Infertility evaluation

Infertility Evaluation

Before infertility testing begins, healthcare providers assess the couple’s medical history, sexual habits, and lifestyle factors that may influence fertility. Advice may be given to improve the likelihood of conception, such as optimizing the timing of intercourse around ovulation.

In some couples, no identifiable cause is found, which is referred to as unexplained infertility.

Infertility investigations can be expensive and may involve uncomfortable procedures, and coverage varies depending on healthcare systems and insurance plans. Even after thorough evaluation and treatment, pregnancy cannot always be guaranteed.

Evaluation of Male Infertility

Male fertility depends on three main factors:

• Production of adequate numbers of healthy sperm

• Effective ejaculation of sperm into the female reproductive tract

• Ability of sperm to travel and fertilize the egg

Testing aims to determine whether any of these processes are impaired.

1. Physical Examination

A general medical examination is performed, including inspection and palpation of the penis, testicles, epididymis, and vas deferens to detect abnormalities such as varicocele or structural defects.

2. Semen Analysis

Semen analysis is the primary test used to evaluate male fertility.

A semen sample is typically collected through masturbation into a sterile container. The laboratory evaluates:

• Sperm concentration (count)

• Motility (movement)

• Morphology (shape)

• Semen volume and other characteristics

In certain situations, post-ejaculatory urine testing may be performed to detect sperm if retrograde ejaculation is suspected.

3. Hormone Testing

Blood tests may measure reproductive hormones including:

• Testosterone

• Follicle-stimulating hormone (FSH)

• Luteinizing hormone (LH)

These hormones regulate sperm production and testicular function.

4. Genetic Testing

Genetic analysis may be recommended when severe sperm abnormalities are present. It can detect chromosomal disorders or gene mutations that affect fertility.

5. Testicular Biopsy

In selected cases, a small sample of testicular tissue is obtained to:

• Evaluate sperm production within the testicles

• Retrieve sperm for assisted reproductive techniques, such as in vitro fertilization (IVF).

6. Imaging Studies

Imaging tests may help identify structural problems. These may include:

• Scrotal ultrasound

• Transrectal ultrasound

• Magnetic resonance imaging (MRI) in specific cases

• Vasography to evaluate the vas deferens if obstruction is suspected

7. Specialized Sperm Tests

In certain cases, advanced laboratory tests may assess sperm DNA integrity or functional capacity.

Evaluation of Female Infertility

Female fertility depends on several physiological processes:

• Release of a healthy egg from the ovaries (ovulation)

• Transport of the egg through the fallopian tubes

• Fertilization by sperm

• Implantation of the embryo in the uterus

Diagnostic tests aim to identify problems affecting any of these steps.

1. Physical and Gynecological Examination

A comprehensive physical examination is performed along with a pelvic examination to assess the reproductive organs.

2. Ovulation Testing

A blood test measures hormone levels (often progesterone) to determine whether ovulation is occurring during the menstrual cycle.

3. Hysterosalpingography (HSG)

Hysterosalpingography is an imaging procedure used to examine the uterine cavity and fallopian tubes.

Procedure:

• A contrast dye is injected into the uterus

• X-ray imaging tracks the dye to determine whether:

  • The uterus has a normal shape

  • The fallopian tubes are open or blocked

4. Ovarian Reserve Testing

This testing evaluates the quantity and potential quality of remaining eggs in the ovaries.

Hormone tests are usually performed early in the menstrual cycle.

5. Additional Hormone Tests

Additional blood tests may measure hormones that regulate reproductive function, including pituitary hormones involved in ovulation.

6. Imaging Tests

A pelvic ultrasound can detect abnormalities in the uterus or ovaries, such as cysts, fibroids, or structural changes.

A sonohysterogram (saline infusion sonography) may also be used. In this test, sterile saline is introduced into the uterus during ultrasound to provide a clearer view of the uterine cavity.

Advanced Diagnostic Procedures (When Indicated)

Hysteroscopy

Hysteroscopy allows direct visualization of the inside of the uterus.

A thin, lighted instrument is inserted through the cervix to detect abnormalities such as polyps, fibroids, or structural defects.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure in which a small incision is made below the navel and a camera is inserted to examine the uterus, fallopian tubes, and ovaries.

This procedure can help diagnose conditions such as:

• Endometriosis

• Pelvic adhesions (scar tissue)

• Fallopian tube blockages

• Structural abnormalities of reproductive organs