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Tests and diagnosis discussion for Female infertility:
The first step for the women to determine, is if she is ovulating properly every month, this can be done by charting the body temperature in the morning using an ovulation kit( which is available over the counter), by examining the cervical mucus, which undergoes a series of hormonal changes throughout the menstrual cycle
Tests on ovulation can be done in the doctor's office with a blood tests , that are used for ultrasound tests of the ovaries hormone levels. Further tests would be conducted if the woman ovulates further.
Common female tests include:
Hysterosalpingogram: Is a test that is taken with a help of an x-ray of the fallopian tubes and uterus, where a dye is injected , to show the shape of the uterus and if the tubes are open
Laparoscopy: A test done to examine the female organs , the tubes, for disease, using a small light -transmitting tube called a laparoscope. The test is done when the woman is under general anesthesia, the tube is inserted in the abdomen through an incision.
Endometrial biopsy: An examination of a small shred of uterine lining to see if the monthly changes in the lining are normal.
Male Partner Semen Analysis: It is essential that part of the infertility evaluation. A semen analysis provides information about the number, movement and shape of the sperm, it is necessary even though your partner has fathered a child before
Trans-vaginal Ultrasonography: To check the uterus and ovaries for abnormalities such as fibroid and ovarian cysts, and ultrasound probe is placed in the vagina
Ovarian Reserve Testing: Is when the doctor is trying to predict whether she can proceed an egg or eggs of good quality and how well her ovaries are responding to the hormonal signals from her brain
To evaluate the ovarian reserve is a blood test which is follicle-stimulating hormone(FSH) done on cycle day 3 in addition to these tests the doctor may recommend other blood tests , such as estradiol, antimullerian hormone(AMH) /or inhibin-B, as well trans-vaginalnal ultrasound , also considering doing an antral follicle count (that is the number of follicles or egg sacs seen the early part of the menstrual cycle)
Woman who have a high risk of reduced ovarian reserve, testing is important , in woman who are:
Woman who are aged over 35 years
history of menopause
radiation therapy of the pelvis, or history of ovarian surgery, or chemotherapy
gonadotropin ovarian stimulation a poor response
Other Blood Tests: Thyroid-stimulating hormone (TSH) and prolactin levels are useful to identify thyroid disorders, problems caused by infertility hyperprolactinemia, menstrual problems and miscarriages. Women who have an overgrowth of hair called hirsutism (including hair on the face chest and abdomen, blood tests for dehydroepiandrosterone sulfate (DHEAS), 17-a hydroxyprogesterone, and total testosterone should be considered. To check whether the ovulation has occurred , a blood progesterone test can help to evaluate that.
Urinary Luteinizing Hormone (LH): Ovulation predictor kits, with the help of them you can detect the presence of LH in the urine, and also the rise in hormones that happens one to two days before ovulation, the test of blood progesterone and urinary tests can predict the ovulation, even before you can ovulate . These tests like urinary LH can help in detecting the greatest fertility the day of the test LH surge and the following 2 days. These tests are pretty expensive , are are only recommended for woman who have lengthy cycles 35-40days
Sonohysterography: Is a process , this procedure uses trans vaginal ultrasound filling the uterus with saline(salt solution), doing this helps to detect intrauterine problems, like endometrial polyps, fibroid compared with trans vaginal ultrasonography
This procedure uses trans-vaginal ultrasound after filling the uterus with saline (a salt solution). This improves detection of intrauterine problems such as endometrial polyps and fibroids compared with using trans-vaginal ultrasonography alone. If an abnormality is seen, a hysteroscopy is typically done. This test is often done in place of HSG.
Hysteroscopy: To view the inside of the uterus , a surgical procedure which is a lighted telescope like instrument called hysteroscope is passed through the cervix. This procedure can help diagnose and treat the conditions of the uterus like fibroid s , polyps (scar tissue)
What is HSG - Hystero Salpingo Gram?
What is the right time to undergo the test ?
It is done once the menstrual bleeding is stopped, preferably between 5 - 10 days after cycle.
Purpose of test ?
To Test the tubal patency (functionality)
Importance of tubal patency ?
The fallopian tube is a passage where the sperms swim to the terminal portion, meet the eggs and fusion (fertilization) takes place . The terminal portion of tube is the broadest portion to facilitate this process. Once fertilization has happend, the zygote and subsequent embryo move backwards and reaches the uterus around 6th day and undergoes implantation and further, the embryo becomes the foetus and grow for the remaining 9 months. So the fallopian tube holds 3 function.
1.Movement of sperm & reaching the eggs.
2.Process of fertilisation
3.Movement of developing embryo back into the uterus.
How is it done ?
It is done with the assistance of x-rays. The female partner is made to lie down in xray table. A small instrument (speculum) is placed to widen the vagina and by small canula, dye is injected into the cervix and uterus. The dye passes through, as sperm does and goes via the fallopian tube and spill into both ovaries. If there is no spill, there is a possibility of blockage, from the place where dye has stopped. This is confirmed by a serial of x-ray films. It is a safe procedure
Why this procedure is needed ?
A couple seeking infertility treatments, at times may have normal ovarian / testicular reserve. A block in the passage can hinder the fusion, leading to infertility. Tubal blocks need not be symptomatic and picked up only on screening. Hence it is mandatory.
Is it painful ?
It has mild discomfort. The sensation is slightly more than the pain perceived during intercourse (coitus)
We as a policy, give intramusscularpainkiller injection (IM) 15 to 30 minutes before the procedure, to reduce the pain.
Do I need to fast (empty stomach) on the day of procedure ?
No need you can have your routine diet.
What is the post procedure advice ?
You can travel back via road (Two / Three / Four Wheeler) / train / flight immediately after the procedure.
Medicines to avoid infection and pain will be given for 3 days. These medicines can be taken with other medicines / fertility supplements
You can resume to work on the same day.
Some female partners can encounter mild spotting for 2-3 days. It is normal.
What if a block is found ?
If a block in present, it can be removed by hystero laprascopy.
Sometimes the test is in conclusive if a female partner is unable to cooperate, the os is patulous or the cervix is very tight.
In such circumstances we suggest to undergo Diagnostic Hysterscopy & laprascopy.
When a female partner has to undergo this test?
A women after 1 year of married life, had a adequate / normal sexual relationship failed to conceive is better to undergo the procedure.
Can we skip HSG test
If you are anxious / want to avoid pain you can plan for Hystero laproscopy, it is done under anaesthesia.
When HSG has to be repeated ?
If a female partner has crossed 2 years after the last HSG, it is better to reconfirm the tubal patency or as recommended by the Specialist
It is mandatory to confirm a tubal patency before IUI is planned.
What other information HSG can provide other than blocks ?
In some female partner, HSG can provide in the following valuable information like