ASSESSMENT OF INFERTILITY IN COUPLES
1.ASSESSING FEMALE INFERTILITY
OVARIAN RESERVE EVALUATION
Nowadays, many women are choosing to delay motherhood because of educational and career goals. For this reason, these women are more likely to experience infertility due to having a reduced ovarian reserve.
What does diminished ovarian reserve mean?
Diminished ovarian reserve (DOR) means a woman’s ovaries lose their reproductive potential, which can cause infertility. Among the causes of DOR, ageing is the most important factor. As age increases, especially after 35 years, the number and quality of eggs decreases. Having regular periods every month does not indicate that ovarian reserve is normal. Women with a low ovarian reserve can still have regular menstruation for a long period of time.
Diminished ovarian reserve is a race with time.
What are the causes of diminished ovarian reserve?
The most important factor for DOR is advancing age. Other reasons are:
- Having a family history of early menopause
- Past ovarian surgeries
- Radiotherapy and chemotherapy (cancer treatment)
- Substance abuse
- Endometriosis and chocolate cyst
- Being overweight and obesity
How is ovarian reserve assessed ?
Transvaginal ultrasound on the 2nd or 3rd day of menstruation is used to count the number of eggs. A low number of eggs shows DOR. In addition, AMH (Anti-Müllerian Hormone) and FSH (Follicle Stimulating Hormone) tests also provide information about ovarian reserve.
Which ovarian reserve test?
What is the AMH test?
Production of AMH is reflective of one’s ovarian reserve. The AMH test is used to assess a woman’s egg count. It can be done at any time in the menstrual cycle, as AMH levels are stable throughout the cycle. A “low AMH value” suggests DOR, while a “high AMH value” is associated with Polycystic Ovary Syndrome.
What is the FSH test?
FSH is one of the hormones that’s involved in reproduction. It is produced and released into the bloodstream by the pituitary gland, located at the base of the brain. It stimulates the ovaries to release eggs. The FSH test is done on the 2nd or 3rd day of menstruation to check how much FSH is in your blood. High blood FSH levels indicate DOR. Normal values do not necessarily mean that the amount of eggs is high.
Ovarian reserve is most accurately evaluated when the number of eggs is counted, together with blood AMH and FSH levels.
What other hormone tests are done for ovarian reserve evaluation?
In women, hormones produced by other glands besides the ovaries also affect fertility. We can assess thyroid hormone disorders along with the Thyroid Stimulating Hormone (TSH) and free thyroxine (T4). In addition, the prolactin (PRL) hormone also affects fertility. Increased PRL levels may cause infertility.
HISTEROSALPINGOGRAPHY (HSG)
HSG is a type of X-ray used to examine the uterine cavity and the integrity of the fallopian tubes by use of an opaque substance introduced into the uterus and fallopian tubes by your doctor using a special cannula. It should take place within 3 days after the end of menstruation. With this method, congenital anomalies of the uterus and subsequent space-occupying pathologies in the uterine cavity (such as myoma, polyps, adhesions) are checked. In addition, information is obtained about the patency of the fallopian tubes.
Normal HSG
LAPAROSCOPY
Laparoscopy is a type of surgical procedure used to examine the organs inside the abdomen. Laparoscopy uses an instrument called a ‘laparoscope’ which is a long, thin tube with a high-intensity light and a high-resolution camera at the front. Laparoscopy is used both for diagnostic purposes and for operative surgery like cutting intraabdominal adhesions, removing tubes, closing tubes, and the removal of ovarian cysts and fibroids.
Laparoscopic surgery
2. MALE INFERTILITY ASSESSMENT
SEMEN ANALYSIS
The basic examination of male infertility is the spermiogram. In this analysis, a semen sample given after 3-4 days of sexual abstinence is examined. In the given sample, the sperm concentration (no of sperms/ml of semen), sperm motility rate and the structure of the sperms are assessed.
In men who cannot ejaculate under laboratory conditions for various reasons, sperms can be aspirated from the testicular tubes by using an injector. In addition, in cases where the semen is ejaculated back into the bladder, these sperms can be collected from the bladder and can then be used in IVF treatment.
Sperm evaluation
GENETIC EVALUATION
The frequency of genetic disorders in infertile men is 5.8%. As the number of sperms decreases, the frequency of genetic anomalies increases. Therefore, genetic evaluation is required in men with a sperm count of less than 3 million per one ml or with no sperm in their semen (azoospermia).
HORMONAL TESTS
In cases where the sperm count falls below 10 million/ml, hormonal imbalances might be a factor. Therefore, certain hormone levels have to be checked. For this purpose, blood FSH, total testosterone, luteinizing hormone, PRL, estrogen, TSH and a free T4 test are performed.
ULTRASONOGRAPHIC EXAMINATION
If necessary, an ultrasound examination of the scrotum and testicles is carried out after the examination.