Diagnosis of Infertility

What is Infertility? How is it treated?

Infertility is a medical condition in which a couple has difficulty starting a pregnancy after trying for one year without any contraception. This duration may be reduced to 6 months if the woman partner is over 35 years of age. It is caused by one or more of the following: ovulation problems, fibroids, polyps, tubal damage, endometriosis, low sperm count, and poor quality sperms or eggs.

Fertility problems can be treated in 5 ways

a. Medical treatment- correct underlying problems medically

b. Surgical treatment- if conditions such as polyps, fibroids, etc are causing infertility

c. Ovulation induction- timed intercourse

d. Intrauterine insemination (IUI)

e. In-vitro fertilization (IVF) and other advanced assisted reproductive procedures

What is infertility? How is it treated?

How is a diagnosis of infertility established?

Infertility treatment may be simple or complex based on the underlying cause. As the treatments offered may be expensive and long at times, meeting a doctor with the right set of training, skills, and experience is critical for success. A trained fertility doctor (a specialist), well versed in handling all types/ causes of infertility is possibly the best course early on, when possible. Doctors usually look at a few factors before suggesting treatment for couples. The important factors for decision making are

  1. Semen analysis in the male partner- Sperm counts, morphology, and motility

  2. age of the female partner

  3. ovarian reserve-number of eggs available

  4. duration of infertility

  5. condition of the fallopian tubes

  6. previous treatment details, if any

  7. previous pregnancy, if any

  8. hormonal tests

  9. Results seen on ultrasound scans and other imaging tests

  10. Results seen on procedures such as hysteroscopy or laparoscopy, if required

Is infertility a problem in women or men?

The problem of infertility is faced by both men and women regardless of their gender. According to the American Society for Reproductive Medicine, Male Factor Infertility is a major cause of infertility in 15-25% of infertile couples. Another major cause is Female Factor Infertility which contributes to 20-30% of all cases. Both the male and female partners could test normal in 10-20% of couples. This condition is known as unexplained infertility. It is important to make a correct diagnosis of the underlying cause before initiating treatment.

What are the causes of infertility in women (female partner)?

There are a lot of health conditions that can cause infertility in a female partner. This is because the ovaries, the fallopian tubes, or the uterus may not be functioning properly.

The common causes for infertility in women are

- - Polycystic ovarian syndrome or other disorders of ovulation

- Pelvic inflammation or infections causing tubal blockages

- Age-related decrease in ovarian reserve

- Underlying medical conditions such as tuberculosis, thyroid disorders, etc.

- Obesity

- Endometriosis

How is infertility tested in women (female partner)?

There are many reasons that infertility may be present in women. These reasons vary from infertility caused by ovulation problems to endocrine problems. There are also some causes that are more difficult to diagnose like genetic causes of female infertility.

A diagnostic test is a medical test that is used to determine if a person has an illness or not. Diagnostic tests for infertility in women include:

- Blood tests to rule out medical conditions, evaluate hormonal levels and ovarian reserve (some tests are done on the 2nd day of the period)

- Ultrasound scan to visualize the ovaries, fallopian tubes, and uterus

-Hysterosalpingography (HSG), a test to evaluate the condition of the fallopian tube

- Diagnostic Hysteroscopy or laparoscopy, a test to directly visualize the uterus from the inside (hysteroscopy) or outside laparoscopy

Causes of infertility in the female partner and how it is diagnosed

What are the causes of infertility in men (male partner)?

Male infertility is a result of a man’s reproductive system not being able to produce a sufficient amount of sperm, or the sperm being unable to fertilize the egg. The causes for male infertility are many and include improper diet, environmental factors, lack of ejaculation, drug use, and stress.

Healthy sperm must be formed in the testicles for a male to be fertile which is then deposited into the female during intercourse. The cycle starts with hormones that stimulate testosterone production in the brain, then it stimulates hormones that produce sperm-producing cells in the testicles.

It is difficult for researchers to pinpoint one exact cause of male infertility, but there are certain risk factors for this condition including age, limited sexual frequency, and lifestyle habits like smoking cigarettes or using illegal drugs. Infections or conditions that may obstruct the passage of sperms may also present as male infertility

How is infertility tested in men (male partner)?

There are many reasons why a couple may be unable to conceive and one of the most common is male infertility. Male infertility is usually diagnosed through the use of a few diagnostic tests.

The most common diagnostic test for male infertility is a semen analysis, which measures sperm concentration and quality in the ejaculate. It may also measure total sperm count or motility, or examine DNA fragmentation in the sperm.

After taking a specimen at home, it is sent to a laboratory where it is analyzed within hours and results can be available in one day. If this test is normal, only 1 in 20 men will have fertility problems and need further testing.

Who should I approach for a fertility test?

A fertility specialist is the best person to approach for a fertility test. They will not only be able to diagnose the cause of infertility but also recommend treatment. Plus, they can provide advice on what couples should do next if their fertility problem is not curable.

Ensure that your doctor or clinic should be qualified with valid degrees and trained appropriately for giving the required treatment. They should not hesitate in giving details such as your treatment records, ultrasound reports, or test reports if asked by you. It is mandatory for your doctor to have a medical council registration number.

When should we seek help for problems related to fertility?

Infertility has various causes from trying at the wrong time, trying infrequently, trying for a short duration ( less than a year).

Other than that hormone imbalance like thyroid prolactin uncontrolled hypogonadism or low sex hormones diabetes genetic conditions can cause infertility

Anovulation is another important cause of infertility among women with irregular periods being one of the common symptoms.

If you have not become pregnant after one year of trying regularly, you need to check if you are infertile. There may be a problem in the production or release of eggs or the quality of sperm or attachment of the formed embryo.

How should a female partner prepare before a fertility test?

Contacting a fertility specialist is the first step. The specialist will be able to examine potential causes of infertility and discuss these with you.

Next, it’s important to think about your lifestyle and habits before you go in for the test. The doctor will want to see your diet, exercise routine, and fertility drug use to determine if any of these could be affecting your fertility. If you smoke or drink excessively these should also be disclosed as they can affect the results of the test.

If you’re experiencing any symptoms such as irregular periods, vaginal pain or discharge, pelvic pain, or abdominal pain it may be important for you to mention them before your visit.

How should a male partner prepare before a fertility test?

Male partners of couples who are having difficulty getting pregnant should prepare for a semen analysis. This is done to determine if there is an issue with the male’s fertility. They should make sure that they avoid alcohol and smoking 2-3 days before the exam as they can affect the results. It's also important to abstain from sexual intercourse for two days before the test as ejaculation can affect results too.

What should we expect on our first visit to a fertility consultant?

Every person’s fertility needs are different, so the first visit should be tailored to the individual’s needs. The first visit to a fertility specialist is usually an interview consultation. The doctor will ask about the couple's medical and family history and then assess them for any medical conditions that may be contributing to infertility.

The first appointment with a fertility specialist starts with a consultation. They may ask you about your medical and reproductive history as well as any family history of infertility problems, before assessing you for any health conditions that may be interfering with your chances of conceiving or carrying a child to term.

The infertility specialist would also want to know about any past attempts at infertility treatment and review the records for the same.

The information you provide will help them create an individualized plan for you from the start, rather than just starting with a set program for everyone without considering their specific circumstances.

The infertility specialist will then explain the next steps on the treatment plan before the end of the consultation. The doctor may advise some tests or medications for the way ahead.

Is infertility evaluation expensive?

The cost of infertility evaluation in India is dependent on a number of factors.

The cost of evaluation of fertility problems for diagnosis could range from Rs. 1500 to Rs. 7,000 depending on individual factors like the clinic and doctor. This would typically involve a consultation, a set of basic blood tests for the male and female partner, semen analysis for the male partner, and a transvaginal scan to visualize the uterus tubes and ovaries. A small percentage of patients (<5%) may require special tests such as DFI, clotting profiles, additional hormone testing, when medically warranted, which may cost an additional Rs 7000-10,000. The doctor would be able to make a diagnosis and suggest a plan for management based on the results of these tests.

Insurance coverage varies from company to company so it's advisable to check with your insurance provider before making any decisions about financing options for infertility evaluation in India.