Dr. Preeti Tandon
(Specialist Obstetrics & Gynaecology Laparoscopic & Robotic Surgeon. )

MBBS, MD(Obs/Gynae), F.MAS(Laparoscopic Surgeon), FICOG
Diploma in Adv Gynae Endoscopy (France), Certified Robotic Surgery Training (USA).

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Infertility Evaluation And Management

Infertility Evaluation And Management

FAQs

What tests should be included in the initial infertility evaluation?

History

  • The doctor will ask you some particular questions and to try to get some facts or the reason of your infertility.
  • These questions will be related to your medical, surgical, gynecological, and obstetric history. This also includes some questions about your lifestyle questions.
  • A detailed review of examination from other fertility doctors that you have seen is also important.

Physical exam

  • A directed physical exam that can also be included and a pelvic ultrasound should be performed.
  • Ultrasound can also help us identify abnormalities with the uterus, fallopian tubes and/or ovaries. We can sometimes see some signs of pelvic scarring, such as when an ovary appears to be stuck to the uterus area.
  • We get information about the woman's potential for adequate ovarian stimulation with medications by counting antral follicles.

Assessment of ovarian reserve

  • This is also considered as the important assessment of a woman's remaining egg supply.
  • It is done through the blood testing and ultrasound.
  • Blood - day 3 FSH, LH and estradiol hormone testing and AMH hormone levels.
  • Ultrasound - assessment of ovarian volume and antral follicle counts.

Assessment of adequate ovulation

This can be done in myriad ways. About 25% of the cases in infertility is caused by an ovulation disorder. One type of ovulation problem, polycystic ovarian syndrome can be efficiently treated with medications.

Assessment of the Male partner:

It is also essential to assess the male partner for any semen or other abnormalities. A consult with the urologist is generally recommended with some important tests.

  • About 25% of the cases in infertility is caused by a sperm defect and 40-50% of infertility cases have a sperm defect as the prime reason, or a contributing cause.

Blood tests

Depending on the particular couple's situation, a series of blood tests on either the female or the male may be performed. Blood tests that might be needed include day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), AMH, prolactin, testosterone (T), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating hormone (TSH).

If there is a history of recurrent miscarriages (2 or more) a lupus anticoagulant (LAC) and anti-cardiolipin antibody (ACL) are often done with some additional tests.

Immunological testing has not been proven to have any value in infertility patients without a history of 2 or more miscarriages.

Testing for tubal patency and normalcy of the uterine cavity with a hysterosalpingogram

The hysterosalpingogram or HSG is done to assess the anatomy of the endometrial cavity of the uterus and the fallopian tubes. The HSG is generally performed between days 6 and 13 of the cycle - after bleeding and before ovulation.

  • This test is generally conducted in a radiology facility.
  • About 25% of the cases in infertility is due to a tubal factor.

Laparoscopy

  • This is a kind of surgical procedure and should not be conducted until the basic testing has been done on both partners.
  • In many cases, laparoscopy for infertility will be act as trepidation to look for pelvic scarring orendometriosis.
  • As in vitro fertilization, success rates have increased unprecedently over the past 20 years, laparoscopy for infertility is done much easier than before.
  • Most couples skip the invasive laparoscopic surgery and do treatments with intrauterine inseminations and then IVF if inseminations are not successful.

What next:

After the initial phases of consultation and evaluation of the recommended diagnostics, Dr Preeti Tandon will assist you through the myriad fertility options available. Accordingly, then you maybe started on some other pertinent treatment options to ensure that you are on your way to a successful conception and easier initiation into pregnancy and child birth.