Testing may be done after a couple had 12 months of sex, without birth control and conception has not occurred. Testing may be begun sooner, though, depending on age and other factors. An infertility workup involves both the man and the woman. If the couple and the doctor decide to proceed, the basic evaluation usually can be completed within a few menstrual cycles. If further testing is needed, several office visits may be required. Ask your doctor about the costs involved. Find out whether they are covered by your insurance. The basic workup includes:
- A semen analysis
- Proof that ovulation has occurred
- A postcoital test to see how the sperm move through the cervical mucus
- Evaluation of whether the woman’s tubes allow passage of the eggs – Tube patency test
The couple will also be asked about their sexual relations to find out whether their infertility might be linked to the timing or frequency of intercourse.
Tests – Man
Semen Analysis: A semen analysis is an important part of the basic workup. The doctor may tell the man not to ejaculate for 2-3 days before he gives his semen sample. Sometimes he is asked to produce the semen sample at the lab, since sperm have a fairly short life span outside of the body and quickly lose their ability to fertilize.
The semen sample is analyzed in the lab to determine the number of sperms present, as well as to study their movement and their structure. Factors such as the presence of infection can be detected as well. The semen analysis may need to be repeated.
Other tests of the man may also be needed. He may be referred to a urologist (a doctor who specializes in conditions involving the urinary tract). The urologist will perform a physical exam, looking closely at the functions and structure of the testes and other reproductive organs. Special tests of sperm function may be done. A blood sample may be taken to check the level of those hormones that affect fertility. Sometimes a biopsy of the testes may be helpful in finding the cause of infertility.
CASA – Computer Assisted Semen Analysis (CASA): Computer Assisted Semen Analysis (CASA) is a catch-all phrase for automatic or semi-automatic semen analysis techniques. It provides fast, accurate and objectively repeatable results. The Inter-observer bias can be eliminated using this technique. It analyzes the sperm basing on image analysis and tracking cell movement on a digitizing tablet. The system provides immediately and objectively detailed results of motility and concentration in a complete report. A precise morphological and morph metric analysis of each spermatozoa is provided in real time. This equipment can also perform certain specialized tests like sperm vitality & sperm DNA fragmentation index.
Tests – Woman
Most tests used to detect infertility in a woman check if and when ovulation has occurred. These tests may be performed before, during, or after ovulation. Other checks are for any structural abnormalities in her reproductive system. Trans vaginal scanning helps in all above said procedures.
Urine Test: A way to predict ovulation is by using a urine test kit at home. This test measures luteinizing hormone (LH), which is released by the pituitary gland to cause ovulation. If the test is positive, it indicates that ovulation is about to occur. Sometimes these kits are used to supplement basal body temperature charts.
Basal Body Temperature: After a woman ovulates, there is a rise in body temperature – as much as 1 degree F – that can happen suddenly in one day or slowly over several days. To record her basal body temperature, a woman takes her oral temperature every morning before she gets out of bed and records it on a sheet of graph paper. This record usually has to be kept for 2-3 months. This test may suggest whether ovulation has occurred and whether it occurs on a regular basis. It may be helpful in planning the timing of other tests.
Progesterone Test: After a woman ovulates, the ovaries produce progesterone, a hormone produced in the ovaries that prepares the lining of the uterus to nourish a fertilized egg. A blood test, taken 5-10 days before a woman’s period is due, can be used to test for ovulation by measuring progesterone.
Endometrial Biopsy: Sometimes this test is performed to find out whether and when ovulation has occurred and whether there are problems with how the lining of the uterus responds to ovulation. The procedure is done a few days before a woman’s period is due. A thin, hollow tube is inserted into the vagina and through the cervix to remove a small piece of the uterine lining. This sample is later examined under a microscope as Histopathological examination. This procedure is done in the doctor’s office.
Postcoital Test (PCT): The postcoital (after sex) test examines the ability of sperm to enter and move into the cervical mucus just before time of ovulation. The couple has intercourse close to the time of ovulation, and the cervical mucus is examined a few hours later. A PCT can also show if there is a reaction between the sperm and cervical mucus that could be causing infertility. Hostile cervical mucus could easily be identified with this test.
Hysterosalpingography (HSG): This test is an X-ray that examines the inside of the uterus and fallopian tubes. It is usually performed soon after the menstrual period in a radiologist’ office or the X-ray department of a hospital. A small amount of fluid (contrast) is injected in to the uterus through a thin tube inserted through the cervix, and an X-ray is taken. The fluid fills the uterus and shows the tubes (by a spill of the fluid out of the tubes) whether they are open. The defects in the uterine inner lining may also be highlighted by this test.
Ultrasound: Ultrasound uses sound waves to produce images of internal structures. This test can check the ovaries and uterus, as well as the thickness of the uterine lining. It can also be used to show the development of the egg in the ovary.
Hysteroscopy: For this procedure, the doctor places a telescope-like instrument, called a hysteroscope, through the cervix. The inside of the uterus may be filled with a gas or liquid. With the hysteroscope, the doctor can see the contents of the uterine cavity, including the opening of the tubes on the inside of the uterus. During this procedure, the doctor can correct minor problems, get a biopsy sample, or determine whether another operation is needed. Hysteroscopy is performed under local or general anesthesia.
Laparoscopy: A light-transmitting, telescope-like instrument, called a laparoscope, is inserted through a small incision (about 1/2 inch or less) at the lower edge of the naval. The abdominal cavity is filled with gas so the uterus can be seen. With this procedure, the doctor can look for pelvic disease, such as endometriosis, that may interfere with conception. The fallopian tubes can also be examined and tested to determine whether they are open by injecting a fluid into the uterus and tubes. It usually is performed under general anesthesia and does not require an overnight hospital stay.
Preimplantation Genetics: Pre implantation genetic diagnosis (PGD), also called Preimplantation Genetic Testing (PGT), is a procedure used prior to implantation to identify genetic defects within embryos created through in vitro fertilization to prevent certain diseases or disorders from being passed on to the child. In most cases, the female, male, or both partners have been genetically screened and identified to be carriers of potential problems. Here one of the 8 cells (Blastomere) is aspirated using specific pipette used for PGD with the help of micromanipulator (same equipment used for ICSI). Then the single cell is subjected for genetic testing using their DNA chain to gain further information. If the cell seems to be normal then the embryo is declared as fit ones to transfer in to uterus. Further research in this field is going on in our centre with respect to this particular modality. A newer genetic screening called Comparative Genomic Hybridization is under trial in our centre.