Infertility Diagnosis

Infertility Diagnosis in Nepal

Infertility diagnosis at Vardhan is a process-led phase consistent with international norms and practices which begins with a thorough assessment of both male and female patients. The diagnostic process typically starts by assessing your medical and sexual health history to understand your sexual habits. The cause of infertility is diagnosed following a series of medical evaluations and tests aimed at identifying the underlying causes. You will be going through initial consultation and physical examination by your fertility expert. During this consultation your doctor will review the couple’s medical history, past pregnancies and/or reproductive health concerns, if any, and lifestyle factors. A physical examination will be carried out to assess your reproductive organs to identify any visible abnormalities. This will be followed by any of the following investigations:

1. Scan – Ultrasound scan is critical to diagnosing infertility. Your doctors will carry pelvic ultrasonography. This is a safe and painless diagnostic imaging test used to evaluate the pelvic area for any abnormalities. Transvaginal Scan or TVS is an internal scan of the female reproductive organs through the vagina to capture detailed images of the pelvic region. TVS allows doctors to examine the uterus, fallopian tubes, ovaries, cervix and vagina. Transvaginal scans help determine antral follicle count (AFC) to estimate the woman's ovarian reserve or the number of eggs remaining in her body. An estimate of the remaining egg supply in the ovary helps predict the response to fertility treatments. Scans are used for follicular monitoring – a crucial part of IVF – to determine the timing of ovulation or the process of producing an egg from the ovary, and the best time for timed intercourse or intrauterine insemination (IUI) or IVF. The USG can also detect uterine abnormalities which may cause infertility: fibroids which is a round-shape mass of cells usually found in the wall of the uterus, and polyps which is a small mass of cells developing inside the body. It can also detect tubal patency (the openness and lack of blockage in the fallopian tubes) by evaluating the passage of fluid within fallopian tubes that may indicate tubal blockage and damage. Other findings which can be drawn from USG are: Endometrial Thickness and Pattern, Ovulation Disorders, Pelvic Pathology (like ovarian cysts, endometriosis) and male infertility. i
2. Blood Tests – Blood tests are done at the initial stage of infertility diagnosis. Your fertility specialists may plan different blood tests to determine your fertility status. These may include:
   Anti-Mullerian Hormone (AMH) – AMH levels indicate ovarian reserve, meaning the capacity of your ovaries to provide viable eggs for fertilization. Higher AMH levels indicates larger number of remaining follicles or better ovarian reserve, while lower levels indicate decreasing ovarian reserve.
   Follicle-Stimulating Hormone (FSH) – This hormone is produced by the pituitary gland in both men and women. In women this controls menstrual cycle and the production of eggs while in men it stimulates sperm production.
   Luteinizing Hormone (LH) – This hormone is produced by the anterior pituitary gland in both men and women. In women, it plays a vital role in menstrual cycle, while in men it helps in the production of testosterone and the regulation of sperm production.
   Estradiol – Estrogen is the primary female sex hormone and is produced by ovarian follicles which develop and thicken the lining of the uterus. This test assesses ovarian function.
   Progesterone – Progesterone is produced by the ovaries in females and it plays a crucial role in menstrual cycle and pregnancy. This hormone helps regulate menstrual cycle and maintain the endometrial lining thus making your uterus receptive for implantation of fertilized egg.
   Prolactin – Prolactin hormone has primary role in reproduction and lactation. However, high levels of prolactin can lead to hyperprolactinemia. The symptoms may include irregular period, inability to conceive and milk production outside pregnancy and breastfeeding. In men, high prolactin may lead to decreased libido, erectile dysfunction and infertility.
   Thyroid Stimulating Hormone (TSH) – Both Hypothyroidism or Hyperthyroidism can disrupt menstrual cycle and create problems in ovulation, resulting in delayed or difficult pregnancy. Sometimes it can affect quality of eggs or even increase the risk of miscarriage and pregnancy complications. By addressing thyroid dysfunction and optimizing thyroid hormone levels, fertility can be improved thus increasing the chances of conception and a healthy pregnancy.
3. Sonasalpingography (SSG) – SSG is a diagnostic procedure which is used to evaluate the fallopian tubes and uterus. It can detect blockages and abnormalities in the fallopian tubes, which may be the cause of infertility. This procedure may involve some discomfort or camping and mild spotting. But generally it is considered safe. If any abnormalities are identified your fertility specialist will determine the appropriate treatment option to help you conceive a baby.
4. Semen Analysis – Sperm health can be one of the reasons of male infertility. Semen analysis evaluates various parameters of semen to diagnose male infertility. Typically, the number, motility and morphology will be assessed during semen analysis. The number of sperm present in per milliliter of semen is called sperm count. At least, 39 million sperm per ejaculate is considered normal sperm count. And 16 million sperm per milliliter is considered to be normal concentration. Semen analysis also involves the study of shape and structure (morphology) of sperm. It is usually evaluated based on the percentage with normal morphology. At least 4% is considered normal morphology. The amount of semen produced during ejaculation is called semen volume. The normal range is 1.4 milliliters. The percentage of sperm actively moving in forward direction refers to sperm motility. The higher the percentage of sperm motility the higher the chance of sperm reaching and fertilizing an egg. At least 42% of sperm should be motile. And the progressive motility of sperm should be 32%. The percentage of live sperm in semen sample is called sperm viability. In a normal semen sample this should be 54%. Semen pH measures the acidity and alkalinity of semen. The pH of semen influences the environment in which sperm survives and travels to reach the eggs for fertilization. The normal range is 7.2 to 8.0 percentage. The alkalinity nature of semen protects sperm from damage as it routes through the female reproductive tract. Semen analysis provides overall information about male fertility and may provide guidance for future diagnosis and treatment or lifestyle choices may affect semen parameters.
5. Genetic Testing – This is recommended by your fertility specialist, if you have recurrent miscarriage or one/both of you have particular genetic conditions in your family. If any abnormality is seen in your blood test, genetic screening and testing options like Pre-implantation Genetic Testing (PGT) will be recommended in IVF procedure. This involves testing of embryos for genetic abnormalities before they are implanted into the uterus. In some cases, genetic factors may contribute to Recurrent Pregnancy Loss (RPL), in which case a chromosomal analysis of fetal tissue miscarriage or parental karyotyping can be helpful in identifying genetic abnormalities.
6. Hysteroscopy/Laparoscopy – Hysteroscopy/laparoscopy is a procedure used to diagnose and treat various conditions which may be a cause of infertility. Hysteroscopy is a medical procedure which examines the inside of uterus to diagnose and treat uterine conditions, such as, uterine bleeding, fibroids and polyps and uterine anomalies. Laparoscopy is a minimally invasive surgical procedure to view the inside of abdomen and pelvis used for both diagnostic and surgical purposes. This procedure is done to inspect the uterus, ovaries, and fallopian tubes. Other findings may be abnormalities such as ovarian cyst, ovarian and uterine tumors, endometriosis and pelvic inflammatory disease (PID). If any abnormalities are seen during the diagnostic procedure, then the surgeon will intervene to perform additional procedure for further treatment.