Reasons of Infertility to begin with, male infertility might be caused by insufficient or defective sperm. To determine the number and quality of sperm, the male partner must submit a sample of their sperm. The next step is to determine whether the woman has enough eggs in her ovaries. Each ovary contains a fixed amount of eggs, around 200,000 immature follicles. As a woman matures, her number of immature follicles diminishes, and her fertility suffers as a result. The number of immature follicles in her ovaries is referred to as ovarian reserve.
Follicle stimulating hormone can be measured between days two and five of the menstrual cycle to determine ovarian reserve. Remember that the first day of bleeding is the first day of reading. If there are a lot of immature follicles waiting to be stimulated, the pituitary gland only needs to release a tiny amount of FSH (follicle-stimulating hormone) to induce them to start developing. However, if there are only a few immature follicles, or a limited ovarian reserve, the pituitary must release a lot of FSH to encourage those follicles to grow. As a result, if the lady has very few eggs left in her ovaries, FSH will be high on days two to five.
Another method is to measure anti-mullerian hormone, which may be evaluated at any point during the cycle and shows ovarian reserve. A greater level implies better ovarian reserve. Another method for determining ovarian reserve is to utilise an ultrasound scan to count the number of antral follicles between days two and five of the cycle. When the immature or primordial follicles get activated, antral follicles emerge as secondary follicles. A bigger ovarian reserve and a better response to FSH are associated with more antral follicles. A large number of antral follicles, on the other hand, could indicate polycystic ovarian syndrome.
Then we’ll have to see if she’s ovulating and releasing eggs on a monthly basis. We can check this using a day 21 progesterone test, which is frequently referred to as a day 21 progesterone test; however, measuring progesterone on day 21 is suitable for someone on a 28-day cycle. Progesterone levels should be checked seven days following ovulation. The best method to do this is to count back seven days from the predicted start of her menstruation using her typical cycle length. So, if she has a 27-day cycle, subtract seven days to achieve a progesterone level of day 20. If she has a 32-day cycle, remove seven days and check progesterone levels on day 25, and so on.
Remember that after ovulation and the collapse of the growing follicle, the corpus luteum secretes progesterone. Because a corpus luteum can develop without a fully developed follicle releasing an egg, if progesterone levels rise at this time, we know the person has ovulated.
If we locate someone who isn’t ovulating, we need to figure out why, and polycystic ovarian syndrome is the most common explanation. Anovulation, polycystic ovaries, and hirsuitism are all symptoms of polycystic ovarian syndrome, which is caused by high levels of androgens, or male sex hormones. Facial hair, acne, irregular periods, and a generally elevated BMI are all indicators.
With a history and an ultrasound of the pelvis to view the cysts in the ovaries, doctors could confirm the diagnosis of polycystic ovarian syndrome. On days two to five, we can examine luteinising hormone together with FSH, and luteinising hormone will be elevated in polycystic ovarian syndrome. We can also check for androgen hormones, which are often elevated in polycystic ovarian syndrome. Hypothalamic amenorrhea is another cause of anovulation. This is when physiological stress causes the hypothalamus gland to stop producing GnRH, and as a result, the gonadotrophins that drive the ovary to grow and release eggs are not produced. This can happen when the body is put under a lot of stress, such as through extreme diets and exercise, a low BMI, chronic disease, or significant psychological lifestyle stress.
Endocrine diseases like as hypothyroidism or hyperprolactinaemia can also cause anovulation. Prolactinoma, a benign tumour in the pituitary gland that secretes the prolactin hormone, is the most common cause of a high prolactin level. The person may be experiencing galactorrhoea, a condition in which they produce breast milk. They suffer amenorrhoea and a low libido, and if the tumour develops large enough, they may develop symptoms such as migraines or cranial nerve palsy.
You can look into this by monitoring prolactin levels in the blood and performing a brain MRI to see if the tumour is there. So, if the woman is ovulating and the guy has sufficient quantities and quality of sperm, we must ensure that the eggs and sperms will meet. If the uterus has structural abnormalities, such as big fibroids or vaginal septums, adhesions that are distorting the form of the uterus, or polyps that are getting in the way, this can be an issue.
So a pelvic ultrasound scan can be used to evaluate all of these things, and it should detect any major structural abnormalities that are interfering with the meeting of the eggs and sperm. The tubes act as another barrier between the sperm and the eggs. These can become damaged, obstructed, deformed, or perhaps disappear entirely. Sexually transmitted diseases or pelvic inflammatory disease as a result of chlamydia or Gonorrhoea infections are the most common causes of such issues. Adhesions from earlier surgery or endometriosis might cause them to become deformed.
A hysterosalpingogram is a procedure that includes squirting a contrast dye via the cervix, filling the uterus, and spilling into the tubes. Then we take an x-ray, and the dye will show up on the x-ray, indicating the location of the uterus and tubes. If they’re open, the X-ray will show the tubes; but, if there’s a blockage, the X-ray will show a gap. During laparoscopy, or keyhole surgery, where a camera is inserted into the abdomen, you can perform something similar.
The surgeon can observe whether the tubes are filling with dye or if there is a blockage anywhere by injecting dye into the uterus and then up into the tubes. If you’re having a hysterosalpingogram with a dye test, make sure you’re free of chlamydia first, because injecting dye into the uterus and allowing it to spread into the tubes is a wonderful way to spread infection.
Baseline tests you perform to rule out reasons of Infertility
A semen analysis would be performed on a guy to determine the quantity and quality of sperm.
Between days two and five, you’d check FSH to see whether the woman has an ovarian reserve and LH to see if she has polycystic ovary syndrome. To check for ovulation, you’ll take a progesterone test on day 21. You get an androgen hormonal profile, a pelvic ultrasound, chlamydia screening, and a hysterosalpingogram to assess the tubes.
We also perform a few other tests on a regular basis as a baseline. The first step is to check for rubella immunity; if they aren’t, a vaccine that protects them during pregnancy can be provided. The second point is that if a woman is trying to conceive, she should take advantage of this chance to make sure her smear tests for cervical cancer are up to date.
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