Comprehensive Infertility Evaluation

When a patient comes into our clinic, Dr. Peyman Saadat will spend all the time needed in the first consultation to review the patient’s history in detail and determine what may be the underlying issue. He will take a complete medical history, and review medical records, if available, for both partners. Based on the interview, Dr. Peyman Saadat can determine which tests are needed to identify the issue, and what approach will be best to achieve everyone’s goal of a successful pregnancy. find a solution.

The three most important tests to determine if there is female factor infertility are:

  • Evaluation of Hormones – To evaluate ovulation, tests of serum progesterone can be done. This will determine if the patient is ovulatory or not. If the patient is not ovulatory, specific lab tests can be done: testing FSH and estradiol levels to determine whether the patient is entering menopause or perimenopause, tests of the thyroid stimulating hormone to determine if the thyroid is causing the patient not to ovulate, and a test of prolactin to determine if a hormonal imbalance in the prolactin level is the reason for anovulation.
  • Evaluation of Tubal Patency – To ascertain whether the fallopian tubes are patent (open) or not, a hysterosalpingogram, which is an x-ray that uses dye, is recommended. At times, laparoscopy, which is a surgical procedure to look into the pelvic cavity, may be recommended to evaluate and treat any problem that exists with the tubes.
  • Evaluation of the Uterus – To evaluate the uterus, a hydrosonogram (water ultrasound) may be done to exam the uterine cavity to ensure there are no fibroids or polyps present. A hysterosalpingogram can be substituted for a hydrosonogram to evaluate the uterine cavity.

To determine the cause of male infertility, a semen analysis is usually recommended to evaluate the male partners sperm count and quality. In a semen analysis, four factors are evaluated:

  • The volume of the sperm that was produced.
  • The count of sperm (in general, a count of 20 million is considered to be normal).
  • The motility of the sperm (in general 50% of the sperm should be moving).
  • The morphology (shape or appearance) of the sperm (at least 40-50% of the sperm must be normal for the sperm to be considered normal).

In special circumstances, extra evaluation may be needed. For example, in patients with recurrent pregnancy loss, additional tests may need to be done. These tests may include genetic testing to check the parents for any chromosomal abnormalities; testing of the uterus to evaluate any congenital abnormalities, such as uterine septum or bicornuate uterus; and antibody testing to evaluate if there are antibodies present in the maternal serum that may affect pregnancy outcomes (these include lupus anticoagulant and anticardiolipin antibodies, as well as other antiphospholipid antibodies). Additional evaluation for the presence of infections such as Chlamydia may be required, as well as ureaplasma and other infectious agents.

Evaluation for infertility may also require further testing, including tests for antibodies present in the female partner that work against the sperm of the male partner, called antisperm antibodies, as well as for the presence of paternal leukocyte antigens, which are present in the mother.

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