Definition & Overview

Infertility investigation, as is suggested by the term, is a thorough assessment to determine the reason/s why a couple (male and female) is unable to conceive. Infertility diagnostics are performed by a gynaecologist or an expert in the field of assisted reproduction with the help of other medical experts.

The entire process of investigation can be long and tedious, and requires access to various medical data pertaining to the physiology of both the male and female patient. Fertility problems can affect a woman or man, or even both, so it is best that both partners visit a fertility expert when trying to conceive. Moreover, aside from physiological aspects, the process of conception also involves emotional aspects, such that stress reduction and support is vital in achieving the goal.

Who Should Undergo and Expected Results

Statistically, over 90% of couples bear a child within a year or two of regular unprotected sexual intercourse. Couples who are unable to conceive after a year and wish to get pregnant, as well as those who have a medical history that may hinder conception must see a doctor for infertility investigation.

To have a comprehensive understanding, the doctor will first assess the couple’s full medical, social, and sexual history. Some common factors that will be considered and asked by the doctor during the initial meeting are the following:

  • Age - Fertility usually declines with age, especially in women. Women who are over 35 years old and unable to conceive may need to see the doctor for assistance.
  • Pregnancy experience - Women will be asked about previous births, possible complications in prior pregnancies, and miscarriages, if any.
  • Length of time – Patients will be asked how long they have been trying to get pregnant
  • Sex - The doctor will ask about the frequency of sexual intercourse or whether the couple has difficulties performing the act. These are common questions which may be embarrassing, but should be answered truthfully as they provide important information that will help in the infertility investigation.
  • Contraception – Patients are asked about contraceptive methods previously used and when it was stopped as it may affect fertility.
  • Medication - Some medications may be affecting fertility so that alternative treatments may be suggested.
  • Medical history - The doctor will ask the couple’s any current or previous medical conditions, if any.
  • Menstrual Period - Women are asked about how regular their menstrual cycle is, and whether there are other symptoms such as bleeding or abnormal pain experienced some time in the cycle.
  • Lifestyle - Smoking, obesity, drinking too much alcohol, the use of controlled drugs, and stress - these all affect fertility and should also be considered in the investigation.

How is the Procedure Performed?

After taking the couple’s full medical history (as detailed above), the doctor then performs a physical test to examine the pelvic area for lumps, infection or tenderness, which could be indicative of conditions such as endometriosis, pelvic inflammatory disease (PID), or fibroids, which are common causes of infertility in women. For men, the GP may examine the testicles for lumps and deformities, and the penis for any abnormalities. Should a disease is suspected, further tests will be performed to determine diagnosis.

If no physical symptoms are present, a number of tests may be recommended to further establish the cause of infertility. These may include:

  • Hormone test (women) - Hormones are usually tested in cases when menstrual period is irregular or absent. A sample of the blood is drawn to check for levels of hormones such as progesterone and gonadotropins to check for ovulation and release of egg cells.

  • Ultrasound/imaging scan (women) - Imaging scans such as transvaginal ultrasound can examine anatomical causes of female infertility. It can detect ovarian cysts, endometrial polyps, and endometriomas that can affect fertility.

  • Chlamydia test (both men and women) - Chlamydia is an infection that affects fertility. Should this be present, it must be treated immediately with antibiotics.

  • Hysterosalpingogram (women) – This is an x-ray of the uterus and fallopian tubes to detect blockage or physiological abnormalities that may be preventing pregnancy.

  • Diagnostic laparoscopy - In some cases such as those involving endometriosis, fibroids and polyps, surgical investigation may be necessary (laparoscopy and/or hysteroscopy).

  • Genetic screening (both men and women) – This investigates gene mutations, genetic incompatibilities, and congenital conditions that may lead to infertility

  • Semen analysis (men) - This involves tests to analyse the health and viability of a man's sperm


Depending on the results of the infertility investigation, fertility treatment will be suggested to increase chances of pregnancy. This may include medications, further surgical treatments, or assisted conception such as in vitro fertilisation (IVF), intrauterine insemination (IUI), intracytoplasmic sperm injection (ICSI), egg donation, gamete intrafallopian transfer (GIFT), or embryo donation.

Possible Risks and Complications

Infertility investigation, although long and tedious, is usually safe and leads to satisfactory results. There are, however, some rare complications that may include infection, spotting, and nausea. Should surgery be performed, possible complications can include bleeding, damage to the fallopian tubes, and possible ectopic pregnancy.

References:

  • Infertility: An overview — A guide for patients. American Society for Reproductive Medicine. http://www.asrm.org/Templates/SearchResults.aspx?q=fertility:%20An%20overview%20-%20a%20guide%20for%20patients.

  • Frequently asked questions. Gynecologic problems FAQ137. Treating infertility. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq137.pdf?dmc=1&ts=20130521T1023327144.

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