What Are The Tests to Investigate Infertility

First, a detailed medical history is essentially taken. The following factors should be investigated in detail, the period of no contraception use, the frequency of sexual intercourse in a week, any history of surgery or medication use, pattern of menstrual cycles, any presence of pain during menstruation or sexual intercourse, and previous contraception history.

What are the infertility tests for men?

• Investigations should start with male fertility testing. A sperm sample that is collected after a sexual abstinence for 3-5 days will be tested (spermiogram) to determine the count, motility, and the structure of sperms by examining the sample under the microscope. Depending on circumstances, the test can be repeated after 3-7 weeks.

Oligospermia:

An average sperm count of 15 million/ml is considered normal. Lower sperm count than this figure is considered abnormally low and called  oligospermia . Oligospermia may develop due to pre-testicular, testicular, and post-testicular causes. When these factors are identified, they should be evaluated by urologists experienced in this field and then an appropriate treatment should be scheduled.

What is azoospermia or "zero sperm count"? Is there a treatment option?

• Azoospermia is the absence of sperms in the ejaculate sample. The factors causing azoospermia are categorized into two, depending on whether there is obstruction in ejaculatory ducts.
• Obstructive azoospermia can be caused due to a congenital obstruction of the ejaculatory ducts or adhesions developing after genital infections or surgical interventions. Surgical interventions can be performed to open the obstructed ejaculatory ducts.
• Non-obstructive azoospermia can be caused by genetic disorders, undescended testis, and testicular torsion.
• In both categories, a testicular biopsy under anesthesia will be attempted using micro surgery (TESE - MICROTESE) to collect sperms. The likelihood of sperm retrieval is high in ejaculatory duct obstruction. The obtained sperms are treated with IVF and embryos are obtained by the method called microinjection (ICSI).

What are tests to investigate female infertility?

• Female infertility tests require a thorough evaluation of all individual organs in the female reproductive system (uterus, ovaries, and tubes).
• On the third day of the menstruation, the patients should undergo a baseline ultrasound examination for an overall evaluation of the uterus and ovaries. The shape of the uterus, any presence of fibroids/polyps, etc., and the contours and space of the intrauterine cavity are examined. A 3-dimensional examination of the intrauterine cavity is performed in every patient to obtain detailed information. Similarly, the ovaries are evaluated in detail in the same session of ultrasound examination performed on the third day of the menstruation. During this baseline examination, the ovaries are evaluated to detect whether there are any cysts or masses, and the condition of the ovarian reserve will be estimated.
• On the 3rd day of menstruation, several hormone tests are also performed. FSH and oestradiol levels are tested because they indicate the number and quality of eggs. The mammary gland hormone (prolactin ) and thyroid hormone ( TSH ) levels are tested to detect any abnormalities.
• After these examinations are finalized, there will remain only one question, which is whether the tubes are patent. The patency of the tubes and the examinations whether there is fluid accumulation in them is evaluated with hysterosalpingography (HSG) , which is colloquially known as the X-ray of the uterus. This test is performed within 2-5 days after menstruation to find answers to the following questions: Are the uterine tubes obstructed? Are there adhesions or deformations in the tubes? Is there a small polyp, membrane, etc. in the uterus.

HYSTEROSALPINGOGRAPHY - HSG (Uterine radiography with the use of an contrast agent)

Popularly known as contrast material enhanced uterine X-ray, the HSG has an important place in diagnostic tests investigating infertility because it allows for examining the intrauterine cavity and the tubes in detail. It is a painless procedure that lasts for 5 minutes on average. The procedure should be performed within the 2 to 5 days after the end of the menstrual period.
The cervix is fixed with a special device and a thin catheter is placed inside the cervical canal to inject the contrast agent into the intrauterine cavity to obtain a radiopaque image. Then, serial images are taken.
Some of the disorders that can be diagnosed with the use of HSG:

• Any space occupying lesion in the intrauterine cavity including polyps, fibroids, and membranes (uterine septum)
• To find out if the tubes are blocked and to find out the site of blockage if they are blocked
• To find out any tubal deformities
• To identify any fluid accumulation in the uterine tubes (hydrosalpinx)