The first step in investigating male partner by any Best Fertility Centre in Chennai is semen analysis.
Normal values of semen analysis are:
- Volume= >2ml
- Sperm concentration= >20million/ml
- Motility= >50%
- Morphology= >30% normal forms.
Abnormal semen parameters include:
- Oligozoospermia which is reduced sperm count. It can be Mild type where 10 to 20 million/ml sperm counts are present, Moderate where 5 to 10 million/ml sperm counts present, Severe -<5million/ml, Extreme – <1million/ml.
- Asthenozoospermia: reduced total sperm motility or reduced sperm progression.
- Teratozoospermia: increased proportion of abnormal forms
- Oligoasthenoteratozoospermia: all semen parameters are abnormal
- Azoospermia: no sperm in ejaculate.
- Aspermia: ejaculate failure
If semen analysis is abnormal then we have to evaluate further by doing a Genital examination in which we should examine the testis for volume. Normal testicular volume is about 15 to 20 ml. Later we have to look for Epididymis volume and consistency. Also look for any abnormalities like Hydrocele, Varicocele.
In case of severe oligospermia (low sperm count) or Azoospermia (no sperm), Firstly Hormonal Study to be done to assess
A) Follicular stimulating hormone (FSH)-normal value ranges 1 to 12 IU/ml
B) Testosterone-normal value 3 to 10 ng/ml
If FSH and testosterone is normal then it denotes post testicular cause. If FSH and testosterone are low then its hypogonadotropic hypogonadism. If FSH is high and testosterone low then its hypergonadotrpoic hypogonadism (testicular failure) and we may proceed for karyotyping.
C)Prolactin -5 to 25mg/dl
Secondly MICROSCOPIC STUDY is done, If pus cells are present we should go for culture & Sensitivity and treat it with appropriate antibiotics.
Thirdly to check the FRUCTOSE CONTENT OF SEMINAL FLUID, If its absent then it indicates congenital absence of seminal vesicle.
Fourthly do a DOPPLER ULTRASOUND to visualize seminal vesicles, prostate and ejaculatory ducts and to see varicocoele.
Fifthly KARYOTYPING done in cases with azoospermia.
Sixthly we check for Y Chromosome Microdeletions
Seventhly plan for DNA FRAGMENTATION INDEX, If DNA Fragmentation is more than 15% then there is poor outcome.
Eightly In case of retrograde ejaculation urine examination to be done immediately after ejaculation and examined under microscope.
The main causes of female infertility is OVULATORY DYSFUNCTION, HORMONAL, UTERINE AND TUBAL DYSFUNCTION.
OVARIAN RESERVE –Especially more important in elderly women more than 35 years suspected ovarian failure and to asses response to ovulation induction
1)Day 3 Antral follicular count(AFC) to be seen.
2)ANTI MULLERIAN HORMONE(AMH)- IT REFLECTS THE NUMBER OF GROWING FOLLICLES IN OVARY. normal AMH value ranges from 0.19 to 9.13ng/ml.
3) FSH Values- High FSH values >14iu/ml indicate ovarian failure.
Ovarian dysfunctions commonly associated with infertility are ANOVULATION or OLIGOOVULATION. It is more common in polycystic ovaries where the follicles doesn’t reach the dominant size. So it is necessary to diagnose ovulation. SERIAL ULTRASOUND FOLLICULAR STUDY is the gold standard method for diagnosing ovulation. Various other methods are also available
- Basal body temperature– Rise of temperature is secondary to rise in progesterone following ovulation.so patient is instructed to take oral temperature daily on waking in the morning before rising out of bed.
- CERVICAL MUCUS STUDY– Disappearance of fern pattern which was present in mid cycle is suggestive of ovulation.
- URINARY LH KITS-Ovulation occurs usually within 14 to 26 hrs of detection of urine LH surge and almost always within 48 hrs.
- SERUM PROGESTERONE– Estimation of serum progesterone is done on day 8 and day 21 of cycle.an increase in value from less than 1ng/ml to greater than 6ng/ml suggests ovulation.
- SERUM ESTRADIOL –Rise approximately 24 hrs prior to LH surge.
- ENDOMETRIAL BIOPSY– Done on 21st to 23rd day of cycle. Evidence of secretory changes in endometrial glands is suggestive of ovulation. If it is out of phase then it indicates luteal phase defect.
The anatomical patency and functional integrity of tubes assessed by following tests.
Hysterosalpingography involve the inspection of the fallopian tubes and uterus, by the injection of a radio contrast agent, to ensure the egg can pass down the tube without obstruction, and to identify uterine abnormalities.
- DIAGNOSTIC HYSTEROLAPROSCOPY WITH CHROMOPERTUBATION:
It is the gold standard for evaluation of tubes. Benefits include detection of tubal patency, block, hydrosalpinx change, adhesions. In Ovaries we can find PCOS changes, endometriosis. In Uterus we look for fibroids, polyps, anomalies. Also we can find peritoneal factors like endometriosis, adhesions, tuberculosis.
In this instead of dye normal saline is pushed within uterine cavity with Foley’s catheter, ultrasonography is done. Ultrasound can follow the fluid through tubes upto peritoneal cavity and pouch of Douglas. There is no radiation exposure.
Commonly associated with subfertility are sub-mucus fibroids, congenital malformations and intrauterine adhesions. They are more likely to cause recurrent pregnancy loss.
Dyspareunia in case of retroverted uterus with prolapsed ovaries, inflamed adnexal disease and pelvic endometriosis. Dyspareunia causes reduced coital frequency.
Congenital defects in genital tract include absent or septate vagina, hypoplasia and absent uterus.
1) Thyroid function tests: TSH, Free T3 and Free T4 levels to be checked. Normal TSH should be 0.25 to 5 miu/ml, Free t4 0.82 to 1.51ng/dl. Ovarian function is markedly related to thyroid activity. If any variation in thyroid values has to be treated.
2) PROLACTIN: Normal value 5 to 35ng/ml in case of elevated prolactin levels there is high incidence of anovulation.
3) GTT 75gms: it is done mainly in PCOS patients. Fasting values range from 70 to 110mg/dl, 2hrs ranges from 80 to 120mg/dl.
For further consultation visit the Best Fertility Hospital in Chennai.