Inability of a couple to conceive after 1 year of regular unprotected intercourse can be termed as infertility.
When the age of the female partner is more than 35, infertility treatment can be started after 6 months of regular unprotected intercourse.
Traditionally, infertility investigations are generally started after a year of involuntary infertility. However, it can be started earlier in some cases like advanced female age, chronic anovulation or a history of previous pelvic surgery.
Baseline Ultrasound scan: congenital anomalies, uterine fibroids, hydrosalpinges, ovarian cysts, endometriomas, polycystic ovaries and ovarian volume with antral follicle count.
Saline sonography may be used to differentiate thick endometrium from submucus fibroid and endometrial polyp. It can also be used to differentiate thin endometrium from Ashermann’s syndrome.
Color & pulsed Doppler ultrasound can be used to predict ovarian responsiveness to gonadotropin stimulation and endometrial receptivity to embryo implantation.
3D technology may be used to diagnose different uterine abnormalities and assessing its degree of interference with endometrial cavity. Ovarian volumes and endometrial volumes can be measured accurately with 3D technology which helps in prediction of success of an IVF cycle.
Serial ovarian ultrasound for follicular study: preferred method
Mid luteal serum progesterone level
Assessing LH surge by measuring blood/urine LH level
Endometrial biopsy: not routinely preferred as it do have wide variation in results
Tests for tubal function
HSG: most widely used tubal patency test. It has added advantage of diagnosing uterine defects like fibroids, polyps & synechia. It has got disadvantage of limited ability to assess peritubal adhesions and infection risk. HSG has 65% sensitivity & 83% specificity in diagnosing tubal obstruction.
HyCoSy (Hysterosalpingo contrast sonography): tubal patency is assessed using transvaginal ultrasound and an injection of a solution containing gas microtubules stabilized on galactose microparticles. It has got the advantage of avoidance of X-ray exposure and assessment of ovaries simultaneously.
Salpingoscopy & Falloposcopy: It is possible to examine whole length of fallopian tube using these methods. Currently, both approaches are of research interest only.
Laparoscopy: It is gold standard test for assessing tubal patency. In addition to tubal patency
Semen Analysis: It is the hallmark of male infertility evaluation.
Specimen is to be obtained following 2-7 days of abstinence from sexual activity, preferably obtained with masturbation in sterile, plastic, widemouth container. Semen should be delivered to the laboratory within 30 minutes of collection and to be transported at room temperature.
World Health Organization (WHO), normal values for semen analysis
Parameter Normal values
Liquefaction Complete within 60 minutes at room temperature
Appearance Homogenous, gray & opalascent
Consistency Leaves a pipette as discrete droplets
Volume 2 ml or more
pH 7.2 or more
Concentration 20 million sperms/ml semen or more
Total number 40 million sperms per ejaculate or more
Motility 50% or more with forward progression, or 25% or more with rapid progression within 60 minutes of collection
Morphology 30% or more with normal forms
Vitality 50% or more
Leucocytes Fewer than 1 million/ml
In azoospermic or oligospermic men, Serum FSH level and scrotal sonography with Doppler can be helpful.
Dr. Nimisha is an experienced Obstetrician & Gynecologist, working as a fulltime Infertility and IVF specialist since last 5 years. Dr. Nimisha is M.B.B.S. and M.D. (Obstetrics & Gynecology) from B.J. Medical College & civil hospital, Ahmedabad. Dr. Nimisha is also Diplomate of National Board (DNB) and cleared MRCOG part one. After completing her post-graduation, she dedicated herself in treating the couples suffering from infertility. She was involved in handling more than 1000 successful IVF cases. Dr. Nimisha has performed more than 300 Ovum pick up and more than 150 Embryo transfer procedure & 20 surrogacy cases. Dr. Nimisha visited various countries viz. Kenya, Ghana, Tanzania, Uganda and UAE for infertility and IVF. She also holds practicing license in Kenya and regularly performs procedures over there.
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