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Infertile Patient - How Is The Investigation Done?

Written and reviewed by
MBBS, MD - Obstetrics & Gynaecology, FICS, FICOG
Gynaecologist, Mumbai  •  42 years experience
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Hi,

I am Dr. Shubhada Sanjiv Khandeparkar, Gynaecologist. In the last video, I discussed the causes of infertility. Now, today I am going to discuss the investigation in an infertile couple. I will be tattling the female partner today. Now, in the female, there is a structure in the brain called hypothalamus. This is a very important structure. It releases certain hormones which in turn at another gland in the brain called the pituitary. Now, it is a very important gland which has to function properly. Now the pituitary secrets certain hormones and these are called the FSH, LH, TSH, and prolactin. They stimulate the follicle to mature. The thyroid-stimulating hormone acts on the thyroid gland and produces the hormone thyroxin which also is required for the ovulation.

This also helps in the ovulation. Once these hormones are all stabilized in the blood and they are normal, then we go to the next phase and that is the genital region of the female. There we have the ovaries. Ovaries are extremely important genital in the female. This is the main functioning organ. Now, we should get a healthy follicle which will rupture and then we transfer the sperm to make the embryo. To get the good follicle, we have to establish how the ovaries are. How do we access the ovaries? The function of the ovaries is accessed by the ultrasound and by the hormone which secret called the anti-mullerian hormone. The test for anti-mullerian hormone is very sensitive and should be done in a standard lab as it can be done ordinarily by any other lab. Once you know that the anti-mullerian hormone test is normal then you need to go for ovarian follicle status. Anti-mullerian hormone tells us how many are healthy and good.

Now, in this modern ear, women do not want to have a child at an early life. They want to settle even if they are married, they want to have their own house, they want to plan pregnancy properly as they say that they are not ready for the baby. Maybe they want to go beyond 30-35. In such cases, we should know are they having enough ovarian reserve to wait that long. If the anti-mullerian hormone tells us that they don't have ovarian reserve then they should rush and at least they should save and preserve their eggs or they should preserve their embryos. What is antral follicle count? Antral follicle count where we do transvaginal scan the 2nd day of menses and we see each ovary that how many follicles we can see. We should have at least 5-6 good follicles with 2-5 mm.

Now we can also monitor the follicular status by transvaginal scan during the cycle till the follicle becomes mature and that also helps us in the case of the infertile couple to find out how the egg is developing and when the egg will mature, it will rupture. So, these are a few tests in the infertile female. Now, the other test which is there is for the uterus, tubes and the cervix. Now, these 3 areas I will tackle in the next episode.

Thank You!

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