Infertility Evaluation

Infertility evaluation involves a comprehensive assessment of both partners to identify the causes or contributing factors to challenges in achieving pregnancy. This evaluation is typically recommended after one year of unsuccessful attempts to conceive (or six months if the woman is over 35). It includes a combination of medical history, physical examinations, laboratory tests, and imaging studies.

Steps in Infertility Evaluation:

  1. Medical History (Both Partners)
    - Female:
    - Menstrual history (regularity, duration, intensity)
           - History of pelvic infections or surgeries (e.g., endometriosis, pelvic infections)
           - Use of contraceptives
           - Previous pregnancies or miscarriages
           - Medications and lifestyle factors (e.g., smoking, alcohol, diet, weight)
           - Presence of hormonal symptoms (e.g., irregular cycles, acne, hirsutism, thyroid issues)
       - Male:
           - History of fatherhood
           - History of infections (e.g., mumps, sexually transmitted infections)
           - Testicular injury or surgeries
           - Use of medications (anabolic steroids, chemotherapy)
           - Exposure to heat or toxins (e.g., hot baths, chemicals)
           - Sexual function and frequency of intercourse

    2. Physical Examination
       - Female: Pelvic examination to detect any abnormalities (e.g., fibroids, ovarian cysts)
       - Male: Testicular examination for size, consistency, and presence of varicocele (enlarged veins)

    3. Laboratory Tests
       - Female:
           - Hormonal assessment (e.g., FSH, LH, AMH, prolactin, thyroid hormones) to evaluate ovulation and ovarian reserve
           - Basal body temperature monitoring or ovulation predictor kits to confirm ovulation
           - Luteal phase progesterone testing (mid-cycle) to confirm ovulation
       - Male:
           - Semen analysis to evaluate sperm count, motility, and morphology
           - Hormonal testing (testosterone, FSH, LH) if sperm abnormalities are present

    4. Imaging and Specialized Tests
       - Female:
           - Transvaginal ultrasound: to assess ovarian reserve, uterine structure (fibroids, polyps), and fallopian tubes
           - Hysterosalpingography (HSG): X-ray test to evaluate fallopian tube patency and uterine cavity
           - Sonohysterography: ultrasound with saline to assess uterine cavity abnormalities
           - Laparoscopy: minimally invasive surgery to diagnose and treat conditions like endometriosis or tubal blockage
       - Male:
           - Testicular ultrasound: to assess structural abnormalities (e.g., varicocele)
           - Testicular biopsy: rarely performed; used to evaluate sperm production in cases of azoospermia (absence of sperm in semen)

    5. Genetic Testing
       - Female: Testing for conditions such as Turner syndrome or mutations associated with ovarian disorders
       - Male: Karyotype analysis or screening for Y chromosome microdeletions in cases of severe or absent sperm production

 

Common Diagnoses from Infertility Evaluation:

- Female Factors:
   - Ovulatory disorders (e.g., polycystic ovary syndrome, premature ovarian failure)
   - Tubal blockage (e.g., from previous infections, endometriosis)
   - Uterine abnormalities (e.g., fibroids, polyps)
   - Cervical issues (e.g., inadequate cervical mucus)

- Male Factors:
   - Sperm abnormalities (low count, poor motility, abnormal morphology)
   - Hormonal imbalances
   - Obstructive issues (e.g., vas deferens blockage)
   - Ejaculatory disorders

Next Steps:

Following the evaluation, treatment options may include lifestyle changes, medications (to stimulate ovulation, balance hormones), surgery (to correct anatomical issues), or assisted reproductive techniques (e.g., IVF, intrauterine insemination).