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Female Infertility

CAUSES DIAGNOSIS TREATMENT

Diagnosis

Infertility is usually diagnosed through medical interviews and physical examinations of both partners. A fertility specialist usually an obstetrician-gynecologist may analyse the health history, menstrual cycle, and sexual habits.

The basal body temperature (BBT) is recorded each morning over several months using a special thermometer to find any ovulatory disorders. A blood test is performed to determine the levels of various hormones, such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), estradiol and progesterone which aid greatly in determining the cause of infertility.

The doctor will perform several specific fertility tests to evaluate the entire reproductive system and these may include : 

Hysterosalpingography (HSG) : This is an imaging study of the uterus and fallopian tubes. A radio opaque dye is injected through the cervix and the outline of the lining of the uterus is examined to confirm that the tubes are normal and open. The X-ray image can help to diagnose fibroid tumors, an unusually shaped uterus, scar tissue or blockages in the fallopian tubes. Hysterosalpingography is usually performed before ovulation so the dye does not disrupt an egg or developing embryo.

Hysteroscopy : In this method, a thin telescope called hysteroscope is passed through the cervix into the uterus to look inside directly to detect the presence of endometriosis, fibroids, polyps, pelvic scar tissue, and blockage at the ends of the fallopian tubes.

Laparoscopy : This is a surgical procedure performed under general anesthesia. A small incision is made beneath the navel and a laparoscope which is an illuminated, fiber-optic telescope is inserted through the abdominal cavity to examine the fallopian tubes, ovaries and uterus. A small amount of gas (usually carbon dioxide) is inserted to create space for entry of the laparoscope. At the end of the procedure, the gas and laparoscope are drawn out and the incision is closed. Laparoscopy may be done to visualise the abdominal and pelvic cavity, to see the uterus, fallopian tubes and ovaries, to detect pelvic adhesions, scarring, endometriosis or other relevant pathology.

Post-Coital Test (PCT) : This test is to evaluate the cervical mucus and its interaction with the sperm. It may be done the day of ovulation and several hours after intercourse. In PCT a small amount of cervical mucus is removed and examined under a microscope.

Endometrial Biopsy : It is performed to check if the endometrium (tissue lining the inside of the uterus) can support implantation and growth of a fertilized egg. The test is usually done three days before the period starts. In endometrial biopsy, a sample of endometrium is removed and studied under a microscope. Problems with the endometrium are called luteal phase defect.

Clomiphene Citrate Challenge Test (CCCT) : This test is usually performed in women older than 35 years to evaluate the ability to become pregnant on the basis of the number and quality of remaining eggs.

Pelvic exam : This is performed to feel the uterus for detectable masses and to view the cervix.

Ultrasound scan : This is the standard imaging technique which uses sound waves to produce an image of the organs. It is done to detect uterine fibroids, endometrial polyps, ovarian cysts, and other abnormalities in the pelvis.

Magnetic resonance imaging (MRI) : This is another imaging procedure similar to an x-ray that uses magnetic waves to create images of the internal organs.





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