Infertility Work Up
Infertility Work Up and Evaluation
Fertility tests evaluate the separate processes that must occur for pregnancy to result. HRC infertility specialists will oversee a thorough screening of each couple’s medical history and hormonal health as well as a physical exam to determine the likely cause of infertility and to create a treatment plan.
The most common causes of female infertility include ovarian disease, tubal disease, endometriosis, uterine disease, cervical disease, immune disorders and a category known as unexplained infertility. “Unexplained infertility” means that a specific cause of infertility cannot be identified.
Fertility tests will be ordered to assess ovarian function including the day 3 hormone evaluation (FSH, LH, E2 and others). Elevated levels of FSH on day 3 may indicate diminishing ovarian reserve and infertility. Ovulation may also be assessed using urinary test kits, progesterone hormone measurements, ultrasound visualization and other means.
Fertility tests are also used to access the tubes and uterus. The tubes must be open and free of obstruction for the eggs to travel from the ovaries to the uterus. Fertility tests are used to evaluate the condition of the uterus and include the hysteroscope, hysterosalpingogram, ultrasound and others. The uterus must be regularly shaped and free of obstructions like fibroids and/or polyps. The laparoscopy is a very valuable fertility test that allows the specialist to directly visualize the reproductive organs. In many cases, conditions such as endometriosis are treated during the diagnostic laparoscopy.
Fertility tests, such as the post coital test, assess the characteristics of the cervical mucus. The cervical mucus supports the transport and nourishment of sperm and must be free of antisperm antibodies and be the correct consistency.
It is important to remember that no fertility therapy, including Clomid, should be administered to the female until the semen analysis has been evaluated. Approximately 47 percent of all infertile couples will have a male infertility component.
Hysteroscopy Infertility Diagnosis
The hysteroscopy is an important tool in the study of infertility, recurrent miscarriage, or abnormal uterine bleeding. Diagnostic hysteroscopy is used to examine the inside of the uterus, also known as the uterine cavity, and is helpful in diagnosing abnormal uterine conditions such as internal fibroids, scarring, polyps, and congenital malformations.
A hysterosalpingogram (an x-ray of the uterus and fallopian tubes) or an endometrial biopsy may be performed before or after a diagnostic hysteroscopy.
Hysteroscopy Procedure
The first step of diagnostic hysteroscopy involves slightly stretching the canal of the cervix with a series of dilators. Once the cervix is dilated, the hysteroscope, a narrow lighted viewing instrument, similar to but smaller than the laparoscope, is inserted through the cervix and into the lower end of the uterus.
Carbon dioxide gas or special clear solutions are then injected into the uterus through the hysteroscope. This gas or solution expands the uterine cavity, clears blood and mucus away, and enables the physician to directly view the internal structure of the uterus.
Diagnostic hysteroscopy is usually conducted at HRC and local anesthesia is a possibility. It’s usually performed soon after menstruation because the uterine cavity is more easily evaluated and there is no risk of interrupting a pregnancy. A mock transfer or trial transfer may also be done at this time.
Laparoscopy Infertility Diagnosis
Laparoscopy is a common outpatient surgical procedure that allows the physician to view reproductive organs such as the fallopian tubes, ovary, and uterus, and diagnose conditions causing infertility including endometriosis and tubal blockage.
Laparoscopy Procedure
The laparoscope is a small “telescope like” instrument that is placed through a small incision in the stomach, usually at the belly button. Small operative tools are inserted through another small incision at the pubic hairline. The laparoscope usually does not produce noticeable scarring. The abdomen is filled with gas causing it to expand making the internal organs more accessible.
Reproductive surgeons undergo extensive advanced microsurgical training with the laparoscope. They are able to perform many, if not most, fertility operations using the laparoscope, which dramatically reduces recovery time, pain cost, and adhesions/scarring.
Fertility specialists will usually treat conditions such as endometriosis during the diagnostic laparoscopy, which is one of the reasons a fertility specialist should perform the laparoscopy when infertility is suspected.