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How To Diagnose The Cause Of Infertility?

Written and reviewed by
MBBS, MD - Obstetrtics & Gynaecology, DNB (Obstetrics and Gynecology)
IVF Specialist, Delhi  •  21years experience
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Today we are going to discuss the investigations which can be done to check what is the cause of infertility. Why some couples may be able to conceive very easily and others may struggle very hard to conceive a baby. So what are the tests which should be done to find out? what is the reason behind this infertility? why they are not able to conceive even after 1 year of regular unprotected intercourse? So we make the couple go through a number of blood tests to test the general health of the couple as well as there are some special investigation to check what is hormonal profile of the couple. So some blood tests are viral markers checking their HIV, hepatitis B, hepatitis C and syphilis, then we check for their blood sugar, thyroid levels, prolactin level, the blood group these all are to check the general health of the couple, then for a female we check her anti-mullerian hormone levels, FSH, LH, estradiol level on day 2 of her cycle to know about her ovarian reserve, how good her ovaries are functioning actually, then we undergo (hysterosalpingography) HSG to check the patency of her tubes, whether her tubes are patent or not.

HSG is generally done on day 7, day 8 and up to day 10 of her cycle if she is having a normal regular cycle of 28 to 30 days. It is generally not done beyond day 10 because women are subjected to three x-rays in that time so unknowingly if she is ovulating or she is getting pregnant in that particular phase so she should not be subjected to those X-rays so that is why it is not advised to undergo HSG after day 10 of any particular cycle, obviously if she has very long cycle like she has every 2 months or 3 months then she may undergo, but generally as a protocol we do not advise HSG after day 10 of her cycle and when she is bleeding so it is between day 6 to day 10 of a particular cycle. In HSG again we inject a type of contrast to her vagina into the uterus and simultaneously do series of x-rays of her abdomen to see whether the contrast has come out of those tubes or not, if it comes out of both the tubes they are called patent tubes.

If it is not coming out then we can see on our film that at what level it is blocked then we label that as one sided block, two sided block or the level cornual, fimbrial whatever. So HSG is one basic investigation which would like to perform on a lady who is not able to conceive after 1 year. Apart from hysterosalpingography or HSG we would like to do follicle monitoring also called as tracking of the ovulation, how fast is her egg growing, whether it is ruptured or not ruptured to check for her ovulation. So one is we are testing the tubes, 2nd we are testing the ovulation and at the same sitting we do test for endometrial thickness or the lining of the uterus to check whether it is growing well along with the egg or not. If everything is going normal then we call it is an ovulatory cycle, generally in follicle monitoring we do 3 to 4 ultrasound to check the growth of the follicle and when it is beyond 18 mm size whether it is ruptured or not ruptured, in same sitting when we are checking the ET we do label it normal ET, thin ET or whether there is a problem in the blood flow of the endometrial thickness.

Third test which is not required in all cases is laparoscopy or hysteroscopy, it is obviously needed when there is a problem in the tubes or the endometrial lining. It is a day care procedure done under anaesthesia. Generally in a laparoscope we introduce to 10 sized scope through her abdominal cavity and we put a single stitch over that scar and she is discharged in the evening and we are seeing the abdominal cavity throygh our camera so able to see the picture in a better way. Hysteroscopy is done through vagina, there is any problem in the uterine lining we do correct it at the same time if there is adhesion, polyp, we do remove it at the same time and in some cases we are able to open the tubes through hysteroscope as well, so we use it to diagnose and treat at the same sitting, so these tests are for women and for any infertile couple we make the husband also undergo tests, these are again viral marker HIV, hepatitis B, C and syphilis and a routine semen analysis and semen culture test to find the cause behind that.

Thank you.

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