How is infertility diagnosed?
Male infertility diagnosis
Male fertility depends on the production of a sufficient number of healthy sperm by the testicles. These sperm need to be ejaculated into the vagina and then travel through the reproductive tract to reach the egg. Evaluating male infertility aims to identify and treat any issues that may occur at any of these important stages.
A physical examination, which includes checking the genital area, may be done. Specific infertility assessments may include:
Semen Analysis: Your healthcare team may ask for one or more semen samples. Usually, you provide these samples through masturbation or interrupting sexual intercourse to ejaculate into a sterile container. The laboratory will then analyze the semen sample. In some cases, urine may also be tested to check for the presence of sperm.
Hormone Testing: A blood test may be done to evaluate your testosterone and other male hormone levels. Hormonal tests assess the levels of testosterone and FSH (follicle-stimulating hormone) to understand the overall hormonal balance and the specific state of sperm production. If the initial tests suggest the need for further examination, serum LH and prolactin may also be conducted. It is suggested to measure testosterone levels beside others.
Genetic Testing: Genetic testing may be performed to determine if a genetic abnormality is causing the infertility.
Testicular Biopsy: This procedure involves taking a small amount of testicular tissue for microscopic examination. While it's not commonly required during infertility testing, it may be done in specific cases to investigate potential blockages in the reproductive tract that may be hindering the release of sperm in semen. Usually, the diagnosis is based on your medical history, physical examination, and laboratory tests. Sometimes, a biopsy may be used to identify conditions contributing to infertility or collect sperm for assisted reproductive techniques like in vitro fertilization (IVF).
Imaging: In some situations, your healthcare team may recommend imaging tests to produce internal body images. For example, ultrasound can detect issues in the scrotum, the glands responsible for semen production, or the sperm-carrying tube originating from the testicles. Additionally, a brain MRI may be used to check for noncancerous tumors in the pituitary gland, which can cause excessive production of prolactin hormone and potentially affect sperm production.
In rare cases, additional tests may be conducted to assess the quality of your sperm. For example, a semen sample may need to be examined for DNA-related problems that could harm sperm.
Women infertility diagnosis
A woman's ability to conceive depends on the healthy release of eggs from the ovaries. The reproductive process involves the movement of an egg through the fallopian tubes, where it can be fertilized by sperm. Afterwards, the fertilized egg needs to travel to the uterus and successfully implant into the uterine lining. Tests for female infertility aim to identify potential issues at any of these important stages.
The assessment may include a physical examination, including a regular pelvic exam. Diagnostic tests for infertility may involve:
Ovulation Testing: This includes a blood test to evaluate hormone levels and determine if ovulation is occurring.
Thyroid Function Test: If there are suspicions of thyroid gland problems contributing to infertility, a blood test is done to assess thyroid hormone production. Imbalances in thyroid hormone levels can affect fertility.
Hysterosalpingography: This procedure examines the condition of the uterus and fallopian tubes, looking for blockages or other issues. A special dye is injected into the uterus, and X-rays are taken to visualize the reproductive structures.
Ovarian Reserve Testing: This test helps the healthcare team assess the number of eggs available for ovulation. The process often begins with hormone testing early in the menstrual cycle.
Hormone Tests: These tests focus on hormone levels that regulate ovulation and control various aspects of the reproductive process.
Imaging Tests: Pelvic ultrasound is used to detect any uterine or ovarian abnormalities. Occasionally, a saline infusion sonogram, also known as a son hysterogram, may be used to visualize detailed information within the uterus that may not be visible with a regular ultrasound.
In rare cases, additional testing may be required, including:
Hysteroscopy: This procedure may be recommended based on specific symptoms. A thin and illuminated hysteroscope is inserted through the cervix into the uterus to examine for any irregularities. It can also assist in guiding minor surgical interventions.
Laparoscopy: Laparoscopy involves making a small incision below the navel, through which a thin viewing device is inserted to examine the fallopian tubes, ovaries, and uterus. This procedure can identify conditions such as endometriosis, scarring, blockages, or other issues with the reproductive organs. Laparoscopy can also be used as a surgical method to treat certain conditions like fibroids or endometriosis tissue.
It's important to note that not every individual undergoing infertility evaluation needs all of these tests, and the selection of tests and their timing are determined through collaboration between you and your healthcare team. The goal is to identify the cause of infertility through a personalized diagnostic approach.
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