Investigations for infertility

by Chris

source: http://www.babyworld.co.uk/information/trying/infertilityinvestigations.asp


Hormone tests
The levels of most of the hormones known to play a part in fertility can be checked with a simple blood test. For a woman, this test is usually carried out around Day 21 of the cycle, when the levels of hormones can indicate whether ovulation has occurred and also where any problem might lie. Hormone test levels vary and you need to discuss carefully with your doctor not only what each hormone level means on its own, but also in combination, before moving on.

Sometimes the man is tested too, as hormone problems can affect sperm production.

Semen analysis
For this test, a man will need to deliver a sample of his semen into a sterile container. A ‘good’ test will show that he is producing enough seminal fluid, that there are more than 20 million sperm per ml, that more than 40 per cent of these are moving forward and that at least 70 per cent of them are not abnormally shaped. If the sperm count is poor, another test will probably be carried out since sperm counts can vary.

If the sperm seem to ‘clump together’, further tests may be carried out to check for anti-sperm antibodies. Two additional tests may also be used: the ‘swim-up’ test, which allows the percentage of normal sperm to be established, and microscopic photography, which checks the distance the sperm travel.

Post-coital test
In this test, a couple needs to have intercourse around the time of ovulation, when a woman has ‘fertile’ mucus. A sample of cervical fluid is then obtained from the cervix a few hours later and checked under a microscope to see if motile sperm are present. If a large proportion are moving through, it shows that there is no ‘hostile’ reaction taking place.

However, if sperm aren’t getting through, this test may be followed by the sperm invasion test. A sample of the woman’s fertile cervical mucus is mixed with the man’s semen and examined under a microscope to see how far the sperm penetrate into the mucus.

If they clump together and don’t move forward, or if they die off inside the mucus, this may be because one of the couple is producing antibodies to the sperm. In such cases, a ‘crossover’ test may be done, in which the man’s semen is put on a slide with someone else’s mucus and the mucus is put on a slide with someone else’s semen. This can show where the problem might lie.

Cervical mucus can also be analysed to see if it ‘ferns’ under a microscope. Ferning is a characteristic pattern of fertile mucus and shows whether it is as stretchy as it needs to be to let sperm through.








Physical investigations
Sometimes a woman will know that she has had an infection which may have caused damage to her fallopian tubes, sometimes she won’t. Chlamydia, for example, sometimes produces no discernible symptoms, so the fact that it has damaged the tubes may come as a complete surprise. This is why a check on the state of the fallopian tubes is essential in any investigation of infertility, and there are several ways in which this can be done:


Laparoscopy test
In a laparoscopy, carried out under general anaesthetic, a viewing tube is inserted through a small incision in the woman’s abdomen. The abdomen is inflated with carbon dioxide, which makes it easier for the surgeon to check the uterus, ovaries and fallopian tubes for structural abnormalities, endometriosis and adhesions, as well as possibly repair any problems at the same time. Some surgeons also use a laparoscopy to assess whether the fallopian tubes are open: dye is injected through the cervix and should flow out of the ends of the tubes; if it doesn’t, they are blocked.

A laparoscopy is usually carried out as a day procedure, but it carries the small risks and potential side effects of any operation which requires a general anaesthetic. Some women take several days to recover and can suffer soreness as the carbon dioxide tries to escape again. Despite these drawbacks, the procedure can provide a great deal of useful information, and the tiny scar will fade.

X-ray Test (hysterosalpingography)
Another standard test to assess whether the fallopian tubes are open is hysterosalpingography. Dye is injected through the woman’s cervix into the uterus. This dye shows up on X-rays, so a series of X-rays is taken to check how it is flowing through the fallopian tubes and whether there are any blockages.

Any problems show up immediately, which makes this a useful procedure, but it can cause mild to severe cramps. Another advantage of this test is that you avoid having to have a general anaesthetic and surgery; it is usually done in the hospital’s X-ray department and you can go home soon afterwards, though you may need someone to drive you.

Ultrasound tests (hysterosalpingo-contrast sonography)
A relatively new test for assessing whether the fallopian tubes are open is hysterosalpingo-contrast sonography. A contrast solution is injected through the cervix and ultrasound scanning allows its flow along the tubes to be traced. The procedure takes between 15 and 30 minutes and you can go home straight afterwards. However, it is not suitable for everyone and a laparoscopy may also be recommended for a full assessment of your pelvic cavity.

Ultrasound scanning
Ultrasound scanning is also sometimes used as a diagnostic test. Abdominal ultrasound can give a picture of a woman’s uterus and ovaries and show any fibroids, uterine abnormalities or polycystic ovaries. Ultrasound can also monitor whether eggs are developing and being released from the ovaries. One uncomfortable aspect of abdominal ultrasound is that a full bladder is necessary to allow the ovaries to be seen more clearly. Sometimes transvaginal ultrasound is used and a full bladder is then not needed.

For a man, ultrasound can show whether the sperm are being stored and passed on through the system as they should be.

Endometrial biopsy
If there is doubt whether a woman’s endometrium (lining of the womb) is thickening as it should be in preparation for a developing embryo, an endometrial biopsy can be undertaken. A catheter is inserted through the cervix and a small sample (biopsy) of the uterine lining removed. If the endometrium has not developed as expected for that phase of your cycle, this can indicate a problem with hormone levels. The test can also be used to check for infection and if this is discovered a D&C (dilatation and curettage of the endometrium under general anaesthetic) may be needed.

Surgical exploration of the testes
This is done if no other reason can be found for a man’s infertility. It can check for blockages or infections, and a biopsy may be taken to check whether sperm are being produced and are maturing properly. If the sperm-producing tubules and the sperm in them are normal but a semen analysis shows no sperm, the problem is likely to be a blockage. A vasogram may be performed to pinpoint the blockage: dye is injected and X-rays will outline the ducts and pinpoint any obstructions.