Male diagnostic testing
The primary investigation for diagnosing male infertility. It is performed after 2-5 days of abstinence.
A semen analysis, tests three basic sperm features:
- Sperm concentration
- Sperm motility
- Sperm morphology
According to the WHO’s 5thEdition, normal semen parameters could be considered:
- Volume: 1.5ml or greater.
- Total Sperm (millions in ejaculate): 39 million or greater.
- Concentration Count (millions per ml): 15 million or greater.
- Motility: 40% or greater.
- Morphology by WHO standards: 30% or greater.
A normal semen analysis will lead the clinical investigation to the female partner. An abnormal sperm analysis may be repeated after 15 days to three months. The entire process of sperm cell maturation takes around three months and normal fluctuations are observed (e.g. due to smoking, alcohol, medicine, stress, etc). It is likely that a sperm analysis may coincide with a “bad” spermatogenic cycle. If a second semen analysis diagnoses abnormal sperm parameters, then male contribution to the infertility cause is confirmed.
Female diagnostic testing
This is one of the most important diagnostic tests for the female. HSG is an X-ray of the uterus and fallopian tubes. During HSG, a radiographic contrast dye is injected into the uterus through the cervix. Then, a series of X-rays are taken, in order to confirm that the dye fills the fallopian tubes and spills into the abdominal cavity. If it does, then fallopian tubes are patent – a prerequisite for the fertilized egg to be transferred to the uterus. HSG has also the advantage of assessing the uterine cavity for defects. (e.g. uterine septum, bicornuate uterus).
If a woman has a menstrual cycle, and no conception occurs, her hormone levels should be tested. Blood for hormone testing should be taken on the first days of the menstrual cycle (on the second and third days of the cycle).
These tests measure the levels of certain hormones (e.g. FSH, LH, oestradiol, prolactin, and progesterone). Anti- Mullerium (A.M.H), FSH, LH and oestradiol levels give information on the aging of the ovaries, meaning the reservoir of eggs present in the ovaries (a woman is born with a reservoir of 1.200.000 oocytes that until puberty reaches 300.000-400.000 oocytes and is constantly declining).
Together with hormone testing, a baseline ultrasound scan is performed on the first days of the menstrual cycle. An ultrasound scan can diagnose abnormalities of the ovaries and the uterus.
Laparoscopy – hysteroscopy
Laparoscopy combined with hysteroscopy provides information about the female reproductive tract (uterus, fallopian tubes, and ovaries).
If a surgeon visualizes an abnormality (e.g. adhesions) at the time of examination, it is possible – in some cases – to treat the problem during the same procedure, avoiding a second operation. In other words, this examination has diagnostic and therapeutic value, regarding infertility. This means, that the couple can continue trying to conceive having regular sexual intercourse (if sperm parameters are normal).
If the cause of infertility is more complicated (e.g. when a woman has one fallopian tube removed in a previous operation and the other tube is blocked) then the couple should seek infertility treatment.
There is evidence to suggest that it is not necessary for an infertile woman to undergo laparoscopy – an operation performed under general anesthesia – before In Vitro Fertilization (IVF) treatment. Most specialists, agree, that laparoscopy is indicated when:
Preliminary testing shows abnormalities of the fallopian tubes or the uterus.
The woman has a medical history of pelvic inflammatory disease.
There is a high suspicion of endometriosis.