Infertility tests for women
· General physical exam: the doctor will ask the woman about her medical history, medications, menstruation cycle, and sexual habits. She will also undergo a gynecological examination.
· Blood test: several things will be checked, for example, whether hormone levels are correct and whether the woman is ovulating (progesterone test).
· Hysterosalpingography: fluid is injected into the woman’s uterus which shows up in X-ray pictures. X-rays are taken to determine whether the fluid travels properly out of the uterus and into the fallopian tubes. If the doctor identifies any problems, such as a blockage, surgery may need to be performed.
· Laparoscopy: a thin, flexible tube with a camera at the end (laparoscope) is inserted into the abdomen and pelvis to look at the fallopian tubes, uterus and ovaries.
A small incision is made below the belly button and a needle is inserted into the abdominal cavity; carbon dioxide is injected to create a space for the laparoscope. The doctor will be able to detect endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes.
- Ovarian reserve testing: this is done to find out how effective the eggs are after ovulation.
- Genetic testing: this is to find out whether a genetic abnormality is interfering with the woman’s fertility.
- Pelvic ultrasound: high frequency sound waves create an image of an organ in the body, which in this case is the woman’s uterus, fallopian tubes, and ovaries.
- Chlamydia test: if the woman is found to have Chlamydia, which can affect fertility, she will be prescribed antibiotics to treat it.
- Thyroid function test: According to the National Health Service (UK) between 1.3% and 5.1% of infertile women have an abnormal thyroid.
Courses of Female Infertility
Unfortunately for many women age plays a big role in their infertility. As a woman ages just like with all the other organ system of the body, her reproductive organs do not function as well as they did when she was younger. Women have the most follicles of their lifetime in-utero. So therefore, as a woman ages her ovarian follicular pool decreases. The American Society for Reproductive Medicine says that, Fecundity declines gradually but significantly beginning approximately at age 35 years, and decreases more rapidly after age 37 years, reflecting primarily a decrease in egg quality in association with a gradual increase in the circulating level of FSH.
Problems with ovulation are the most common cause of infertility in women, experts say. Ovulation is the monthly release of an egg. In some cases the woman never releases eggs, while in others the woman does not release eggs during come cycles.
Ovulation disorders can be due to:
- Premature ovarian failure- the woman’s ovaries stop working before she is 40.
- PCOS(Polycystic ovary syndrome) is a serious condition resulting in ovaries which cannot ovulate an oocyte. Polycystic ovaries are the main cause of infertility in women. According to The Federal Government Source for Women’s Health Information, ―In women with PCOS, the ovary doesn’t make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur. Women with PCOS produce an excess amount of androgens. When too much is produced, it can prevent ovulation as well. .
- Hyperprolactinemia: if prolactin levels are high and the woman is not pregnant or breastfeeding, it may affect ovulation and fertility.
- Poor egg quality: eggs that are damaged or develop genetic abnormalities cannot sustain a pregnancy. The older a woman is the higher the risk.
- Overactive thyroid gland
- Underactive thyroid gland
- Some chronic conditions, such asAIDS or cancer.
Problems in the uterus or fallopian tubes
The egg travels from the ovary to the uterus (womb) where the fertilized egg grows. If there is something wrong in the uterus or the fallopian tubes the woman may not be able to conceive naturally. This may be due to:
- Surgery: pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. Cervical surgery can sometimes cause scarring or shortening of the cervix. The cervix is the neck of the uterus.
- Submucosal fibroids: benign or non-cancerous tumors found in the muscular wall of the uterus, occurring in 30% to 40% of women of childbearing age. They may interfere with implantation. They can also block the fallopian tube, preventing sperm from fertilizing the egg. Large submucosal uterine fibroids may make the uterus’ cavity bigger, increasing the distance the sperm has to travel.
- Endometriosis: cells that are normally found within the lining of the uterus start growing elsewhere in the body.
- Infertility often results from complications from having a sexually transmitted infection. According to research The top four STD’s that affect fertility are Chlamydia, Gonorrhea, Syphilis, and HPV. PID (pelvic inflammatory disease) is often 2 associated with these four STD’s. Sadly, women can have an STI and not even know it because many times a person will not present symptoms. And even without symptoms these infections in the upper genital tract may cause permanent damage to the fallopian tubes, uterus, and surrounding tissues, which can lead to infertility.
Mental stress – studies indicate that female ovulation and sperm production may be affected by mental stress. If at least one partner is stressed it is possible that the frequency of sexual intercourse is less, resulting in a lower chance of conception.
Fertility treatments for women
Ovulation disorders – if the woman has an ovulation disorder she will probably be prescribed fertility drugs which regulate or induce ovulation. These include:
- Clomifene(Clomid, Serophene): this medication helps encourage ovulation in females who do not ovulate regularly, or who do not ovulate at all, because of polycystic ovary syndrome (PCOS) or some other disorder. It makes the pituitary gland release more FSH (follicle-stimulating hormone) and LH (luteinizing hormone).
- Metformin(Glucophage): women who have not responded to Clomifene may have to take this medication. It is especially effective for women with PCOS, especially when linked to insulin resistance.
- Human menopausal gonadotropin, or hMG, (Repronex): this medication contains both FSH and LH. It is an injection and is used for patients who don’t ovulate on their own because of a fault in their pituitary gland.
- Follicle-stimulating hormone(Gonal-F, Bravelle): this is a hormone produced by the pituitary gland that controls estrogen production by the ovaries. It stimulates the ovaries to mature egg follicles.
- Human chorionic gonadotropin(Ovidrel, Pregnyl): this medication is used together with clomiphene, hMG and FSH. It stimulates the follicle to ovulate.
- Gn-RH (gonadotropin-releasing hormone) analogs: for women who ovulate prematurely, before the lead follicle is mature enough during hmG treatment. This medication delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH.
- Bromocriptine(Parlodel): this drug inhibits prolactin production. Prolactin stimulates milk production in breast feeding mothers. If non-pregnant, non-breast feeding women have high levels of prolactin they may have irregular ovulation cycles and have fertility problems.
Risk of multiple pregnancies
Injectable fertility drugs can sometimes be the victims of their own success and cause multiple births – when the woman gets pregnant she has twins, triplets, or perhaps more babies in one go. Oral fertility drugs also raise the risk of multiple pregnancies, but much less so than injectable ones. It is important to monitor the patient carefully during treatment and pregnancy. The more babies the mother carries inside her the higher is her risk of premature labor.
If a woman needs an HCG injection to activate ovulation and ultrasound scans show that too many follicles have developed, it is possible to withhold the HCG injection. Couples may decide to go ahead regardless if the desire to become pregnant is very strong.
Multifetal pregnancy reduction is possible if too many babies are conceived – one or more of the fetuses is removed. Couples will have to consider the ethical and emotional aspects of this procedure.
Surgical procedures for women
· Fallopian tube surgery: if the fallopian tubes are blocked or scarred surgery may repair them, making it easier for eggs to pass through them.
- Laparoscopic surgery: a small incision is made in the woman’s abdomen. A thin, flexible microscope with a light at the end (laparoscope) is inserted through the incision. The doctor can then look at internal organs, take samples and perform small operations. For women with endometriosis, laparoscopy removes implants and scar tissue, reducing pain and often aiding fertility.
IUI (intrauterine insemination)
A fine catheter is inserted through the cervix into the uterus to place a sperm sample directly into the uterus. The sperm is washed in a fluid and the best specimens are selected. This procedure must be done when ovulation occurs. The woman may be given a low dose of ovary stimulating hormones.
IUI is more commonly done when the man has a low sperm count, decreased sperm motility, or when infertility does not have an identifiable cause. The procedure is also helpful for males suffering from severe erectile dysfunction.
IVF (in vitro fertilization)
Sperm are placed with unfertilized eggs in a Petri dish; the aim is fertilization of the eggs. The embryo is then placed in the uterus to begin a pregnancy. Sometimes the embryo is frozen for future use (cryopreserved).