Infertility testing is a medical procedure that is used to understand why a woman is not able to become pregnant. The problem can either be with the male partner or the female partner and the testing can be carried out one by one on both the partners to understand where the problem lies. Typically, it includes physical examination, blood tests, semen analysis and if need be, special procedures.
Not many people are aware of the fertility cycle of a woman. Trying fertility awareness methods, to find the best time to become pregnant rules this issue out in most cases. A woman’s fertility is at its peak during ovulation and 1-2 days before that. If you have tried to conceive during these times and have regularly failed for 4-5 months, only then you should opt for an infertility test. Also, it’s recommended that the female partner keeps a track of her menstrual cycle and her ovulation timings. This information can come handy when the doctor is going to examine the female partner.
Female Fertility Tests
There are multiple tests that can help the doctor in understanding if the problem is associated with the female partner. Here are some tests that focus on one or the other reproductive organ and check for underlying problems.
It’s a blood test that is used to check whether the female partner is ovulating or not. The most common one is a blood test that measures the hormone levels to determine whether you are ovulating. Alternatively, you can opt for a Urine-based test that checks your urine for a surge in Luteinising Hormone (LH). This sudden surge is a trigger for ovulation and one can expect to ovulate within one to two days after this surge.
Ovarian Reserve Testing
This test helps to determine the quality and quantity of the eggs available for ovulation. This approach often begins early in the menstrual cycle via hormone testing. During the reproductive cycle of a woman, a single follicle is picked out of a couple of potential follicles and is assisted in maturing. Once the follicle matures, it releases a single egg. This is the natural process. However, doctors can try to mature other follicles of that group, via medication, so that multiple eggs can be released during ovulation, thus improving the chances of pregnancy. If the female partner responds positively to such fertility medications, then she has a normal ovarian reserve. The ones who do not respond to such fertility medications are said to have a diminished ovarian reserve.
Hysterosalpingography is a medical procedure where a low radiation X-ray is used by the doctor to view the reproductive organs of the female partner. The primary focus is the fallopian tubes. In this process, a contrasting dye is injected into the uterus and fallopian tubes. That dye enables the organs to be clearly visible in the X-Ray. For conditions like a blockage in the fallopian tubes or uterine abnormalities such as cavitary fibroids, polyps, or abnormal shape of the uterus; a Hysterosalpingogram can be the procedure of choice.
As opposed to the X-Ray vision involved in Hysterosalpingogram (HSG), Transvaginal ultrasound is executed by looking at the pelvic organs from inside the vagina by using a special handheld device called transducer which is smooth and thin for comfort. It is used to examine the pelvis area of the female partner and check for any abnormality in the uterus (womb), cervix (the neck of the womb), endometrium (lining of the womb), fallopian tubes, ovaries, bladder or the pelvic cavity. This differs from an abdominal ultrasound, which uses a warm water-based clear gel applied to the skin of the abdomen and the transducer is moved gently across the pelvic area (not inside).
Saline Infusion Sonohysterography
A sonohysterogram is an ultrasound test that uses saline and ultrasound to look at the female reproductive organs.
Hysteroscopy is a procedure that is similar to Transvaginal ultrasonography and looks at the lining of the uterus using a thin, lighted scope that is put into the uterus through the vagina and cervix. In examining issues with the uterine lining, this process comes handy. Sometimes your doctor can use small tools during the procedure to take samples of tissue (biopsy) or open a blocked fallopian tube.
Laparoscopy is a procedure in which a small incision is made in the belly button and a camera along with a small surgical instrument is introduced into the abdominal cavity. Laparoscopic surgery is used to treat endometriosis and to remove uterine fibroids, ovarian cysts, and/or scar tissue.
Male Fertility Tests
The process of diagnosing the underlying causes of infertility typically starts by having a small conversation regarding the sexual life and habits of both the partners. Some preliminary questions are asked by the doctor to understand whether he should start the diagnosis by examining the female partner first or the male partner. If the doctor has successfully performed all the tests on the female partner and there is no result, chances are that the male partner might have health issues that are stopping the pregnancy from happening.
One of the first tests used to check the fertility of the male partner is Semen Analysis. This test is used to check multiple factors associated with the health and mobility of the sperm. Information on the quantity of sperm, number of sperms that have healthy shape and structure (also called morphology) and regarding the mobility and quality of the sperms of the male partner can be gained via this procedure. In some cases, sperm levels might vary from one test to another and there might be a possibility that the male partner might have an infection. These things can impact the results. That is why semen analysis may be conducted more than once to counter these issues.
Male hormones play an important role in the development of reproductory organs, fertility and sex life of a male partner. This test examines the male hormones to check for any problems that might be leading to infertility. A standard hormone evaluation on human male partner focuses on testosterone, LH, prolactin, and FSH. In some cases, Estradiol levels are also examined. For male partners who have soft testicles and a sperm concentration less than 10 x 106 sperm/mL, these are the hormones to be primarily checked. Let’s see what are the common patterns of hormonal issues that cause infertility in men:
Characteristic hormone profiles in infertile men:
|Primary Testis Failure||Low||High||High/NL||NL|
When should Hormonal Testing be done?
Hormone levels should be measured if:
- Sexual functioning of the male partner is not satisfactory (erectile dysfunction, low libido)
- An earlier diagnose has yielded disorder related to Thyroid hormone.
- Sperm concentration is less than 10 x 106sperm/mL
Testicular biopsy is a surgical procedure that helps the doctors in doing a first-hand analysis of the testicular tissue of the male partner, under a microscope.
How is the procedure executed?
First, antiseptic medicine is applied evenly on the skin that covers the testicle. A sterile towel covers the area around the testicle. Then, a local anesthetic is given to the patient to numb the area.
Then the doctor proceeds towards the surgery. A small surgical incision is made through the skin, and a small piece of the testicular tissue is extracted. The opening in the testicle is then stitched shut. After that, the incision made in the skin is also sealed via stitching. If need be, the procedure might be executed on the second testicle too.
Another method of tissue extraction, that does not need a surgical cut, is Needle biopsy. The starting steps are same as an open biopsy. That is, sterilizing of the area and application of local anesthesia is done. After that, a special needle is used to extract a sample of the testicle. This process does not require any cut in the skin.
Imaging – Scrotal Ultrasound
In the cases where the doctor feels that a detailed analysis of testicles is needed, a testicular ultrasound is used. It is an imaging method used to observe and diagnose defects in the testicles. Following are the cases that might motivate your doctor to recommend a testicular/scrotal ultrasound :
- Check whether the testicle has a solid/firm lump. A presence of such a lump indicates the presence of a cyst, a tumor or a fluid-filled-sac.
- If the scrotum area has suffered some physical injury or trauma, this procedure can be used to measure the level of damage sustained by the scrotum.
- Check whether the male partner has a twisted testicle (also called testicular torsion).
- If the male partner is suffering from pain or swelling of testicles, this procedure can be done to identify the causes.
- Detect for and evaluate varicoceles, which are varicose spermatic veins.
- Assess the other causes of infertility.
- If the patient has an undescended testicle, this procedure can help the doctor in locating it.
A scrotal ultrasound can reveal structural or blockage issues in the testicles. To check problems related to the vesicles that transport semen or the ejaculatory ducts, a transrectal ultrasound may be used.
This process involves the analysis of the post-ejaculatory urine for the presence of sperm in the male’s urine. If the sperm is present, this might indicate a retrograde ejaculation (also called dry ejaculation).
Advanced Tests for Male Infertility Testing:
- Blockage of the vas deferens
The epididymis is a twenty-foot-long, tightly coiled duct inside the scrotum that collects sperms from the seminiferous tubules. These tubules are where the manufacturing of sperms takes place. This duct is present in the back of the testis and as the walls of this duct start to thicken and straighten up, it becomes the vas deferens. When the sperms are passing through the epididymis, they mature and gain movement. If there is a blockage in the epididymis, it might prevent the sperm from entering the vas deferens. This blockage can occur either on one side or both the sides. This blockage can be a result of a hydrocele repair or a hernia. If the obstruction is on one side, the patient may have a comparatively lowered sperm count. If the obstructions persist on both sides, this might result in a zero sperm count (also called azoospermia).
Retrograde ejaculation (sometimes called “dry ejaculation”)
Occurs when the semen, that is ejaculated via the urethra, is released back into the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation and consequently forcing the semen to exit via the urethra. If there are any issues with the functioning of the bladder sphincter, then failure may occur in contraction and lead to retrograde ejaculation.
Erectile dysfunction is the case associated with the ability of the penis in staying erect. If you are not able to have a stable erection while having sex or you can see a loss in your libido (interest in sexual activities) or you have a trouble in getting an erection, then you might be suffering from erectile dysfunction.
The study indicates that up to 10 % of couples, who are experiencing infertility or repeated loss in pregnancy, have problems stemming from their genetics. Genetic Testing can play an important role in diagnosing and treating such cases.
Types of Genetic Testing
Pre-implantation Genetic Screening (PGS)
PGS is a last generation genetic test to look for defects associated with chromosomes of the embryos, during IVF cycle. A small biopsy might be performed on the embryos to analyze all 24 chromosome types using an Array Comparative Genomic Hybridization (aCGH), in order to detect aneuploidies (alterations in the number of chromosomes) and select chromosomally normal embryos, who are most likely to develop to term and to be born as a healthy baby, for implantation. The most common syndromes caused by chromosome aneuploidies are Down syndrome, Edwards syndrome, and Patau syndrome.
Who should opt for this procedure?
Risks of having a child with a chromosome abnormality increase with maternal age and most of the spontaneous miscarriages and some of the birth defects are caused by chromosomal abnormalities. This procedure is recommended to:
Pre-implantation Genetic Diagnosis (PGD)
Genetic alterations caused by single gene diseases or mutations are diagnosed via this procedure. Common examples of monogenic disorders are fragile X syndrome, Huntington disease, spinal muscular dystrophies (SMA), Duchenne muscular dystrophy (DMD) and cystic fibrosis. If a couple has a known history of genetic conditions in their families or there are any signals that might indicate that the couple’s baby is at a risk of suffering a genetic disease, this procedure might be their key to a healthy pregnancy.
Endometrial Receptivity Array [ERA]
ERA determines the ideal time-period for transferring the embryo inside the woman’s uterus, to achieve a healthy and successful pregnancy. Cases where this process can help:
If there is a chance that your infertility is related to genetic causes, these tests can help you in identifying the right reason and taking appropriate measures to tackle them.
Risk of Infertility Tests
There aren’t any risks associated with Simple tests like ultrasound, semen analysis or blood tests. On the other hand, special medical procedures like hysteroscopy or laparoscopy may have some chances of facing some problems after the test. But a normal conversation from the doctor can give you an idea of what symptoms you can expect.