The treatment of infertility first requires an understanding of why a couple is unable to conceive. Once the cause is determined (or is determined to be unexplained), we can plan the best individualized treatment course for our patients.
In order to understand why we do these various tests, it helps to know the steps the have to happen in order to have a child naturally.
A specimen of
the male partner's semen is obtained in a sterile collection cup, and brought to
the laboratory. The best results are obtained when the husband abstains for 3
days, and the sample arrives at the lab within an hour of ejaculation. The
sample is then evaluated for volume, sperm count, motility (the percent that are
swimming) and morphology (the number that are normally shaped). Although normal
values, vary between laboratories, a normal count is typically >20 million/ml
and normal motility and morphology are >14 %. This test is done rule-out male
causes for infertility, and to see if the couple might benefit from treatment
such as artificial insemination or IVF. A special type of analysis may be
required for couples undergoing IVF.
This is an x-ray
test in which dye is injected through the cervix and up into the uterus and
fallopian tubes, while the doctor watches on a video screen. This test is done
some time between the end of the menstrual period and ovulation. In some
patients, particularly those with blocked fallopian tubes, it be somewhat
painful. It is useful to determine if the fallopian tubes are open and if the
cavity of the uterus is normally shaped. It is not uncommon for couples to
conceive following this test.
This test is
similar to having a pap smear done, but requires a couple to have intercourse
2-8 hrs beforehand. It is done at midcycle when the cervical mucous is thin and
receptive to sperm. A small sample is removed, placed on a slide and examined
with the microscope. If good, it suggests that the cervix is not a barrier to
fertilization. If the test is poor, the couple may benefit from
insemination. Once a common test, the PCT is done less commonly today.
A small sample
of the lining of the uterus (endometrium)is obtained in the latter part of the
cycle to see if the endometrium has properly matured, under the influence of the
hormone Progesterone. If there is a "lag" e.g. the endometrium has not reached
the proper stage, there exists a condition is known as a Luteal Phase Defect,
which may be treated hormonally.
A plastic
probe is inserted into the vagina and the uterus and the ovaries can be seen on
a monitor. This test is used to look for such things as fibroid tumors of the
uterus and ovarian cysts,and to follow patients on fertility medications and
early pregnancies..
An ultrasound is performed,
and then a catheter is inserted in the uterus. Saline is injected and the
ultrasound repeated. This test is very accurate when looking for
abnormalities in the uterine cavity but poor at determining if the fallopian
tubes are open.
This is a
blood test drawn about one week prior to the onset of menses since in a normal
cycle , this is when progesterone levels peak. A good level of progesterone
confirms ovulation. This may be used to monitor patients on fertility
drugs.
Blood is drawn
as close as possible to day 3 of the cycle. FSH is hormone from the pituitary
gland that increases as menopause approaches and the ovary begins to show signs
of aging. A high level suggests that the chances for achieving pregnancy are
poor.
Most of the
other test are useful only if the menstrual cycles are irregular. Prolactin is
pituitary gland hormone that may go up in women with small benign growths of the
pituitary gland and on certain medications. Thyroid tests help to determine if
there may be a problem with the thyroid. Testosterone, DHEAS and
17-hydroxyprogesterone are androgens (male hormones) that may be useful to check
in women who also have excessive hair growth or PCOS. Women with PCOS are
also screened for diabetes.
This is a
same-day surgical procedure in which a telescope is inserted into the belly
button and the pelvic organs are examined. Using the harmonic scalpel, laser, electrocautery or
other tools, endometriosis and/or scar tissue can be resected. This is usually
done under general anesthesia, but in some instances is done under local
anesthesia only.
This is a
same-day surgical procedure in which a telescope is inserted through the cervix
into the uterus. The cavity of the uterus can then be examined, a procedures
such as removal of a fibroid tumor, polyp or scar tissue can be performed. When
done for diagnostic purposes, this can often be done in the office under local
anesthesia.