Infertility is a social disease due to its prevalence worldwide. There is no concise definition of infertility. However, the national institute of health and clinical excellence has defined it as a failure to conceive after two years of regular sexual intercourse without any underlying disease. There is no clear answer to the diagnostic methods or which investigation is considered as the gold standard to diagnose infertility in males or females.
Diagnosing Female Infertility
Reaching a diagnosis is a complex process but no diagnosis is achievable without proper evaluation. The first step towards diagnosing female infertility is proper history taking. If the treating doctor can extract out the major details like any history of a medical condition, surgery, irregular menstruation, or any relevant cause, then after conducting a general physical examination it will be easy to funnel down the major issue causing infertility through various diagnostic laboratory investigations.
Women’s fertility depends on a number of releasing healthy eggs and moist fallopian tubes to allow easy transport of eggs for fertilization with sperm to be later implanted in the uterus. The initial blood tests for ovulation are LH, FSH, TSH, and prolactin, these tests determine if the female is ovulating or not.
The next step in achieving diagnosis is through ultrasonography of ovaries and uterus to rule out any septum in uterus and measure if enough follicles are being formed for ovulation or if there is any cyst or fibroid in ovaries and uterus.
Tubal Patency Test
Hysterosalpingography is done to evaluate the tubal patency, this test is done by injecting a contract medium into the uterus and Xray is taken to measure if all the cavities are normal and observe if the contrast medium flows out through fallopian tubes.
When the treating doctor is not able to diagnose even through tubal patency test, depending upon situation and patient needs a diagnostic procedure known as hysteroscopy is performed to find any uterine disease which was not visible through an ultrasound scan.
Laparoscopy is a minimally invasive surgery to investigate tubes, ovaries, and uterus through a viewing device usually inserted under the navel through ports to rule out any tubal blockage, endometriosis, or any anatomical defect within the reproductive system.
It’s important to understand that not every female needs to undergo such investigations to reach the diagnosis of infertility.
Diagnosing Male Infertility
Among infertile couples, more than 30% of infertility is due to a male factor which is often ignored. It is required from male testicles to form enough active sperms which may travel through the vagina to fertilize with egg. There are various tests being performed to evaluate male fertility after initial history taking and general physical examination.
A semen analysis is one of the common diagnostic investigations for male infertility. Semen obtained through masturbation is usually analyzed in laboratory according to the criteria set by WHO in 2010, a semen analysis must meet below minimum parameters.
Like females, in male hormonal investigations like TSH, Testosterone, Estrogen levels are done to find out a possible causes.
Sometimes causes of infertility are due to chromosomal abnormalities leading to diseases like Klinefelter syndrome, downs syndrome, and Marfan’s syndrome which causes infertility in males.
In males with abnormal semen analysis and low motility rates, testicular biopsy is performed to retrieve sperm for assisted reproductive procedures such as IVF.
Most common infertility causing disease known as varicocele or spermatocele could well be diagnosed by performing ultrasound of testicles, appearance of testicles like a beg of worm help treating doctor in diagnosis varicocele, the grade of varicocele is usually determined by ultrasound.
Another Test to measure quality of sperm is DNA Test, however it is rarely performed.
It has been observed that either male of female or both could be cause of infertility among couple. However, it is important to reach correct diagnosis early to start prompt treatment ensuring the universal desire of couples to have baby is fulfilled. The clinician’s approach in diagnosis plays vital role specially if proper history taking and clinical examinations are done, then there will be no need to perform expansive infertility laboratory investigations.