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Investigation in Infertile Couple

 What are the Tests and investigations done in infertile couple ?

1.  A detailed history and physical examination of both partners
2 .  Basic  blood tests for both partners,
3.  Hormonal evaluation to test the ovarian reserve for the female partner (usually done on day 2 or day 3 of menstrual cycle)
FSH and AMH are done to assess the fertility potential Thyroid and prolactin hormones abnormalities
(interferes with ovulation and Causes  infertility.)
4.semen analysis for the male partner.

(For conception there must be the release of egg and a mature sperm with the ability to   
 meet in a timely fashion allowing fertilization to occur. After fertilization, the embryo needs  to be transported to a receptive uterus for pregnancy to occur.

So we need to answer four basic questions

1.Is the woman ovulating?
2.Are there adequate motile sperms?
3. can the egg and sperm meet?
4.can implantation occur and be maintained?

Assessment of Ovulation

women with history of regular, cyclic menses varying within 2 to 4 days is indicative of      
ovulation in 95% of cycles.

Women with irregular periods (<21 days or >35 days ) is probably not ovulating and should be investigated.

Inexpensive Home monitoring Tests to predict ovulation.

Basal body temperature chart

The temperature of human body is 98.6 F during first half of menstrual cycle before ovulation, the temperature ranges from 97.2 to 97.4F. It will rise to above 98 F during ovulation and it will remain for the rest of 14days.

If you choose to use BBT to time ovulation intercourse should occur overy 48hrs during 5 to 7days period around the time of ovulation –[ 3-4 days before and 2-3 days after the temperature shift.]

Ovulation prediction kit

During regular menstruation, LH level will peak before ovulation. LH surge can be assessed by daily testing of urine sample in morning at mid cycle{ day 12 to day 16 of menstruation] 95% of time ovulation can be expected to occur 24to 48hrs after LH positive test. LH peak is present when urine test shows equal /dark colour than the control.

Assessment of sperm

Accurate information of sperm concentration ,motility and morphology can be obtained  by this simple,inexpensive test.

Sample is collected by masturbation in a private room in the fertility center; There should be a minimum of 3-5 days abstinence before producing a sample.

A normal semen sample should have

1. Sperm counts : more than 20 million  per ml

2.  Motility: In a normal sample at at least 50% of sperms should be motile and 30% of
sperms should have normal morphology(shape).

If a single test is abnormal, it should be repeated again in 2 to 3 months because sperm production requires 72 days.If the semen parameters are abnormal in three consecutive tests, the male partner should be treated.

Assesment of Tubes

Hysterosalphingosram is a test done to see the presence of normal internal uterine cavity and open tubes.

HSG is performed between 7thTo 10thDay of your menstrual cycle. It is performed as outpatient basis with x ray facility. Dye is injected into the cavity and on a TV screen you can see the dye flowing out through the tubes in to abdominal cavity.

If HSG is normal, you can continue attempting pregnancy in that cycle, If HSG is abnormal further evaluation with Laparoscopy is essential.

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