Infertility is a condition of the reproductive system that prevents the conception of children. About 80% of couples who are regularly trying for a baby get pregnant within a year. Many of the remaining 20% achieve a pregnancy within the next year. An estimated one in seven couples have difficulty conceiving and women are less fertile as they get older.
At an Assisted Conception Unit(ACU), a team of medical and scientific experts provide comprehensive fertility service for all couples who have difficulty getting pregnant. In order to deliver the appropriate care, it is important to accurately diagnose and asses the condition of the parent’s reproductive health.
Diagnostic tests for the Female
1. Baseline Investigations
- Clinical assessment.
- Hormonal Assays: Hormones produced by thehypothalamus, pituitary and ovaries play a key rolein ovulation. Abnormalities in other hormonal ororgan systems may also contribute to infertility. Ablood test measures the level of various hormones at different times of a woman’s menstrual cycle.
- Ovarian reserve testing includes blood tests and atransvaginal scan to make an assessment of thequality and quantity of eggs.
- Cycle monitoring involves tracking the release of anegg.
2. Tubal Assessment
- Hystero-Contrast-Salpingo-Sonography (HyCoSy Scan) and Saline Infusion Sonography (SIS-for uterine cavity assessment): This is an outpatient procedure sometimes requiring sedation, where the fallopian tubes are tested by passing a special fluid through the cervix under transvaginal ultrasound guidance. This is much less uncomfortable than a HSG (see below) and allows you to continuetrying for a pregnancy in the same cycle. SIS is a similar procedure to assess the womb cavity.
- Hysterosalpingogram (HSG): This is an outpatient procedure sometimes requiring sedation where thefallopian tubes are tested by passing a special fluid through the cervix under radiological guidance.
- Laparoscopy, Dye Test and Hysteroscopy: A laparoscopy is a procedure to check the fallopian tubesalong with the woman’s pelvic organs. It is a minimally invasive procedure in which a telescope called laparoscope is inserted through the abdominal wall to see the fallopian tubes, ovaries and uterus toexclude problems such as endometriosis, fibroids, ovarian cysts and adhesions (scar tissues). Manyinfertile couples require a diagnostic laparoscopy for a complete evaluation of their infertility. This isusually done as a day case surgery under general anaesthesia. A hysteroscopy is a procedure where thetelescope is passed into the uterus at the same time to assess the inside of the womb cavity. A coloreddye (methylene blue) is then passed through the cervix. If the tubes are not blocked the dye should passalong them and spill into the abdomen.
3. Advanced Investigations
- Genetic Testing: A genetic test is a blood test that looks at a person’s DNA, or genetic information.This may be recommended if you have repeated IVF failures or miscarriages. Genetic testing may also beordered to diagnose various congenital or inherited syndromes.
- Immunological Assessment: Dysfunction of the immune system could contribute to infertility andpregnancy loss. Blood tests related to the immune system may help to diagnose a problem.
Diagnostic Tests for the Male
- Clinical Assessment
- Detailed Semen Analysis
- Hormonal Assays: Hormones produced by the hypothalamus, pituitary and testicles play a key role in sexualdevelopment and sperm production. Abnormalities in other hormonal or organ systems may also contribute toinfertility. A blood test measures the level of testosterone and other hormones.
- Scrotal and Transrectal Ultrasound (USS): A scrotal ultrasound can help your doctor see obstructions orother problems in the testicles and supporting structures. In a transrectal USS, a small, lubricated wand is insertedinto the rectum. It allows your doctor to check the prostate, and look for blockages of the tubes that carry semen(ejaculatory ducts and seminal vesicles).
- Post-ejaculation Urinalysis: Sperm in your urine can indicate your sperm are traveling backward into thebladder instead of out of the urethra during ejaculation (retrograde ejaculation).
- Genetic Testing: When sperm concentration is extremely low or sperm are absent, genetic causes could beinvolved. A blood test can reveal whether there are subtle changes in the Y chromosome or the Cystic Fibrosisgene. Genetic testing may also be ordered to diagnose various congenital or inherited syndromes.
- Sperm DNA Fragmentation Test: This is a specialized test done on a semen sample to assess breakage orlesions in the genetic material of the sperm.
- Testicular Biopsy: This test involves removing samples from the testicle. The results of the testicular biopsy willtell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport.
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