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  Infertility - Which tests are necessary? Download

INFERTILITY - Which tests are necessary? The doctor will perform different tests for the infertile couple to identify the cause of infertility so that it can be appropriately treated. Doctor will try to answer at least four basic questions: Is there any coital difficulty? Is there a problem with his sperm? Is there a problem with her ovulation? Is there a problem with her genital tract? Is there any coital difficulties? If he cannot ejaculate in her vagina, then they are having problem in sexual intercourse. Urologist, gynaecologist or sex therapist may help them to resume normal sex life. Is there a problem with his sperm? Besides detailed medical history and examination, semen analysis is the single most important test in evaluating his fertility. It can tell whether he is producing adequate number of healthy sperms. The commonest reasons for abnormal semen analysis results are improper specimen collection and history of recent illness that may have affected the production of sperm. Therefore, at least two abnormal samples collected in separate occasions at least 3 months apart are necessary to say he has a problem. Other tests for him In some cases, further investigations such as anti-sperm antibody, sperm function tests, hormonal tests, microbiological assessment of the semen and imaging of the male genital tract may be necessary. However, this should be initiated in the specialist infertility centre.
Is there a problem with her ovulation? If she has irregular or absent periods, she may have problem in ovulation. Although regular menstrual cycle usually implies normal ovulation, it isn't always true. Some specific tests may be required to determine the ovulatory status. Basal body temperature chart Every morning, she has to take oral temperature once she wakes up, plots its daily changes throughout the cycle and notes events of importance, such as sexual intercourse or illness. A rise in temperature of about half a degree celsius around mid-cycle, maintaining for the remaining days until the next menstruation will suggest that ovulation has occured. Urinary ovulatory kit In recent years, urinary testing kits are available to detect ovulation. It may be helpful in planning sexual intercourse around ovulatory period to increase the chance of pregnancy. Other tests to detect ovulation In some cases, more complicated investigations may be necessary, however, this should be initiated in the specialist infertility centre.
Is there a problem with her genital tract? Ultrasound scan This is a painless test performed by applying a probe over the abdomen, or by inserting a probe into the vagina. It can detect abnormalities of the uterus or the ovaries. Hysterosalpingogram (HSG) Blockage of the fallopian tubes and structural abnormality of the uterus may be diagnosed through X-ray examination after injecting dye into her genital tract. This test needs no operation or anaesthesia. Yet, it provides no information on peritoneal diseases such as endometriosis or pelvic adhesion. Laparoscopy and dye studies This is performed under general anaesthesia and enables the doctor to directly view the outside of uterus, pelvic cavity, fallopian tubes and ovaries. It can identify endometriosis, pelvic adhesion, tubal blockage and ovarian diseases at the same time. Therefore, it is the preferred work-up when there is a strong suspicion of peritoneal disease. Laparoscopy may also be necessary when planning for infertility surgery. Hysteroscopy This is usually performed at the same time with laparoscopy. A probe is inserted into the uterus through the vagina. The inner lining of the uterus can be seen. Abnormalities such as intrauterine adhesion or congenital uterine abnormality can be detected. Where can infertile couples get these tests? Both gynaecologists in the Hospital Authority and private sector offer most of these tests to infertile couples.
 
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Last revision date: 01 September 2006