Definition of infertility: In a couple, if the female partner is not able to get pregnant even after frequently having unprotected sex for at least a year, then the condition is defined as infertility. It can affect around 15% of married couples.
Experienced gynaecologists and infertility specialists evaluate both the male and female partners to detect the factors contributing to their infertility. Therefore, they recommend both partners undergo fertility testing. The basic infertility evaluation involves physical examination, medical history, imaging tests, and blood tests and examinations to find out the reason why the female partner is not getting pregnant. The assessment of the male partner involves physical examination, semen analysis, and blood tests.
1 in 3 cases of infertility – the problem is there with the female reproductive system. Similarly, in 1 in 3 cases of infertility, the problem is there with the male reproductive system. 1 in 3 couples both have problems and in the remaining, the cause is unknown.
Infertility workup and investigations
Doctors try to detect and diagnose the underlying cause of infertility in one or both partners depending on the circumstances and individual cases. If they find certain factors are responsible for infertility, then they perform more detailed, comprehensive, and extensive investigations.
Infertility evaluation: Even after evaluating every single factor and extensive investigations, if no cause is found – still, in many cases, infertility can be successfully treated.
Causes of Infertility
Infertility causes in male
Low sperm count or abnormal sperm production is the main cause of male infertility. It can be due to infections such as gonorrhoea, chlamydia, mumps, or HIV; small testicles, undescended testicles; and genetic defects. Structural defects such as blockage in the testicles; injury or damage to the testicles; enlarged veins in the testicles (varicocele – one of the common causes); testicular cancer; genetic diseases such as cystic fibrosis and other issues such as premature ejaculation and erectile dysfunction can also cause infertility in males.
The other causes of male infertility may include smoking, recurrent use of certain medicines, high blood pressure, alcohol, anabolic steroids usage for building muscles, and depression. Frequent exposure to heat can also affect sperm production in men.
overexposure to radiation, pesticides, and other chemicals may also cause infertility in men. Cancer treatment (radiation therapy and chemotherapy) can severely impair sperm production in men.
Infertility causes in female
The causes of female infertility may include the following:
Ovulation disorders – PCOS: This condition affects the release of eggs from the ovaries. Excess prolactin hormone (hyperprolactinemia) may also interfere with ovulation. Hypothyroidism and hyperthyroidism can affect menstruation and cause infertility. Excess work – too much indulgence in exercise and eating disorders, stress can also affect a woman’s fertility.
Pelvic adhesions: bands of scar tissue that bind organs that can form after pelvic infection, appendicitis, endometriosis, or abdominal or pelvic surgery may cause infertility in females.
Endometriosis can affect the structures and functions of ovaries, fallopian tubes, and uterus and cause infertility.
Pelvic inflammatory disease: It may result from adhesions, endometriosis, or sexually transmitted diseases.
Blockage of the fallopian tube or damage to the fallopian tube can be due to salpingitis – an inflammation of the fallopian tube. It can be due to Pelvic inflammatory disease.
Cervical and uterine abnormalities: inflammation and abnormalities of the cervix; uterine fibroids and polyps in the uterus may cause infertility by blocking the fallopian tubes or blocking a fertilized egg from implantation.
Infertility symptoms in females: There are no obvious symptoms of infertility in women apart from being not getting pregnant. In addition, some women may have irregular periods (menses) or absent periods altogether. Some women become obese with hirsutism – growth of facial and body hair as seen in PCOS. If infertility is due to PCOS, then treatment of PCOS can improve the chances of pregnancy.
Infertility symptoms in males: The symptoms associated with male infertility are not apparent in most cases. However, the symptoms if present may include pain or swelling in the genital area, painful ejaculation, retrograde or delayed ejaculation, and other problems associated with ejaculation; low sex drive, erectile dysfunction, and varicocele – this is one of the common causes – in addition to structural abnormalities of the testes.
For a male to be fertile, he should produce healthy sperms – which are active, energetic, and active enough to travel to the egg after being ejaculated into the vagina.
Doctors prescribe infertility tests for males to determine whether any of these processes are defective. A standard infertility evaluation includes physical exams, the medical and sexual history of the male partner, and semen analysis.
Infertility workup male
Semen analysis: Your doctor may recommend laboratory analysis of one or more semen specimens. They ask the patients to collect their semen in a clean container. It is recommended to evaluate sperm count, sperm structure, and movement – motile, active, sluggish, immotile, etc.
Blood tests also involve the determination of androgen and testosterone hormone levels in the blood (hormone testing)-rarely required.
If the doctor suspects genetic defect as the cause of infertility, he may order genetic testing to determine the cause of infertility.
Imaging tests are done in cases of proved male infertility, include scrotal ultrasound or transrectal ultrasound, and the test of the vas deferens (vasography). In certain cases, doctors may recommend a testicular biopsy to determine the abnormalities contributing to infertility. A biopsy may also be performed to retrieve sperm for assisted reproductive techniques (IVF). Sperms may also be evaluated for DNA abnormalities to determine the quality of the sperms.
Infertility workup female
Ovaries release eggs. An egg passes into the fallopian tube and combines with the sperm (fertilization). The fertilized egg travels to the uterus and implants in the uterus lining.
Gynecologists and infertility specialists recommend tests to detect whether any of these processes are defective. An experienced gynaecologist performs a general physical examination (gynaecological exam) and also a PAP smear.
The other tests include the following:
A blood test to measure hormone levels is ordered to see whether the woman is ovulating (ovulation test).
Ovarian reserve testing (AMH) is done to determine the quality of eggs available for ovulation. It is often done with hormone testing. Hormone tests may also be recommended to diagnose PCOS in women. Another hormone testing involves checking the levels of reproductive hormones such as Estrogen and progesterone and the pituitary hormones that control the reproductive process.
Pelvic ultrasound is recommended to look for uterine and ovarian disease.
Hysterosalpingography may be ordered to detect the problems associated with the uterus and to look out for blockages and other problems associated with fallopian tubes and to evaluate whether the uterus cavity is normal. The test involves taking an X-ray after injecting a contrast.
Based on the circumstances and requirements, a gynaecologist may also request hysteroscopy to check the uterine disease. In this procedure, a hysteroscope is inserted into the vagina to examine the cervix and uterus.
Laparoscopy: This is a minimally invasive diagnostic and therapeutic surgical procedure that helps examine the uterus, ovaries, and fallopian tubes. It is a gold standard diagnostic and therapeutic procedure for the detection and treatment of endometriosis, irregularities, and blockages of the fallopian tubes, adhesions, and scarring. Laparoscopy helps in detecting the problems associated with the uterus and ovaries.
Your gynaecologist after discussing with you will decide which test or a group of tests would be advisable for you as you may not need all the tests together. In addition, based on the detection of infertility cause – your gynaecologist will decide the type of therapy, surgical intervention, or procedures that are suitable according to your individual case.
Owing to the technological advancement, ongoing research and expert gynaecologists and infertility specialists – and the robust equipment, investigative, diagnostic, and therapeutic approaches, the treatment of infertility is very much possible – even if the cause is unknown. If you have any health issues that are interfering with your pregnancy or any other concerns regarding your infertility, you can meet me personally for infertility evaluation.