Diagnosis and treatment of infertility should be made by physicians who are fellowship trained as reproductive endocrinologists. Reproductive Endocrinologists are usually Obstetrician-Gynecologists with advanced training in Reproductive Endocrinology & Infertility. These highly educated professionals and qualified physicians treat Reproductive Disorders affecting not only women but also men, children, and teens. Prospective patients should note that reproductive endocrinology & infertility medical practices do not see women for general maternity care. The practice is primarily focused on helping their patients to conceive and to correct any issues related to recurring pregnancy loss.
In any fertility work-up, both male and female partners are tested if pregnancy fails to occur after a year of regular unprotected sexual intercourse. Fertility testing should especially be performed if a woman is over 35 years old or if either partner has known risk factors for infertility. An analysis of the man's semen should be performed before the female partner undergoes any invasive testing.
Medical History and Physical Examination: The first step in any infertility work up is a complete medical history and physical examination. Menstrual history, lifestyle issues including smoking, drug and alcohol use, and caffeine consumption, any medications being taken, and a profile of the patient's general medical and emotional health can help the doctor decide on appropriate tests.
Monitor basal body temperature: This is accurate in determining if ovulation is actually taking place.
Test the consistency of your cervical mucus: Consistency of mucus at the time of ovulation can be checked by collecting some mucus between two fingers and stretching it apart. The mucus will stretch more than 1 inch before it breaks.
Take an over-the-counter urine test for detecting luteinizing hormone (LH) surges: This helps determine the day of ovulation. Tests are also available to measure levels of follicle-stimulating hormone (FSH).
Several laboratory tests may be used to detect the cause of infertility and monitor treatments.
Hormonal Levels: Blood and urine tests are taken to evaluate hormone levels. High follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels and low estrogen levels suggest premature ovarian failure. High LH and low FSH may suggest polycystic ovary syndrome or luteal phase defect. High FSH and high estrogen levels on the third day of the cycle predict poor success rates in older women trying fertility treatments. LH surges indicate ovulation.
Blood tests for prolactin levels and thyroid function: These are hormones that may indirectly affect fertility.
Clomiphene Challenge Test: Women over age 35 and those with autoimmune disease and smokers are at a risk of depleted egg supply. Hormonal tests for ovarian reserve that detects the number of follicles and quality of the eggs are especially important for older women. Clomiphene citrate, a standard fertility drug, may be used to test for ovarian reserve. With this test, the doctor measures FSH on day 3 of the cycle. The woman takes clomiphene orally on days 5 and 9 of the cycle. The doctor measures FSH on the tenth day. High levels of FSH either on day 3 or day 10 indicate a poor chance for a successful outcome; ultrasound imaging of the ovaries to determine ovarian volume or follicle count; and blood tests to detect other markers of ovarian reserve can also be performed.
Tissue Samples: To rule out luteal phase defect, premature ovarian failure, and absence of ovulation, the doctor may take tissue samples of the uterus 1 - 2 days before a period to determine if the corpus luteum is adequately producing progesterone. Tissue samples taken from the cervix may be cultured to rule out infection.
Tests for Autoimmune Disease: Tests for autoimmune disease, such as hypothyroidism and diabetes, should be considered in women with recent ovarian failure that is not caused by genetic abnormalities.
More extensive tests may be carried out to reveal abnormal tubal or uterine findings in some cases. The four major approaches for examining the uterus and fallopian tubes are: Ultrasound, Hysterosalpingography, Hysteroscopy and Laparoscopy. Combinations of these imaging procedures may be used to confirm diagnoses.
Ultrasound and Sonohysterography: Ultrasound is the standard imaging technique for evaluating the uterus and ovaries, detecting submucosal fibroids, ovarian cysts and tumors, and also obstructions in the urinary tract. It uses sound waves to produce an image of the organs and entails no risk and very little discomfort.
Transvaginal sonohysterography: It uses ultrasound along with saline infused into the uterus, which enhances the visualization of the uterus. It is currently the gold standard for diagnosing polycystic ovaries.
Hysteroscopy: Hysteroscopy is a procedure that may be used to detect the presence of endometriosis, fibroids, polyps, pelvic scar tissue, and blockage at the ends of the fallopian tubes. Some of these conditions can be corrected during the procedure by cutting away any scar tissue that may be binding organs together or by destroying endometrial implants. There are small risks of bleeding, infection, and reactions to anesthesia. Many patients experience temporary discomfort in the shoulders after the operation due to residual carbon dioxide that puts pressure on the diaphragm. The wound itself is minimally painful.
Hysterosalpingography: This test evaluates the size and contour of your uterine cavity and checks whether your fallopian tubes are open. Hysterosalpingography is performed to discover possible blockage in the fallopian tubes and abnormalities in the uterus. Fluid is injected into your uterus, and an X-ray is taken to determine if the uterine cavity is normal and whether the fluid passes out of the uterus and into your fallopian tubes. Woman is subjected to further evaluation if any abnormalities are found. In a few women, the test itself can improve fertility, possibly by flushing out and opening the fallopian tubes. There is a small risk of pelvic infection, and antibiotics may be prescribed prior to the procedure.
Laparoscopy: Laparoscopy is a minimally invasive surgical procedure. It requires general anesthesia and is performed in an operating room. Laparoscopy allows the doctor to view ovaries, fallopian tubes and uterus to check for endometriosis, scarring, blockages or irregularities. The surgeon makes a very small incision below the belly button and inserts an instrument called a laparoscope, which is similar to a hysteroscope. A laparoscope is inserted through the abdomen, while a hysteroscope is inserted through the cervix. Through the laparoscope, the surgeon can view the uterus, fallopian tube, and ovaries. Laparoscopy is most helpful for identifying endometriosis or other adhesions that may affect fertility. The doctor may remove endometrial adhesions, treat scarring or remedy other problems with cutting instruments, lasers or ablation at the same time.
There are genetic testing techniques under development to detect any mutation in genes associated with female infertility.
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