Infertility Evaluation

Infertility

Most couples have a strong desire to have a child. Most couples (approximately 85%) will achieve pregnancy within one year of trying. An additional 7% of couples will conceive in the second year.

Infertility has come to be defined as the inability to conceive within 12 months, a diagnosis shared worldwide by about 15% of couples, but a percentage that is increasing.

If a couple who fail to conceive seek the help of a reproductive endocrinologist and infertility specialist within 12 months, then the chance of achieving a pregnancy is very high.

However, there are other conditions where it may be advisable to seek help earlier. These include;

Female Age factor

Female Age factor

Female age-related infertility is becoming the most common cause of infertility today. As women age increases, egg numbers decrease at a rapid rate, as does the eggs’ quality and likelihood of the eggs being genetically normal. The ability to conceive a normal pregnancy decreases rapidly when a female is in her late 30s and early 40s. A woman is rarely fertile beyond the age of 45 with her own eggs. We recommend a fertility evaluation if a couple has been attempting for natural pregnancy for 6 month or more when the woman is 35 years of age or above.

Known Male factor

Known Male factor

Male factor infertility has been associated with 40-50% cases of infertility cases. It is also the sole cause for infertility in 15-20% of cases. If a semen analysis is found to be abnormal, generally it will be repeated to confirm the abnormalities. Some changes in lifestyle (quit smoking) or a period of medication could be helpful to increase the fertility of semen. Clinicians may consider further treatments such as hormonal treatments, sperm collection by PESA/TESE, and additional fertilisation procedures such as Intracytoplasmic Sperm Injection (ICSI), pICSI or Sperm MACS maybe considered.

Uterine abnormalities

Uterine abnormalities

Uterine abnormalities such as Fibroids and Endometrial polyps can reduce the chance of pregnancy. Uterine Fibroids, which are very common among women, are grouped in three types; Subserosal, Intermural and Submucosal. The Submucosal Fibroid is affecting the chance of having a successful pregnancy in women. However, their removal can bring the chance of pregnancy up to normal rate. Endometrial Polyps are finger-like growths in the uterine cavity arising from the lining of the uterus. This can reduce the fertility by 50%. Similar to Fibroids, the Hysteroscopy procedure to remove the endometrium will bring the pregnancy rate to almost normal.

Tubal Occlusion (Blockage)

Tubal Occlusion (Blockage)

A history of sexually transmitted infections including Chlamydia, Gonorrhea or Pelvic Inflammatory disease can cause a blockage in fallopian tubes in women. This will prevent the ovulated egg and the sperm from reaching each other, and the egg will not be fertilized by the sperm and will not reach the endometrial cavity. In cases where both tubes are blocked, an IVF procedure is required, however in some cases minimal invasive surgery (Laparoscopy or Hysteroscopy) is recommended.

Endometriosis

Endometriosis

Endometriosis is the condition when the cells similar to the ones lining the uterus wall are found outside the uterine cavity. Endometriosis is found in approximately 10-50% of reproductive aged women and it can cause infertility by producing inflammation, scarring and obstruction of the ovaries. It is common to have it surgically removed to reduce the pain and improve the fertility.

Unexplained / other factors

Unexplained / other factors

Sometimes the full evaluation of infertility does not reveal the cause. This can occur about 15% of the time. Fortunately, even when the cause of infertility is unknown, various fertility treatments can overcome the issue and eventually lead to a successful pregnancy.

Fertility Evaluation and Testing

History and physical examination

History and physical examination

First and foremost, your fertility clinician will take a very thorough medical and fertility history. Many other questions will help your clinician design a specific evaluation and potential treatment for you. In addition to a careful history, a physical evaluation may also be performed.

Transvaginal ultrasound

Transvaginal ultrasound

Ultrasound is an important tool in evaluating the structure of the uterus, tubes, and ovaries. It also allows your clinician to assess the relative number of available eggs. This measurement is called the antral follicle count and may correlate with fertility potential.

Laboratory testing

Laboratory testing

Your clinician will request a series of pre-IVF blood tests, and dependent on your history perhaps some specific blood tests. The most common tests are blood levels of certain hormones such as AMH (anti-mullerian hormone), estradiol, FSH, etc. which are related to ovarian function and overall egg numbers. There will also be general blood tests such as CBC, Hb typing, viral test, etc.

Hysterosalpingogram (HSG)

Hysterosalpingogram (HSG)

May be ordered dependent upon your medical history. This test is essential for evaluating fallopian tubal patency, uterine filling defects such as fibroids and polyps, and scarring of the uterine cavity.

Semen analysis

Semen analysis

The semen analysis is the main test to evaluate the male partner, and includes semen volume, sperm concentration, sperm motility or movement, and sperm morphology or shape. An abnormal semen analysis may require further evaluation or use of specialist semen collection techniques or fertilisation methods.