The female partner
To determine if the female partner has problems concerning ovulation, egg transport, fertilization or implantation, various tests may be administered based on the physician’s examination and analysis.
Serum hormone testing – measures the levels of luteinizing hormone, follicle-stimulating hormone (FSH), Anti – Mullerian Hormone (AMH), prolactin, progesterone and thyroid stimulating hormone (TSH). Follicle stimulating hormone is produced by the anterior pituitary gland and stimulates the ovary to develop a follicle for ovulation. Anti –Mullerian Hormone is a marker of ovarian reserve. Progesterone hormone is produced after ovulation has occurred and prepares the uterus for pregnancy.
Luteinizing hormone and follicle stimulating hormone are checked for hypothalamic pituitary dysfunction. Prolactin (a hormone that stimulates breast milk production) levels are done to see if an excessive amount has caused hyperprolactinemia, a condition that interferes with ovulation. Progesterone levels are performed to determine if inadequate levels are interfering with the development of the endometrium, the lining of the uterus that prepares embryo implantation. TSH is checked as a measure for normal thyroid function.
Hysterosalpingogram (HSG) – an x-ray of the uterine cavity and fallopian tubes using a radiographic dye to detect structural abnormalities of the uterine cavity, fallopian tubes, as well as tubal patency.
Diagnostic laparoscopy – a minimally invasive surgical procedure typically performed in an outpatient day surgery setting. It permits direct visual assessment of the uterus, fallopian tubes, ovaries, and lower pelvis. It is particularly useful in diagnosing endometriosis, tubal disorders or pelvic adhesions and generally is performed at the end of a work-up, but may be performed earlier if deemed appropriate by the patient’s history and referral diagnosis.
Hysteroscopy – often done in conjunction with a laparoscopy to examine visually the interior of the uterine cavity for scar tissue, adhesions, polyps, tumors, and other abnormalities and to eliminate endometriosis.
Ultrasound – performed seven to nine days after ovulation to reveal the thickness of the uterine lining (the endometrium) and its response to hormonal stimulation and as well as growth of the ovarian follicles can be monitored.
Endometrial biopsy – used to determine if the endometrium, the lining of the uterus, has responded appropriately for implantation of the embryo. This is obtained as a tiny tissue sample from the endometrium.
Recurrent Pregnancy Loss profile – This includes the list of all tests require to find the cause in a women with multiple miscarriages.
Polycystic Ovarian Disease (Anovulation) profile – Women with polycystic ovaries often need help conceiving. This profile includes all the tests to be done in women with anovulation.
The male partner
Male factor problems may be related to:
- Inadequate or abnormal sperm production and delivery
- Anatomical problems
- Previous testicular injuries, or
- Hormonal imbalances
The male partner provides a semen sample that is analyzed with a battery of advanced Andrology tests in our affiliated laboratory. In addition to the standard semen analysis using World Health Organization (WHO) criteria, we also analyze sperm to assess the number of motile sperm that can be extracted from the ejaculate.
We encourage male partners to have their semen analyzed at our Laboratory so their samples can be tested against rigorous standards. In addition to the routine analysis of morphology, motility, and concentration, some of the additional testing we perform on the semen includes:
- Comprehensive genital cultures to detect infections
- Pre and post-processing to determine what to expect for IUI or IVF procedures
- Testing for antisperm antibodies and for IgA, IgM, and IgG antibodies
- Long-term survival studies
- Detection of biochemical markers in the semen, e.g., fructose testing and also additional diagnostic testing for patients with severe male problems e.g. Hos Test
In cases where the semen analysis is normal, treatment will focus on the work-up of the female partner only.
According to WHO a normal semen analysis includes:
- A sperm concentration of greater than 15 million sperm/ml
- Motility (movement) of greater than 40%, and
- A volume greater than 2cc
Additionally, our laboratory uses the Kruger classification of more than 14% normal morphology.
Abnormal semen analysis – An abnormal sperm analysis is repeated first for verification. Typically, the male partner is referred to an urologist for evaluation. If the urologic evaluation is normal, results of the sperm count determine further treatment. For example, a total motile sperm in excess of 0.5 – 10 million would make intrauterine insemination an option. If the number is less than a 1 million, ICSI would be a better course of treatment.
Anti Sperm antibodies – Anti-sperm antibodies are substances that attach to the surface of the sperm and may interfere with the ability of the sperm to move & penetrate the cervical mucus, or to fertilize an egg. They must be done when infertility is either unexplained, following an abnormal postcoital test, or when significant sperm coagulation is noted in the initial semen analysis. Our laboratory uses the immunobead technique to detect sperm antibodies. If they are detected, sperm washing in conjunction with IUI or IVF is considered.
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