal and Ovulation Tests

A hormonal profile test for the following hormones on day 2 or 3 of a given menstrual cycle should be undertaken to assess ovarian reserve and fertility potential. Normal thyroid function and any potential pelvic inflammation should also be investigated.

  • FSH
  • LH
  • Estradiol
  • AMH
  • Prolactin
  • TSH
  • CA 125marker
  • Progesterone (day 21 following ovulation confirmation)

Assessment of Reproductive Organs

Baseline Ultra Sound

The hormonal profile tests are followed by an initial baseline internal ultra sound scan for the assessment of the ovarian status. The latter is optimally undertaken on the 5th day of the menstrual cycle and aims at determining the antral follicle count in each ovary and whether the ovaries appear multi-follicular or polycystic

Normal

MultiFollicular

Polycystic

A second baseline ultra sound scan must be undertaken just before ovulation (day 12-13 for normally menstruating individuals) so the uterus is utterly assessed inclusive of the potential presence of fibroids and their location in the uterus, polyps in the endometrial lining and any adnexal masses

Normal endometrium before ovulation

HSG (Hystero-Salpyngo-Gram)

This procedure is undertaken after menstrual bleed cease and aims at diagnosing tubal patency and structure as well as uterine defects such as the presence of a septate, bicornuate or unicornuate appearance, endometrial adhesions (i.e. Asherman’s Syndrome), cervical adhesions or even stenosis. The test makes use of a radiographic contrast dye which is injected into the uterine cavity through the cervical canal. The patency of a fallopian tube is confirmed when free spillage of the medium is observed out into the abdominal cavity. If this is not observed the location of the blockage will be identified. While the notion exists that a specialist’s intervention can result in the opening of the tubes especially when these are proximally occluded it is widely supported that this will be a temporary solution to the problem. The procedure incurs pain to the recipient who may be advised to receive analgesic medication prior to and post the procedure. Although antibiotics are not prescribed as standard practice their administration will reduce the risks of a potential infection resulting from the procedure.

Hystero-Salpingo-Contrast-Sonography (Hy.Co.Sy) Scan

This examination besides detecting a potential occlusion in the fallopian tubes and whether any transformation into a hydrosalpinx had occurred, it contemporaneously assesses the status of the uterus regarding its size, shape and contour and whether benign muscular growths such as polyps and/or fibroids are present distorting the uterine cavity which can result in early pregnancy loss or a miscarriage. The procedure is undertaken at the clinic by a specialist gynaecologist using advanced transvaginal 3D/4D ultrasound guidance and appropriate software. The principle of the technique resembles that of the HSG however there are marked differences between the two. It is normally curried out following cessation of menstrual bleed and preferably between day 8 and 14 (before ovulation) of the cycle. The patient is asked to refrain from unprotected intercourse or use contraceptive sheaths one month in advance therefore a potential pregnancy is prevented. A routine chlamydia test is also advised prior to the procedure so that the risk of spreading infection is prevented. The patient is asked to empty her bladder before the procedure while the vagina is cleansed using an antiseptic solution. A fine flexible catheter is introduced through the cervix up to the orifice of the uterus and this is kept in position amid a small inflated balloon. An echogenic contrast or foam solution is then introduced to fill up the cavity of the uterus and therefore flow through the tubes whilst this is inspected at real time on the monitor of the ultrasound. Minor discomfort may be experienced by the recipient at the time and/or thereafter which may entail the use of simple pain killers. The procedure is relatively fast and the results can be reported on the same day. Minor whitish/pinkish discharge can be expected within the next 24 hours but this symptom is temporary.

The Hy.Co.SY examination is superior to the conventional HSG for a collection of reasons the most important of which are;

  • The patient is not exposed to radiation i.e. X-rays
  • The 3D/4D ultrasound software used allows for repeated observations of the procedure therefore a more accurate diagnosis can be made
  • It provides a more comprehensive assessment since the cavity of the uterus and the existence of tissue such as polyps and fibroids can be recorded with precision
  • It incurs less discomfort to the recipient