rom
the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,
MD.
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How Babies are Made - The Basics (Page 4)
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the Man - Semen Analysis
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What
are the basic medical tests needed to assess fertility
?
How
are these basic infertility tests done ?
What
are the basic medical tests needed to assess fertility
?
In order to understand why pregnancy
doesn't occur , we need to examine only the four critical
areas which are needed to make a baby - eggs, sperm,
fallopian tubes, and the uterus. The tests, which often
seem endless, will actually fall into examining one
of these four areas. In 40% of cases, the problem will
be with the male, in 40% with the female, and in 10%
both partners will have a problem. In some cases, about
10%, no cause can be identified (unexplained infertility)
even after exhaustive testing.
Before starting with tests, the doctor
takes a detailed medical history from the couple, and
also performs a physical examination for both of them,
to determine if this can provide clues as to the cause
of the problem. The doctor will need to find out details
about your menstrual cycle, as well as your sexual habits
and past history of surgery or illness, so you should
be prepared to answer these questions. Many clinics
give patients a form to fill out, so that they can provide
all this information. A physical examination can also
provide the doctor with useful information, and he will
look specifically for important clinical findings such
as abnormal hair growth, excessively oily skin, or the
presence of a milky discharge from the breast.
How are these basic
infertility tests done ?
However, for most couples, investigations
are needed to establish a diagnosis. These specialized
tests constitute the infertility workup and they can
be completed efficiently in one month . Timing the procedures
properly during the menstrual cycle is important and
we have found the following strategy useful in our practice.
Remember that the couple must be seen
together and the first test which should be done is
a semen analysis. Sadly, sometimes the wife will have
undergone innumerable tests (sometimes repeatedly !)
and the husband's semen analysis (where the problem
lies) has not been done even once.
The first day the bleeding starts is
called Day 1, and the semen analysis to check
the husband's sperm count and motility can be done can
be done on Day 3-4 , after requesting him to abstain
from ejaculation for at least 3 days . The wife's blood
is then tested for measuring the levels of her four
key reproductive hormones: prolactin, LH ( luteining
hormone) , FSH ( follicle stimulating hormone) , TSH
( thyroid stimulating hormone). Since these levels vary
during the menstrual cycle, they should be done between
Day 3-5 of the cycle. We then do a hysterosalpingogram
(an X-ray of the uterus and tubes) for her after the
menstrual bleeding has stopped - between Day 5-7, to
confirm her uterus and tubes are normal. We then see
the couple on Day 9 with all these reports and review
the results . These three basic tests allow us to check
whether the eggs, sperm, uterus and tubes are normal.
Some doctors will perform further testing
during the rest of the month, though we rarely do these
tests in our own practise . They include: ultrasound
scans for ovulation monitoring between Day 11-16 ; and
the scan results can be used for timing the PCT (postcoital
test) as well, during which time the cervical mucus
is assessed also. A serum progesterone level can be
measured on Day 21, about 7 days after ovulation , and
this provides information about the quality of ovulation.
Some doctors will also performed a laparoscopy in the
same month (Day 20-25) ; and combine it with an endometrial
biopsy , if desired.
With this strategy, time is not wasted,
and couples can be reassured that a possible reason
for the cause of the infertility , if it exists, will
be detected within one month.
Unfortunately, it is very common to
find that tests are done piecemeal - or sometimes, not
done at all. Often treatment is started before coming
to a diagnosis. Conversely, some doctors take so long
to do the tests, that patients get fed up - after all,
they want treatment!
The workup should not stop when a problem
is discovered - it is still important to complete the
testing, since it is possible that infertile couples
may have multiple problems. Many diseases, such as pelvic
inflammatory disease ( PID) which can cause the tubes
to get blocked, can be "silent", so that the patient
may have absolutely no signs or symptoms.
A single test abnormality does not necessarily
mean that a problem exists and the test may need to
be repeated, to confirm that it is a persistent problem.
Sometimes it can be difficult for patients
to come to terms with the fact that there is a major
problem which presents a significant hurdle to getting
pregnant. The truth can be bitter , but it’s far better
to face up to it and deal with it, rather than live
in a fool’s paradise ! With today’s advanced reproductive
technology, we can always find a solution, no matter
what the problem – but remember that unless you can
intelligently identify the problem, you cannot find
a solution !
It is only after the workup has been
completed , that a treatment plan can be formulated
- and you will now need to make decisions about treatment
options.
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the Man - Semen Analysis
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