Normally, infertility is defined as no pregnancy after 1 year of unprotected regular sexual intercourse. Though the time period may be relaxed to 6 months and 3 months for females above 35 years and 40 years of age, respectively.
You might also want to see a senior specialist for a second opinion or when basic treatments for infertility like Clomiphene, IUI etc are not working.
You and your partner should consult a gynaecologist who is specialising in Infertility and Assisted Reproductive Technology (ART).
Involves looking at the reproductive health of both the male and female partner. Testing both partners is an important step as the causes of infertility are evenly divided between men and women.
Your doctor can evaluate the female partner with following few the tests:
Generally, we will order these tests for day 2, 3, or 4 of your periods.
Testing Hormones that Control Ovulation and Fertilized Egg Implantation, We will test the following hormones:
Testing Additional Hormones that Can Interfere with Ovulation, We will test the following hormones:
The HSG requires the assistance of a special type of x-ray called a fluoroscopy, or “real time x-ray.”
The actual HSG procedure generally takes approximately 10 minutes. During the procedure, the doctor will place a speculum into your vagina in the same manner as if you were undergoing a Pap smear. He or she will cleanse the cervix with an antiseptic solution before placing a small, flexible catheter approximately 1 inch into the cervical canal, where it rests against the cervix. The clinician will pass a small amount of dye through the catheter, filling the uterine cavity and then filling the Fallopian tubes. The tubes are considered open when the dye “spills” at the ends of the tubes (this is visible on the fluoroscopy). If your tubes are open, they should be able to “pick up” your ovulated egg. This part of the process generally takes less than 1 minute.
A physician can evaluate the male partner’s reproductive system with one simple test: Semen analysis
Some of the parameters we check for in a semen analysis include:
Low testosterone, also called low T, occurs when a man has testosterone levels that are below normal levels. The condition—defined as a combination of sexual symptoms and measured testosterone level—is actually quite rare (affecting only 0.1 percent of men in their 40s, 0.6 percent in their 50s, 3.2 percent in their 60s, and 5.1 percent of men in their 70s, according to the British Medical Journal’s European Male Ageing Study).
BEFORE THE SEMEN ANALYSIS
You should abstain from sex or masturbation for at least 3 days before the analysis, but not longer than 1 week.
DURING THE SEMEN ANALYSIS
In order to perform the semen analysis, your doctor will want you to provide a semen sample. You may collect the sample by masturbation. One of our clinicians will ask you to collect your semen in a sterile specimen cup. Another option is to collect your semen at home by masturbation or during intercourse in a special condom that you can get from your doctor. You must deliver your sample to our office within 60 to 90 minutes of collecting it (please check for specific drop-off office availability). Speak with your doctor about instructions for transporting the sample to the office. In some cases, you will need to repeat testing (e.g., small sample size, abnormal test result). Because test results often vary, you may need to repeat testing more than once.
Semen analysis results are generally available within a few hours. If test results are abnormal, your physician may diagnose one or more of the following conditions:
LOW SPERM COUNT
A low sperm count is fewer than 15 million sperm per milliliter ejaculated. The normal range is between 40 million and 300 million sperm per milliliter of ejaculation. Certain medications or a medical problem such as a blocked duct, a low testosterone level, or a condition in which sperm back up into the bladder may cause a low sperm count. Fever can also reduce sperm count.
LOW MOTILITY
Motility describes the movement of the sperm. Some men may have enough sperm, but their sperm may not swim well enough to reach the egg. Low motility may reduce your chances to conceive, especially if your sperm count is also low. In a normal semen sample, at least 40 percent of the sperm have appropriate movement.
ABNORMAL MORPHOLOGY
A normal sperm has an oval head, slender midsection, and a tail that moves in a wave-like motion. Sperm that do not have this normal shape may not be able to swim effectively or penetrate the egg.
FURTHER TREATMENT
In the event that severe male factor infertility is present, intracytoplasmic sperm injection (ICSI) has made it possible for patients to conceive using their own sperm.
If the analysis is abnormal, your doctor may also want to check for a hormonal imbalance by measuring the following hormone levels as well as checking for genetic defects:
Testosterone: a male hormone that is vital for healthy sperm
Follicle-stimulating hormone (FSH): a male and female hormone; in males, FSH helps maintain sperm production
Luteinizing hormone (LH): a male and female hormone; in males, LH stimulates the production of testosterone
Thyroid-stimulating hormone (TSH): a male and female hormone; in males, TSH helps maintain sperm quality and motility
Prolactin: a male and female hormone. in males, prolactin also helps maintain sperm quality and motility
The male partner will also undergo infectious disease testing, similar to the female partner, in order to check for hepatitis B surface antigens, hepatitis C antibodies, human immunodeficiency virus (HIV), and other infectious diseases.
TREATING INFERTILITY
Once your physician has determined the cause of your infertility, the next step is to determine the best treatment options. This decision is one made in conjunction with your physician that both satisfies the desired outcome and the desires of the couple. Generally we take a stepped-care approach to treatment starting with the least invasive and cost effective options first and move to more advanced options, such as in vitro fertilization (IVF) only when necessary.
Common treatment options include: