In order to properly diagnose infertility, we have outlined a basic description of tests administered:
Hormone analysis
Hormone analysis consists of quantifying principal female sex hormones to ensure there are no endocrine issues affecting menstrual cycle and conception:
- FSH: Follicle-stimulating hormones are secreted by the pituitary gland and stimulate ovaries so follicles – cells surrounding the eggs – can correctly mature.
- Oestradiol: Hormones produced by cells which surround the egg as it matures inside the follicle.
- LH: Often referred to as luteinising hormones or lutropin, the hormone is secreted by the pituitary gland. Controlling the menstrual cycle in tandem with FSH, they increase considerably in the middle of a menstrual cycle (peak LH) to induce ovulation.
- Progesterone: produces the remaining follicles of the ovary after ovulation (corpus luteum) so the endometrium is receptable to embryo implantation after the egg has been fertilised. If implantation is carried out, the hormone will be secreted by the placenta to maintain pregnancy.
- Anti-Müllerian hormones (AMH): Produced by the ovarian follicles, the hormone is proportional to the amount of eggs available in the ovary and is used to measure ovarian reserve.
Measuring hormones aims to assess the functionality of the pituitary gland and ovaries. Tests for FSH, oestradiol, prolactin and LH should be administered between days two, three or four of the menstrual cycle, or in other words, between the third and fifth day of menstruation. This is a basal analysis of hormones recorded between the first few days of a menstrual cycle.
In contrast, progesterone needs to be quantified between days 21 and 23 of a menstrual cycle to verify if ovulation has happened. Anti-Müllerian hormones are usually measured on days three and five, although can be evaluated at any time during a menstrual cycle as levels do not vary.
It is also possible to request a basal analysis of hormones TSH (thyroid stimulating hormone), free thyroxine (T4), free triiodothyronine (T3), prolactin and testosterone. While not sex-related hormones, if levels are incorrect, can directly impact the hormones which do control menstrual cycle and ovulation. Therefore, in order to measure hormone levels, a two blood tests are submitted: one at the beginning of a menstrual cycle and a second towards its conclusion.
Various tests are also carried out to detect sexually transmitted diseases (STDs), bacterial infections or viral contagion which may affect fertility.
Gynaecological Test
Administered to test uterine anatomy and ovary conditions.
- By means of a transvaginal ultrasound scan, the uterus and ovaries can be examined. This test is used to check for any uterine malformations or anatomical complications, as well as count antral follicles in the first days of a menstrual cycle.
- In order to perform such inspection, the gynaecologist inserts a probe covered by a condom into the vagina using a lubricating gel. This probe sends out sound waves which project the structure of the uterus and ovaries onto a screen as they bounce off organs. While there may be slight discomfort from the pressure of the probe, the test is considered painless.
- Pap smear. The test is recommended to examine if there is any infection or change in cells which could affect fertility and is executed by gently scraping the cervix for aforementioned cells.
Hysterosalpingography
Hysterosalpingography is administered to find out if fallopian tubes are permeable. Hysterosalpingography or uterosalpingography is a diagnostic test used to view the structure of a uterus and function of the fallopian tubes using x-rays (radiography) and a contrast medium.
If tubes are not permeable, sperm required for fertilisation will be unable to pass through, while if there is any abnormality in the structure of the uterus or tubes, conceiving may become difficult.
In order to undergo hysterosalpingography, a catheter is inserted into the cervix using a radio-opaque liquid contrast and circulated through the cervix, uterus, tubes and later the pelvic cavity to determine any potential blockage.
This procedure can be used to diagnose:
- Structural uterine malformations.
- Abnormal formations in the uterus such as myomas, polyps or adhesions.
- Pathologies which inflame tubes such as salpingitis.
- Pathologies which obstruct tubes such as hydrosalpinx.
The liquid contrast used in hysterosalpingography can unlatch fallopian tubes and permit women to fall pregnant naturally once there is no longer blockage.
Other fertility studies can be done depending on the needs of each individual as there are as many types of patients as there are people in the world.
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