Infertility assessment plays a crucial role in addressing the infertility issues faced by approximately 15% of couples worldwide and 3.9 to 16.8% of couples in India.
The process of infertility examination becomes imperative as it allows for a comprehensive understanding of the underlying cause of infertility, enabling more accurate diagnosis and personalized treatment approaches.
Through the application of Assisted Reproductive Technology (ART), one of the treatment options for infertility, the aim is to enhance the chances of conceiving.
The choice of which ART method to opt for can be decided based on the results of the infertility assessment.
Following is a guide on what is infertility assessment along with its process, followed by its benefit in IVF treatment.
What is an Infertility Assessment?
Infertility assessment is a crucial process aimed at determining the underlying cause for a couple’s infertility, as defined by the World Health Organization (WHO) as the failure to conceive after 12 months or more of regular unprotected sexual intercourse.
Various factors contribute to infertility, including ovulation disorders, uterine disorders, cervical abnormalities, tubal blockages, endometriosis, cancer, abnormal sperm cells, environmental factors, lifestyle choices, age, and unexplained factors.
To ensure appropriate treatment, it is essential to identify the specific cause of infertility.
Both partners undergo a series of tests, including analyzing hormonal levels, and evaluating the uterine cavity, fallopian tubes, and ovaries in women, while men undergo semen analysis and additional tests to assess fertility parameters.
Why is an Infertility Assessment Done?
Infertility assessments are conducted for various reasons.
Patients who have been unable to conceive for more than a year without the use of birth control are recommended to undergo an assessment.
Additionally, individuals with a high risk of infertility should also consider undergoing this evaluation.
Women who are 35 years or older should undergo an assessment if they have been unsuccessful in conceiving after six months of attempts.
Moreover, for women above 40 years who desire to conceive, an immediate evaluation is advised.
Couples with known conditions that can cause infertility, such as ovulation disorders, endometriosis, blockages, abnormal sperm, cancer, or other related conditions, should undergo an immediate assessment as well.
How is Infertility Assessment Carried Out?
The process of conducting an infertility assessment involves several key steps.
It typically begins with an initial assessment performed by an obstetrician-gynecologist, who specializes in women’s reproductive health.
Following this, a reproductive endocrinologist, who specializes in fertility and hormonal disorders, may be involved in further evaluation and treatment.
In the case of male infertility concerns, men may seek the expertise of a urologist, who specializes in conditions related to the male reproductive system.
Together, these healthcare professionals collaborate to provide a comprehensive assessment and guidance for individuals or couples experiencing infertility.
Medical History Assessment
The preliminary assessment in infertility cases involves a crucial step of determining the medical history, which helps identify potential infertility problems.
This assessment entails asking a series of important questions.
These questions cover various aspects, such as medications (including prescription, over-the-counter, and herbal), the presence of birth defects in the family, any past illnesses, the occurrence of diseases like diabetes, thyroid disorders, or pulmonary infections, pelvic pain, the frequency of menstrual periods, and any abnormalities related to bleeding or discharge from the vagina.
Lifestyle factors, including alcohol consumption, tobacco or drug use, are also addressed.
Moreover, questions are asked about sexually transmitted infections, previous surgeries, childhood history such as precocious puberty, exposure to environmental risk factors, and past pregnancies along with their outcomes.
Additionally, details regarding sexual history, including frequency and methods, are also gathered.
Physical examination
Male
During a physical examination for male infertility, several factors are assessed.
This includes a thorough examination of the genitals, along with the inspection of secondary sexual characteristics and body habitus.
The assessment also includes evaluating body hair, checking for obesity, and identifying the presence of gynaecomastia.
The genital examination involves a detailed inspection of the penis, testicles, scrotum, epididymis, spermatic cord, and prostate.
Additionally, the examination aims to identify the presence of varicoceles, which are important to consider in the evaluation of male infertility.
Female
During a physical examination for female infertility, several factors are considered.
The woman’s weight, blood pressure, and body mass index (BMI) are determined to assess her overall health.
The evaluation includes an assessment of the thyroid gland for any enlargement or abnormalities. The health of the breasts is also examined. Pelvic tenderness is checked as part of the examination.
Signs of excess androgens, such as increased body hair, are identified.
Furthermore, the vagina and cervix are evaluated for any signs of bleeding, which is relevant in the assessment of female infertility.
Semen Analysis in Male
Semen analysis is the most important step in diagnosing male infertility.
It involves analyzing the health and viability of sperm cells.
The test evaluates various factors including sperm count, morphology (shape), and motility (movement).
It is often recommended to undergo at least two separate semen analysis tests for accurate results.
During the analysis, a semen sample is collected, and different tests are performed, including microscopic examination.
The results take into account multiple factors such as sperm shape, movement, number, semen pH, appearance, and volume to provide a comprehensive evaluation of male fertility.
Blood tests
Male
In the evaluation of male infertility, blood tests play a crucial role in measuring reproductive hormones.
A basic hormonal evaluation typically includes assessing follicle-stimulating hormone (FSH) and total testosterone levels.
However, if there is a suspicion of an endocrine disorder, additional hormonal levels such as prolactin and luteinizing hormone may also be measured.
The interpretation of these hormone levels allows for a comprehensive assessment of the individual’s clinical condition.
Female
In the evaluation of female infertility, blood tests are essential for assessing various factors.
A progesterone test is conducted to determine ovulation as progesterone levels increase during this period, preparing the endometrial lining for implantation.
Prolactin levels are measured as elevated levels can disrupt ovulation, leading to irregular menstrual cycles.
Ovarian reserve tests are performed to assess the quantity and quality of eggs in the ovaries. This is determined by evaluating levels of follicle-stimulating hormone (FSH), Anti-Mullerian hormone (AMH), estradiol, inhibin B, as well as the antral follicle count.
Thyroid function tests, which include measuring thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3) hormone levels, are conducted as thyroid problems can contribute to infertility.
Additionally, testosterone and luteinising hormone (LH) levels can be tested, and LH can also be detected through urine tests for ovulation detection.
Genetic testing
Male
Genetic testing is an important component in assessing male infertility, as genetic defects can significantly impact the production or transport of sperm.
Several tests are commonly performed to evaluate genetic factors in male infertility. However, there are three important tests commonly carried out which include Karyotyping, YCMD and CFTR tests.
Karyotyping involves microscopic chromosomal analysis to examine the number and structure of chromosomes.
Another test, known as Y-chromosome microdeletion (YCMD) testing, utilizes polymerase chain reaction (PCR) with YCMD-specific primers to detect any deletion mutations in the Y chromosome that may cause infertility.
This is due to the fact that Y chromosome carries genes for sperm production and deletion of these genes can impair sperm production.
Additionally, the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Gene Mutations test is conducted to analyze the CFTR gene and identify mutations associated with the Congenital absence of the vas deferens (CAVD) which can be unilateral or bilateral.
These genetic tests provide valuable insights into the genetic aspects of male infertility, aiding in diagnosis and guiding appropriate treatment options.
Female
Genetic testing plays a crucial role in assessing female infertility, as genetically inherited defects can be a significant contributing factor.
One commonly used test is karyotyping, which detects chromosomal aberrations and can identify conditions such as Turner syndrome and chromosome rearrangements. These aberrations can have a direct impact on fertility.
Additionally, genetic carrier screening tests are employed to identify individuals who carry genetic disorders that may lead to infertility.
For example, screening for Fragile X syndrome carriers is essential, as this genetic disorder poses a risk to fertility.
These genetic testing methods provide valuable insights into the genetic factors influencing female infertility, aiding in diagnosis and guiding appropriate treatment approaches.
Imaging tests
Male
Imaging tests are utilized in male infertility cases to identify the underlying causes related to obstructions or abnormal structures within the reproductive tract.
Scrotal ultrasonography is a commonly performed imaging test that allows visualization of the testes and other reproductive organs.
Another imaging technique, magnetic resonance (MR) imaging, is employed for pelvic examinations to assess potential obstructions within the reproductive tract.
Additionally, MR imaging of the brain is conducted to detect any potential endocrine disorders that may be contributing to infertility.
Female
Imaging tests play a crucial role in diagnosing female infertility, allowing for a comprehensive evaluation of the reproductive system.
An ultrasound exam is performed to scan the entire reproductive system, enabling the detection of any size or shape abnormalities in the ovaries as well as assessing follicular changes.
Hysteroscopy involves using a thin, lighted tube with a camera to visualize the inside of the uterus, facilitating the examination of intrauterine changes.
Hysteroscopy
Sonohysterography, a specialized ultrasound exam, is utilized to assess uterine scarring and tubal patency.
X-rays can be used to determine the shape of the uterus and identify any blockages in the fallopian tubes.
Hysterosalpingography, an X-ray procedure utilizing contrast material, is particularly important in understanding the internal shape of the uterus and detecting any blockages in the fallopian tubes.
Laparoscopy, involving a thin, lighted tube, primarily focuses on examining endometrial lesions and other reproductive organs to further evaluate potential causes of infertility.
Benefits of Infertility Assessment in IVF
Infertility assessment plays a crucial role in IVF by identifying the cause of infertility, which is essential for selecting the most appropriate treatment option.
This assessment helps determine if medications, surgery, or Assisted Reproduction Techniques (ART) are needed for treatment.
In the case of IVF, understanding the infertility cause of the male partner can guide the decision between conventional fertilization or Intracytoplasmic Sperm Injection (ICSI) technique for fertilization.
Additionally, infertility assessment aids in preventing the transmission of infections and genetic disorders to offspring. It also helps determine whether a surrogate is necessary or not.
Furthermore, conducting an infertility assessment reduces the risks associated with IVF, such as miscarriages and premature births.
Success rates of IVF can be estimated based on the results of the infertility assessment. Personalized care and treatment can be provided based on these results.
In conclusion, infertility assessment significantly increases the chances of conceiving by guiding the selection of appropriate treatments and optimizing outcomes in IVF.