Menstrual history including the regularity of cycles, amount of flow, pain during cycles, recent change in pattern of cycles, missed periods, medications, recent weight gain, stress, food habits and lifestyle are elicited. Clinical examination of the reproductive tract and a basic transvaginal ultrasound of the pelvis to look for ovarian volume, presence of polycystic ovaries, uterine cavity assessment endometrial thickness is the first set of tests done for women.
Second tier of investigations in the female partner
The second tier of investigations include female hormone profile (preferably on second day of cycles), additional blood tests like thyroid hormone levels and prolactin in some women. Ultrasound (Transvaginal) guided follicular monitoring (from second day of cycles), anti mullerian hormone and hysterosalpingogram are done in select patients.
Causes of male infertility
Advanced testing in women
Diagnostic laparoscopy (with tubal patency assessment) is done for women with suspected pelvic endometriosis or blockage in the tubes and associated polycystic ovaries or uterine abnormalities. It can be combined with diagnostic (± therapeutic) hysteroscopy.
How is treatment planned?
Once all the investigations of husband and wife are completed, treatment is planned based on the age of the female partner, years of married life, previous treatment failures or miscarriages, egg reserve and sperm quality.
The couples have options like assisted natural conception, assisted reproduction techniques like intra uterine insemination, test tube baby technique which includes IVF and ICSI. After successful embryo transfer the women would be expected to be on hormone therapy till the placenta takes over.
Is there a chance of defective babies after IVF?
The final myth that babies born out of assisted reproduction will be genetically defective is wrong. Though there is a slightly increased chance of congenital abnormalities, we perform scans, blood tests and special diagnostic procedures like PGS in in specialised circumstances and in women with recurrent pregnancy losses, as such the babies born out of assisted reproduction are normal.
Repeated miscarriages/ abortions
Repeated miscarriages is a distressing problem. Both female and male partners might be completely normal but still the couple will be facing repeated miscarriages. We do some investigations, assess the uterine cavity and endometrial receptivity assay to see if there is a problem with the embryo getting attached to the uterine wall. There are also some medications help in successful implantation of the embryo to the uterine cavity.
In case you are suffering from infertility visit the andrologist and the reproductive medicine expert to get yourself assessed and soon successfully carrying your baby inside.