Tuesday, May 23, 2017
Monday, May 22, 2017
The workup for infertility begins with the clinical history and examination.
The ability of a couple to become pregnant depends on normal fertility in both the male and female partners and so both must be evaluated.
EVALUATION OF INFERTILITY IN WOMEN
Although a variety of tests are available for evaluating female infertility, it may not be necessary to have all of these tests. Doctors usually begin with a medical history, a thorough physical examination, and some preliminary tests.
Medical History :
A woman's past health and medical history may provide some clues about the cause of infertility. Following questions are usually asked during the history:
- Age at which menses started.
- The duration of menstrual cycle and if its regular or not.
- Any pain during periods / intercourse
- Frequency of sexual intercourse
- any history of illness /surgeries in the past
- Any medications which the patient might be taking.
- Any children from previous relationships (if any)
A physical examination usually includes a general examination, with special attention to any signs of hormone deficiency or signs of other conditions that might impair fertility. The points that are noticed include:
- Pallor for anemia
- Acne, excessive facial hair
- Breast development
- Pelvic examination for any masses.
After a detailed clinical history and examination , doctor may need some basic investigations to find out the cause for infertility. These tests are explained below:
1. Blood test for hormones: FSH, LH, estradiol, prolactin & AMH are done on day 1-3 of the menstrual cycle.
FSH- Follicle stimulating hormone is one of the most important hormones in the normal menstural cycle. It helps in producing mature eggs by stimulating the ovaries. If the ovaries are not working and the eggs are not developing, the body response is to increases FSH production.
LH- Luteinizing hormone, again an important hormone that helps an egg to grow and be released once mature.
The time when the egg is released from the ovary it is called ovulation. Ovulation can be tracked by urine testing strips which detect a rise in LH at the time of ovulation.
Estradiol-is tested to check the quantity and quality of egg production.
Prolactin- hormone is normally responsible to produce milk for breast feeding.This hormone naturally prevents conception by inhibiting ovulation in breast feeding mothers. If abnormally high without a woman breast feeding it may lead to irregular menstrual cycles and lack of ovulation.
AMH- a recent test introduced to check ovarian reserve. If low means the woman is approaching menopause and chances to conceive are low.