Baseline investigations to know the well being of both male + female partner like Haemoglobin, Blood sugar, Blood group and screening test.
PERTAINING TO FEMALE PARTNER
- Hormones assessment – To estimate FSH, LH,TSH, Prolactin to evaluate the group I factors of infertility
- Ultrasound ( scan ) of the uterus and ovaries to find whether there is any fibroid, Cyst in ovaries, polycystic ovaries, tubal block as seen by fluid collection within tubes. Remember! All tube blocks and peritubal adhesions cannot be diagnosed by scan 3D ultrasound gives extra information regarding the ovaries and uterus.
- Hysterosalphingogram is used ( dye is injected in uterus and x ray is taken )
In addition to predicting the tubal patency, hysterosalphingogram also suggest whether there is any abnormal shape of uterus and also relieves flimsy adhesions in the fallopian tube. Beware! Peritubal adhesions that prevent tubes from moving freely to pick up the eggs from ovary cannot be ruled out by HSG. This can be evaluated by laparoscopy. Arriving at diagnosis and preparing the patient for treatment is of utmost importance.The patients may need surgical corrections of their problems for which hysteroscopy and laparoscopy are done.
- AMH -> Antimullerian Hormone which can predicts the reserve of ovaries accurately.
PERTAINING TO MALE PARTNER
- Hormonal Assay: Estimation of hormones like FSH / LH/ TSH/ Prolactin / Testosterone can reveal the underlying problem.
- Semen analysis Better to give after 3 days abstinence.
- Scrotal scan if varicocele is diagnosed clinically and also to find the cause of male infertility.
- CASA to thoroughly assess the sperm parameters like sperm count, motility and morphology In a more precise way.
- Sperm DNA fragmentation is the physical breaking of one or both DNA strands in sperm chromosomes. So a DNA test is done to find the DNA Integrity to identify men who are at risk of failing to initiate pregnancy. This is treatable if it was induced by life style, smoking, alcohol or by Varicocele.
Steps of treatment
- Making Diagnosis is based on the investigations
- Hormone profile abnormalities if any are corrected with medications.
- Structural problem like ovarian cysts, fibroids, tubal block hydrosalphinx, endometrial polyp, septum if any are corrected with hysterolaparoscopy.
- Male problem are corrected with medications and varicocele by laparoscopic surgery
- Natural intercourse is encouraged after correction is made.
- If 3 cycles do not give a result, Assisted technology comes into the picture.