Diagnosis of Infertility

Like always, we would again re-iterate the fact that what attempts to defeat the grim statistics is the remarkable increase in the popularity of Assisted Reproductive Technology Training Programs. It is not unknown to us that the stigma associated with infertility has slowly started to decrease and people are now willing to seek help. Thankfully, with the dedicated Assisted Reproductive Technology Training Programs available, they can now count on embryologists, clinicians, doctors and alike to give them that lost hope.

The main reasons behind infertility in a couple can be briefly summarized as follows.

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However, the diagnosis is the most important step. Artificial Reproductive Technology Training Programs focus on an error-free diagnostic process.

1. Male factor testing:
Semen analysis is the single best test for evaluating for male factor infertility.
Abstinence is required 3-5 days prior to semen collection for optimum and consistent results. The World Health Organization (WHO) has established methods and set many reference values for semen analysis, but methods may vary among facilities.

Another commonly used method for evaluating morphology is the strict Kruger method. Although no particular measurements can be used to discriminate between fertile and infertile men, odds of male infertility increase with increases in the number of semen parameter abnormalities. The Halosperm test and the Sperm Chromatin Structure Assay (SCSA) have been devised to evaluate the DNA fragmentation of sperm.

2. Ovulatory Function Testing:

For patients to become more accustomed to predicting ovulation so that they can appropriately time intercourse, they may wish to initiate basal body temperature monitoring or use luteinizing hormone (LH) detection kits.
BBT monitoring best serves as a method to confirm the time of ovulation and helps the patient to predict future cycles based on data she has gathered over prior cycles. This method is inexpensive but time-consuming and cumbersome. A deficiency in progesterone production by the corpus luteum (CL) has historically been attributed to infertility and recurrent pregnancy loss in many women with otherwise unexplained miscarriages.

3. Ovarian reserve testing:

Initial testing usually includes cycle day 3 laboratories including follicle stimulating hormone (FSH), estradiol (E2), and luteinizing hormone (LH). Typically, if the FSH level is greater than 15 mIU/mL or the estradiol level is greater than 75 pg/mL, the prognosis is poor. Day 3 antral follicle scans and ovarian volume may also be used to evaluate ovarian reserve and are simple and accurate.
In patients older than 40 years or for whom poor ovarian reserve is suspected, a clomiphene citrate challenge test may be performed.

4. Tubal disease testing:

The HSG is a radiographic technique in which a dye is injected into the cervix. This dye fills the uterus and eventually the tubes. If the tubes are patent, dye spills out into the abdominal cavity. The test requires approximately 10 minutes for completion. This procedure is primarily diagnostic, but it may possibly be therapeutic (for approximately 6 mo), primarily when using an oil-based dye. Additionally, it provides imaging of the uterine cavity.

5. Cervical disease testing:

Women who have had cervical cone biopsies or trauma to the cervix are at risk for cervical abnormalities and cervical stenosis. If a cervical abnormality is found, the most logical approach is to recommend bypassing the cervix with intrauterine inseminations (IUI), especially if the rest of the findings from the infertility evaluation are normal.

6. Testing for endocrine abnormalities:

If the patient displays hirsutism, with or without menstrual irregularity, androgen studies such as dehydroepiandrosterone sulfate (DHEA-S), total testosterone, and 17-hydroxyprogesterone should be performed. If unusual weight gain or fatigue develops, a thyroid-stimulating hormone (TSH) should be obtained.

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