Investigations

Investigations

Investigation of infertility is aimed to determine the cause of infertility and the appropriate treatment for the infertile couple. Therefore, the investigation will need the involvement and co-operation of both the husband and the wife.

After a complete investigation and treatment, majority of the infertile couple will successfully have their own babies. The chance for them conceiving and having their own babies will fall as the age of the women increases. So, do not delay in seeking professional help if you are unable to conceive;

a) after 12 months if you are less than 30 years of age

b) after 6 months if you are 30-34 years of age

c) after 3 months if you are 35 years of age or more

1) Medical History

A good medical history of the couple may suggest the cause of infertility. It will help the doctor if the couple takes care to provide a good medical history. This will save time and cost. The following histories are relevant and should be volunteered to the doctor during consultation.

The women
I) Long menstrual cycle, e.g. every 2 to 3 months or no menses at all; implies failure of ovulation.
II) Severe pain during menses, especially after the menses has started; implies endometriosis.
III) History of sexually transmitted diseases (STDs); implies adhesion.
IV) History of appendectomy (cutting off the appendix) or pelvic surgery; implies adhesion.
V) Sexual problems; may have coitus failure.
VI) Previous investigations and treatments for infertility; so that we need not to repeat the same test
and save cost.

The men
I) History of STDs; may affect semen quality.
II) History of mumps or genital surgery; may cause low sperm count.

Subsequent investigation will be done depending on the findings from history and physical examination.

2) Ultrasound Scan

Ultrasound scan is a simple and easy way to examine the internal reproductive organs. It can clearly show the position and size of uterus, endometrial lining and the ovaries. Certain abnormal conditions such as fibroid, double uterus and ovarian cyst can be diagnosed through ultrasound scan alone.

During the treatment of infertility where ovarian stimulation is involved, ultrasound scan is repeated done to monitor the growth of eggs (follicular tracking) and endometrial lining. Follicular tracking is started on Day 9 of a menstruation cycle for every 2 days until the eggs are mature. Normally the egg will mature on Day 12, which is defined by a 18mm follicle. Only mature egg can be ovulated and fertilized by sperm.

Picture shows a fibroid with a size of 4.78cm

3) Blood Test

Blood test is performed to measure the different hormones levels in serum, mainly the levels of follicular stimulating hormone (FSH) and luteinizing hormone (LH), progesterone and prolactin. Besides doing blood test, the patient is also screened for hepatitis B, human immunity virus (HIV), STDs and Pap smear.

4) Ultrasonicsalpingiogram

This is a simple outpatient test used to detect tubal patency (no blockage of Fallopian tubes). The uterine cavity and Fallopian tubes are filled with ultrasonic dense fluid. If either of the Fallopian tubes is patent, the fluid will flow out from the end of the Fallopian tubes and fill up the adnexa (side of uterus) and pouch of Douglas (the cavity between uterus and rectum). Patient may feel pain and discomfort at pelvic area after the test if her tubes are patent.

The advantages of ultrasonicsalpingiogram compared to hysterosalpingiogram (HSG) and laparoscopy are; no radiation or surgery are required.

5) Laparoscopy

This is a daycare surgery procedure, where a fine telescope is inserted through a small incision at the umbilicus and the internal female organs are visualized. The Fallopian tubes are tested for patency using methylene blue dye injected at the vagina end. If the tubes are patent, the blue dye will be seen flowing out at the fimbriae (tube) end.

During laparoscopy, the cause of infertility such as endometriosis, adhesion, fibroid can be confirmed. Laparoscopy is diagnostic as well as therapeutic. For an example; at the time of laparoscopy, endometriosis is confirmed and it can be cauterized and treated at the same time. Other treatments that can be done at the time of laparoscopy are release of pelvic adhesion and ovarian drilling (making hole in capsule).

6) Semen Analysis (SA)

SA is a scientific examination of semen fluid using microscope to investigate male infertility or effectiveness of vasectomy. The parameters and the normal values commonly used are the one standardized by World Health Organization (WHO).

In the laboratory, after the sample liquefies, the criteria below are determined:

The man ought to abstain from coitus for 3 days before the test and produce sample by masturbation. The sample must reach laboratory within 45 minutes after being produced.