DIAGNOSIS

Sub fertility is defined as inability to attain pregnancy after 1 year of regular, unprotected intercourse since 85% of couples conceive within this time frame.

The diagnostic investigations are crucial in fertility treatment. The actual crux of the problem can only be identified by accurate evaluation. A wide range of fertility diagnostic services is available at Dr. Sridhar Hospital for accurate fertility evaluation. These are offered in affordable packages to the couple. The result of the investigations directs the appropriate treatment

The fertility investigations are usually directed for fertility evaluation and other investigations that may affect the fertility. The incidence of male factor and female factor infertility are similar, the assessment of both partners should begin simultaneously.

Age and Fertility

Fertility starts to decline for women from about the age of 30, dropping down more steeply from the age of 35. As women grow older the likelihood of getting pregnant (with or without treatment) falls while the likelihood of sub fertility rises.

Most women will be able to conceive naturally and give birth to a healthy baby if they get pregnant at 35. After 35 the proportion of women who experience sub fertility, risk of miscarriage also tend to increase with the age. By the age of 40 only two in five of those who wish to have a baby will be able to do so. Fertility also declines in men with age, but does very gradually. So men tend to remain fertile for a much longer time compared to women.

Basic Infertility Evaluation (One-stop fertility evaluation)

Basic fertility evaluation involves assessment of ovaries (for ovulation), fallopian tubes (for tubal patency) and uterus (for uterine concerns) in women and semen analysis in men. These could be combination of blood tests, radiological investigations(X rays and Ultrasound scans) and invasive procedures (laparoscopy & hysteroscopy).

Infertility Diagnosis

Around one in ten couples has difficulty in getting pregnant. Women are often blamed for infertility but in fact in a third of cases it is because of male problems, such as a low sperm count. It could be male factor, female factor or combined sub fertility. In about 15% of the couples an obvious cause may not be found, and it is deemed as "Unexplained sub fertility". Only after thorough evaluation and assessment the likely cause of sub fertility may be detected. Treatment usually follows based on the evaluation and assessment.

Infertility in women:
  • Ovulatory Dysfunction.
  • Tubal Dysfunction.
  • Endometriosis.
  • Uterine Disorders.
  • Combined factors
  • Unexplained.
  • Other factors:
  • Age – female fertility declines sharply after the age of
  • Polycystic Ovary Syndrome (PCOS)
  • Medical conditions such as diabetes, epilepsy, and thyroid and bowel diseases
  • Lifestyle factors: stress, being overweight (Obesity) or underweight, and smoking.
  • Infertility in men:
  • Low sperm count or quality
  • Erectile Problems
  • Ejaculatory Problems.
  • Other factors that may play a part in infertility include:
  • Infection of testes (orchitis / epididymis /etc.)
  • Having received cancer treatment such as drug treatment, radiotherapy other surgeries like hernia operation, undescended testes or twisted testicles
  • Genetic problems
  • Diabetes
  • Lifestyle factors: overweight (obesity) or having a job that involves contact with chemicals or radiation.
  • Ovulation Dysfunction and PCOS

    What are ovulation disorders?

    Usually in women of reproductive age group, one egg is released from an ovary every month. In 25 % of sub fertile women this does not occur due to various reasons.

    What is PCOS?

    PCOS is one of the commonest endocrine(hormone related) disorders affecting women. It presents in wide variety of ways. Though usually the patients are obese with irregular periods and elevated serum insulin and androgen levels. They have a classical looking appearance on ultrasonography. They generally do not ovulate regularly hence they often find it difficult to conceive.

    What are the tests to diagnose ovulation disorders & PCOS?

    Usually blood tests (hormones), ultrasound scans.

    Tubal Dysfunction

    What are tubal factors causing sub fertility?

    Tubal factors account for 25% of all causes of sub fertility. Normal tubal function is important for conception. Tubal disorders (block / abnormal function) can block an egg from entering or travelling down the fallopian tube to meet the sperm, preventing fertilization. Pelvic infections and sexually transmitted infections damage the tube. Tubal disorders can be diagnosed using various tests like Hysterosalpingography (HSG), Saline sonography, Laparoscopy with chromotubation (dye test).

    What is Hydrosalpinx?

    Hydrosalpinx is a fallopian tube that is filled with fluid. It is caused by an injury to the end of the tube, which causes the end to close. Glands within the tube produce a watery fluid that collects within the tube and produces swelling. It is one of the common tubal factors for infertility

    How does it affect fertility and infertility treatment?

    It increases risk of ectopic pregnancy. It decreases the success rates of IVF by preventing embryo implantation. This is due the back flow of the harmful fluid from the hydrosalpinx.

    Hence, It needs to be removed or separated from the uterus before commencing IVF treatment.

    Fibroids, Polyps and Uterine Disorders

    What are Fibroids?

    Fibroids of the uterus are benign (non-cancerous) growths within wall of the uterus. A woman may have a single fibroid or multiple fibroids and they may be located anywhere in the uterus (exterior or interior or within the wall).

    They are usually associated with heavy menstrual flow, severe cramping, pelvic pressure, fertility and pregnancy related issues.

    How do Fibroids affect fertility?

    The implications of the uterine fibroids on the fertility are uncertain. The exact mechanism of fibroids causing infertility is less clear but it is thought that it may prevent embryo implantation by distorting the uterine cavity.

    What are polyps?

    Uterine polyps are growths attached to inner wall of the uterus and protruding into the uterine cavity. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of uterine polyps. The sizes of uterine polyps range from a few millimetres — no larger than a sesame seed — to several centimetres — golf ball sized or larger. They are attached to the uterine wall by a large base or a thin stalk.

    You can have one or many uterine polyps. They usually stay contained within your uterus, but occasionally, they may slip down through the opening of the uterus into your vagina

    How do polyps affect Fertility?

    Uterine polyps may disrupt the lining of the uterus (the endometrium). They may even reduce blood flow in parts of the endometrial lining. This disruption could possibly prevent a fertilized embryo from implanting in the endometrial lining. The polyps could also cause a miscarriage after the embryo has implanted. There is evidence to show that removing uterine polyps does boost fertility in previously infertile women.

    Endometriosis

    What is endometriosis?

    Endometriosis is a condition where endometrial tissue (tissue from the inner lining of the uterine cavity) is found outside the uterus, usually in different areas of the pelvis. It is found in 25% of the sub fertile women and an estimated 50 – 60% of those with endometriosis may be sub fertile. The only reliable method of diagnosing endometriosis with certainty is by laparoscopy.

    Male Factor Infertility

    What is male factor infertility?

    Male factor sub fertility ranges from 30 – 50 % of the causes. It can be diagnosed using a very simple non – invasive test "Semen analysis". So it is imperative to get this test done before considering any complex investigations on the female partner and before commencing any sub fertility treatment.

    Unexplained Infertility

    Unexplained Infertility (UI) represents the approximately 30% of all cases.

    A couple that has been assigned the diagnosis of unexplained infertility (UI) obviously suffers from infertility and has undergone a diagnostic work up that failed to reveal a credible underlying cause for their condition. In other words, the diagnosis of UI is reached by default; it is a negative diagnosis, suggesting that a clinical problem exists but that the probable cause for this problem has remained elusive.

    The reasons why underlying problems may not be identified can, of course, vary. One possibility is that there is no one obvious cause for a couple's infertility and that their problem may be the result of multiple minor aberrations in how their respective reproductive systems cooperate. After all, the successful establishment of pregnancy is a highly complex process, and, at least on a theoretical level, one can assume circumstances where male and female fertility, each, are affected only to such a mild degree that standard diagnostic test results would still be considered within normal parameters. Yet, together, the reduction in the couple's combined fertility potential is large enough to cause infertility.