Diagnosis

Diagnostic Procedures for Males

In order to assess infertility in men, the following can be conducted: semen analysis, semen culture, hormonal analysis, urological exams, PESA, TESA or TESE, viral tests, and genetic investigations.

1: Semen Analysis

During semen analysis, four properties of a single ejaculate are measured. The characteristics recorded are the volume of the ejaculate, the concentration of the sperm (count), the percentage of the sperm that are moving (motility), and the percentage of the sperm that are normal in shape (morphology). Normally, the ejaculate of a man will be greater than 2cc in volume, will have a sperm count of approximately 20 million/cc, will have 50% motile sperm, and will have 15-20% morphologically normal sperm.


Normal Sperms	Forward Progression of Motile Sperms

2: Semen Culture

This is mainly performed in cases of symptomatic diseases or when pus cells have been observed in semen analysis (leucospermia).

3: Percutaneous Epididymal Sperm Aspiration (PESA)

If a urological exam is conducted and reveals blockage or absence of the vas deferens, then PESA may be undertaken in order to obtain viable sperm. During PESA, the male is given local anesthesia, general anesthesia, or may be sedated. Sperm is then aspirated from the epididymis, or the housing area for produced sperm.

PESA

4: Testicular Sperm Aspiration (TESA) or Testicular Sperm Extraction (TESE)

In TESA or TESE, the testicular tissue containing the semineferous tubules (the actual location of sperm production) is aspirated or extracted from the testes while the patient is under local or general anesthesia. This tissue can then be frozen in order to prevent the need to repeat this particular procedure.

This procedure is necessary in cases of azoospermia (absence of sperms) or severe oligoasthenospermia (diminished number/motility of sperms) in patients with at least one normal sized testis and normal FSH. It may provide prognostic information for the application of ICSI with testicular sperms.


TESA	TESE

5: Hepatitis (B &C)), HIV

Tests are administered routinely to diagnose patients carrying these viruses, as they can be transmitted to the female or to attending healthcare providers.

6: Genetic Investigations

Chromosomal analysis (Karyotyping) of a blood sample is necessary when family history indicates structural chromosomal anomalies, in cases of unexplained azoospermia or oligoasthenospermia, and in couples with prolonged unexplained fertility.

Chromosomal Karyotyping

Diagnostic Procedures for Females

In order to ensure that females receive proper treatment and are not exposed to unnecessary risk, several investigations take place. The screening process often requires the individual to be tested for certain viruses, hormonal imbalances, and abnormalities along the reproductive tract. Specific examples of diagnostic tests/procedures for females include a full blood count, viral tests, tests for blood levels of luteinizing hormone and progesterone, tests that reveal information on the quality of eggs produced, tests for thyroid function and prolactin levels, post-coital tests (PCT) to assess sperm migration, immunological investigations to detect antisperm and antiphospholipid antibodies, HSG, Ultrasonography, endoscopic procedures, cytogenetic analysis, and psychological assessment.

1: Full Blood Count

A full blood count is often used to help test for the presence of anemia (low hemoglobin count), bleeding tendencies (low platelet count), or infections (high white cell count). Therefore, information derived from the blood test helps doctors provide proper medical care for their patients.

2: Hepatitis (B & C) HIV Antibody Status Rubella Immune Status

These three viruses are tested for in women before the onset of treatment. Hepatitis B, Hepatitis C, and HIV have all shown vertical transmission, or the transmission of the disease from mother to child during the perinatal period (the period immediately before and after birth). If a mother contracts Rubella during her first trimester, the fetus can suffer from Congenital Rubella Syndrome (CRS). CRS results in the child possibly having numerous birth defects. Therefore, the presence of any of these viruses can prove harmful to a developing fetus. In addition, these viruses often prove detrimental to an individuals health. In order to appropriately treat the patient and develop a proper protocol, a doctor has to be aware of the presence of such viruses.

3: Luteinizing Hormone (LH)

LH is the hormone that triggers ovulation, and a surge in this hormone can often be detected in the urine. Usually, ovulation occurs 24 hours after the increase in LH. Therefore, this test can help doctors determine when ovulation occurs, and is helpful in indicating normal ovarian function and the proper timing for intercourse, insemination, or other treatment protocols.

4: Progesterone

Progesterone is necessary for preparation of the uterine lining for implantation. By testing serum progesterone, doctors can discover if the ovary is releasing enough of the hormone for proper endometrial formation. Therefore, it is used as a marker to measure adequate ovulation.

5: Follicle Stimulating Hormone (FSH) Oestradiol (E2) Clomid Challenge Test (CCT)

Both FSH and E2 help provide information on the quality of eggs produced by the female. The levels of these hormones are measured extremely early during the menstrual cycle (days 2 and 3). It is also used as a prognostic marker for the failure or success of IVF cycles (high FSH > 12 IU/ml is associated with low success rates). The CCT is a test specifically designed to assess egg quality.

6: Thyroid Function Tests Prolactin

Improper thryoid function can result in the excess or scarcity of certain hormones, which may in turn affect the maturation and ovulation of the ovum. Problems with the levels of the hormone Prolactin can also impair ovulation.

7: Post-Coital Test (PCT)

A cervical scrape is taken half an hour after sexual intercourse to examine the number and motility of available sperms. This test assesses the ability of sperm to penetrate the cervical mucus as well as the actual occurrence and efficiency of intercourse.

8: Immunological Investigarions

Antisperm antibodies (ASA): These can be detected directly in genital secretions (cervical mucus and semen) or in a blood sample. Qualitative and quantitative determinations can be performed by checking sperm agglutination (stickiness). The presence of ASA can lead to infertility.

Antiphospholipid antibodies: These can be detected in a blood sample and have been shown to reduce implantation and pregnancy rates after IVF.

9: Hysterosalpingogram (HSG)

A HSG is an X-ray test that provides information on Fallopian tube occlusion and uterine abnormalities. During this procedure, the patient lies on an X-ray table. A speculum is then inserted into the vagina, and a catheter is moved through the cervix. The catheter is attached to a syringe containing HSG dye, and this dye is then injected into the uterus. The movement of the dye through the uterus and Fallopian tubes can be seen on the X-rays. Failure of the dye to move through the Fallopian tubes can be an indication of blockage. The HSG also shows if there are abnormalities in the shape of the uterus. Distortion of the uterine cavity can be caused by polyps, fibroids, and adhesions.


Normal HSG Free spill of dye from both tubes	Bilateral Blocked Tubes

10: ltrasonography

This test is performed with either abdominal or vaginal probes. It is now an irreplaceable investigative tool in routine practice for anatomical and functional evaluations of the genital tract. It is mandatory for the monitoring of ovarian stimulation (induction of ovulation) where it can visualize follicular growth in the ovaries and the associated gradual thickness of the uterine endometrium (inner wall).


Multiple Ovarian Follicles After Ovarian Stimulation	Uterus with Thick Endometrium

11: Laparoscopy and Hysteroscopy

Both of these are endoscopic (keyhole) procedures. Laparoscopy can reveal a great deal of information on the extent of endometriosis and adhesions in the pelvic cavity. Hysteroscopy helps derive information regarding uterine abnormalities, such as the presence of polyps and fibroids. Both these procedures require anesthesia.


Laparoscopy	Laparoscopy Procedure Showing Normal Tubes and Ovaries

Hysteroscopy

12: Cytogenetic Analysis

Chromosomal analysis in a blood sample is necessary in the case of primary or secondary amenorrhoea (absence of menstruation) with elevated FSH, premature ovarian failure (early menopause), long-term unexplained infertility, and recurrent spontaneous abortions.

13: Psychological Assessment

Psychological factors have been implicated in reproductive performance and infertility. Therefore, psychological assessment and counseling may be advised for some infertile couples, and psychological support for couples undergoing infertility treatments.