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Investigations for men

A preliminary male fertility investigation contains a medical history, physical examination, general hormone tests and one or more semen analyses, which measure semen volume as well as sperm number, ability to move spontaneously and quality of motion.

Male fertility needs that the testicles produce adequate vigorous sperm and that the sperm is ejaculated efficiently into the woman’s vagina and travels to the egg. Tests for male infertility attempt to regulate whether any of these processes are impaired. You may have an overall physical exam, with the investigation of your genitals.

What is included in a detailed fertility test?

Medical History

Preliminary requests may include:

• An evaluation of previous medical history, prior surgeries and medications used
• A conversation of family history of infertility or birth defects
• A cautious analysis of social history and occupational hazards to estimate potential exposure to hazardous substances that could impact fertility

Physical Exam

Physical examination is conducted to evaluate the pelvic organs — the penis, testes, prostate and scrotum, etc.

Laboratory Tests

Laboratory tests may include:

  • Seminal Fluid Analysis Test — the evaluation assesses sperm motility or movement, the shape and maturity of the sperm, the volume of the ejaculate, the actual sperm count and the liquidity of the ejaculate. Liquefaction time (semen starts out viscous and over time should become watery) and pH of semen (how acidic it is). For around 40% of couples who are having difficulties conceiving, the cause of their infertility is sperm-related. Semen is usually obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A lab analyzes your semen specimen.
  • Seminal Fructose Test — To identify if fructose is being added properly to the semen by the seminal vesicles
  • Post-ejaculate Urinalysis — To determine if obstruction or retrograde ejaculation exists. In some cases, sperm may be tested for in the urine.
  • Semen Leukocyte Analysis — To identify if there are white blood cells in the semen
  • Kruger and World Health Organization (WHO) Morphology — To examine sperm shape and features more closely
  • CASA with DNA Fragmentation – Computer Assisted Seminal Analyzing

What are the main methods to collect a semen sample?

  1. Masturbation
  2. Sex with a condom
  3. Sex with withdrawal before ejaculation
  4. Ejaculation stimulated by electricity

 

Masturbation is considered the preferred way to get a clean sample.

Testicles are constantly producing sperm. During ejaculation, the sperm stored in your epididymis are shot out and fresh sperm come in. It takes 3 days to completely refill the epididymis. Testing too soon after ejaculation will usually show a lower sperm count than your average.

Essential things you should know about the fertility test

  • You will be asked to abstain from both intercourse and masturbation for at least 3 days before the sample is collected. This will help make sure your sperm count is at its highest level.
  • A fertility specialist may also advise alteration to positive lifestyle issues, such as avoiding alcohol, caffeine and some medications in the days leading up to the sample production.
  • Wash your hands carefully before producing the semen sample.
  • The sample should be produced into a sterile specimen pot (provided by your fertility centre). The pot will need to be labelled with your full name, date of birth, and date and time of ejaculation. If these facts are not present, the sample will not be analyzed.
  • If you choose to produce a sample from the comfort and privacy of your home, please keep in mind that the sample must be kept warm and delivered to your fertility centre within exactly one hour of ejaculation. Also, you cannot use a condom to transport the sample, as condoms contain spermicide.

 

Hormone Evaluation

Hormonal tests evaluate levels of

  1. Testosterone
  2. FSH (follicle-stimulating hormone) to determine the overall balance of the hormonal system and specific state of sperm production.
  3. Serum LH and prolactin are other hormonal tests that may be done if initial testing indicates the need for them.

If analysis and hormonal tests are not recognizable after the initial assessment, further testing may be compulsory:

Anti-sperm Antibodies Test — To identify the presence of antibodies that may contribute to infertility
Sperm Penetration Assay (SPA) — To confirm the sperm’s ability to fertilize
Ultrasound Scan (Scrotum) – To detect varicoceles (varicose veins) or duct obstructions in the prostate, scrotum, seminal vesicles and ejaculatory ducts
Testicular Biopsy — To determine if sperm production is impaired or a blockage exists
Vasography — To check the structure of the duct system and identify any obstructions
Genetic Testing — To rule out underlying mutations in one or more gene regions of the Y chromosome, or to test for cystic fibrosis in men missing the vas deferens. Genetic testing may be done to determine whether there’s a genetic defect causing infertility.
Testicular biopsy — In select cases, a testicular biopsy may be performed to identify abnormalities contributing to infertility and to retrieve sperm to use with assisted reproductive techniques, such as IVF.
Imaging — In certain situations, imaging studies such as a brain MRI, bone mineral density scan, Tran’s rectal or scrotal ultrasound, or a test of the vas deferens (vasography) may be performed.
Another speciality testing — In rare cases, other tests to evaluate the quality of the sperm may be performed, such as evaluating a semen specimen for DNA abnormalities.

After the diagnostic evaluation is completed, treatment may involve medical or endocrinology treatment, surgical correction or a decision to manipulate or process sperm to achieve a pregnancy.

Investigations for Females

Womanly Sterility can be caused by a number of underlying surroundings including ovulatory disorders, tubal damage, and uterine or peritoneal problems. Before action is started, it is essential that a clinical evaluation,

  1. Namely, history taking and physical examination are undertaken.
  2. In most cases, further diagnostic investigations are also undertaken in order to establish if a pathological condition is present. However, in 25% of cases, no cause of fertility problems can be established, even after investigations, and the term ‘unexplained infertility’ is used. Once assessment and investigations have been undertaken, a management plan can then be established with the individual or couple in an attempt to improve their chances of conception

What are the available female fertility tests?

  • Hysterosalpingogram (HSG) — This is an X-ray technique to see if the fallopian tubes are open and to if the shape of the uterine cavity is normal. A catheter is inserted into the opening of the cervix through the vagina. The liquid containing iodine (contrast) is injected through the catheter. The contrast fills the uterus and enters the tubes, outlining the length of the tubes, and spills out their ends if they are open.
  • Transvaginal Ultrasonography — An ultrasound probe placed in the vagina allows the clinician to check the uterus and ovaries for abnormalities such as fibroids and ovarian cysts.
  • Ovarian Reserve Testing — When attempting to test for a woman’s ovarian reserve, the clinician is trying to predict whether she can produce an egg or eggs of good quality and how well her ovaries are responding to the hormonal signals from her brain.
    1. Serum FSH – The most common test to evaluate ovarian reserve is a blood test for follicle stimulating hormone (FSH) drawn on cycle day 3.
    2. Estradiol
    3. Antimüllerian hormone (AMH)
    4. Inhibin-B

Ovarian reserve testing is more significant for women who have a developed risk of reduced ovarian reserve, such as women who:

  1. Overage women (Above 38 years)
  2. Have a family history of early menopause;
  3. Have a single ovary;
  4. Have a history of previous ovarian surgery, chemotherapy, or pelvic radiation therapy;
  5. Have unexplained infertility; or
  6. Have shown poor response to gonadotropin ovarian stimulation.

Other Blood Tests

1. Thyroid-stimulating hormone (TSH)
2. Prolactin levels are useful to identify thyroid complaints and hyperprolactinemia, which may cause difficulties with fertility, menstrual abnormalities, and repeated miscarriages. In women who are thought to have an increase in hirsutism (including hair on the face and/or down the middle of the chest or abdomen),
3. Blood tests for dehydroepiandrosterone sulfate (DHEAS),
4. Progesterone, drawn on cycle day 21
5. Total testosterone should be considered. A blood progesterone level drawn in the second half of the menstrual cycle can help document whether ovulation has occurred.
6. Serum Luteinizing Hormone (LH) drawn on cycle day 3

Urinary Luteinizing Hormone (LH) — Over-the-counter “ovulation predictor kits” detect the presence of LH in urine and can detect a rise in this hormone that occurs one to two days before ovulation. In contrast to blood progesterone levels, urinary LH tests can predict ovulation before it occurs. Urinary LH testing helps define the times of greatest fertility: the day of the LH surge and the following two days.

However, these tests can be expensive and should only be used by women with menstrual cycles that are consistently 25-35 days in length.

Sono hysterography — This process uses Transvaginal ultrasound after filling the uterus with saline (a salt solution). This improves the detection of intrauterine problems such as endometrial polyps and fibroids compared with using Transvaginal ultrasonography alone. If an irregularity is seen, a hysteroscopy is typically done. This test is often done in place of HSG.

Hysteroscopy — This is a surgical procedure in which a lighted telescope-like instrument (hysteroscope) is passed through the cervix to view the inside of the uterus. Hysteroscopy can help diagnose and treat abnormalities inside the uterine cavity such as polyps, fibroids, and adhesions (scar tissue).

Laparoscopy — This is a surgical technique in which a lighted telescope-like instrument (laparoscope) is inserted through the wall of the abdomen into the pelvic cavity. Laparoscopy is useful to evaluate the pelvic cavity for endometriosis, pelvic adhesions, and other abnormalities. Laparoscopy is not a first line option in the evaluation of a female patient. Because of its higher costs and potential surgical risk, it may be recommended depending on the results of other testing and a woman’s history, such as pelvic pain and previous surgeries.

For best results, the infertility evaluation should be individualized based on each woman’s specific circumstances.