Infertility affects one in every six couples and it affects 15% of couples in the reproductive age group. Nowadays male factors become the most common cause of infertility accounting for about 40% of cases and female factors also contribute 30 -40%.
Timing to ask for fertility help:
Fertility depends on four main three factors
1. Ovulation and egg release,
2. Tubal patency ,
3. Normal uterine cavity and receptive endometrium.
4. semen quality of male partner.
If everything is ok then the chance of getting pregnant in a month is 5% .when it is about one year of trial the chance of successful pregnancy becomes 80%. Now the couple who has tried for more than 1 year but couldn’t conceive seek help from doctors.
Early evaluation is needed
❖ Women over 35 years of age
❖ history of past radiotherapy chemotherapy
❖ Stage 3 -4 endometriosis
❖ known case of male infertilityEvaluation:
I. evaluation of female infertility
❖ History
A thorough medical history and personal history is very important.
Duration of infertility,
previous pregnancy history,
Previous surgical history ,
occupational history are also taken.
❖ Physical examination
always see body mass index,
any medical disorder,
sign of androgen excess vaginal of cervical abnormality.
❖ Tests
A. Ovulatory function evaluation :
age is an independent and most important prognostic factor
transvaginal sonography on Day 2 or day 3 off period to see the antral follicle count so very important.
In blood test AMH & day 3 fsh also assess the ovary and function
B. Tubal factor test:
1. HSG is a radiographic investigation to evaluate the fallopian tubes by injecting a radiocontrast media or water soluble media through the cervix into the uterine cavity. It is typically done between day 62 day 10 of period and it can detect any tubal block 65% sensitivity and 83% specificity.
2. HyCoSy here the tubal patency is seen with USG by visualising intratubular flow of high contrast medium which allows to the detection of any tubal block. It is very less painful and Pizza new technique to see tubal patency.
3. Laparoscopy with K Mohapatra Pareshan is the gold standard method to see the tubal patency.
C. Evaluation of uterus :
1. pelvic scan can help us to understand the uterus and the adnexal structure. With the invention of 3D ultrasonography and MRI nowadays many pathology of uterus can be detected.
2. Saline infusion sonography is an advanced technique where we in steel water in the uterine cavity and do you wish evaluations of the cavity to see any structural abnormality.
3. Hysteroscopy is the gold standard to diagnose intrauterine pathologies.
D. Hormonal test :
Basic thyroid function test, sugar test blood for prolactin can help us to understand any contributory factors of infertility.
II. Evaluation of male infertility
❖ History
Duration of fertility ,
age of the husband,
previous fertility with same or different partner,
coital frequency and timing
nature and volume of ejaculate can help us to understand many of the pathologies.
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- in medical history always see chronic medical disease post pubescent mumps ,onset of puberty any history of testicle trauma ,any post surgeries in the groin region, chronic medical drug use history of any chemical a radiotherapy.
- Physical examination is done to see the position of the bilateral testes presence of any hydrocele or vericocele.
❖Tests:
1. Semen analysis is the main cornerstone of evaluating male factor infertility it is typically performed after 2 to 3 days of abstinence and is evaluated for its count, motility and structure . They are specified who criteria a sample to be normal.
2. Hormonal test
It is not a routine test of male infertility evaluation. it is only done if
the sperm concentration is less than 10 million per ml,Where there is an impaired sexual function such as decrease volume of ejaculate and libido,
Clinical findings suggestive of a specific specific endocrinological problem.
FSH, LH testosterone are mainly evaluated in case of male infertility to understand the particular cause.