Saturday, June 06, 2015

Overtesting and the Infertile Couple



Fertility tests are a very essential part of any type of fertility evaluation and need to be done before starting treatment. Your doctor conducts these tests to discover what is preventing you from achieving a pregnancy. Though  your  gynecologist  might  carry out  some basic testing, you  may also be referred  to an IVF doctor  for more  comprehensive fertility testing.

When couples come to our clinic, it’s common to find that most people feel only the woman will be tested for infertility. But the fact is that conception takes two.  One-third of all  infertility cases  in India are caused by female factor  infertility, one-third are a result  of male factor  infertility; the remaining one-third are  caused  by both male as well as female  infertility ;  or are labelled as having unexplained  infertility.

Female Fertility Tests

There are a very wide range of infertility tests , but please remember that most of them do NOT need to be carried out for you. Sadly, some doctors just mindlessly tick off all the boxes in their fertility test checklist, which means that a lot of unnecessary ( and expensive) overtesting is done for a lot of infertile couples.

For women, the different types of fertility testing include:

•    Basic gynecological exam
•    STD testing (Certain STDs can be the cause of infertility)
•    Blood work- this may check for antiphospholipid and thrombophilia syndrome (in case there have been recurrent miscarriages)
•    Tests for hormones, including LH and FSH, androgen hormones, thyroid hormones, prolactin, progesterone and estradiol (E2).
•    AMH/anti-mullerian hormone, might also be tested for. Some of these tests have  to be done on a specific  day of your menstrual cycle. For instance, FSH is generally checked on Day-3 of your cycle; progesterone is generally checked on Day-21 of your cycle
•    Ultrasound will be conducted to look for ovarian cysts, polycystic ovaries, fibroids etc and at times to confirm whether ovulation is taking place. It is also used to ascertain the shape of the uterus as well as the uterine lining’s thickness
•     An antral follicle count that  predicts the actual quantity of eggs that are available in the woman’s ovaries, might also be actioned via ultrasound
•    HSG (hysterosalpingogram) to check whether the fallopian tubes are open or not . It also helps us check the shape of the uterus
•    Endometrial biopsy involves taking a very small amount of tissue from the endometrium (uterine lining)- This is not a very commonly-used test
•    Hysteroscopy involves positioning a telescope-like camera via the cervix right into the uterus; this helps us take a closer look at the uterus. This will be carried out if an HSG exam shows any potential abnormalities
•    Sonohysterogram involves placing a sterile liquid inside the woman’s uterus and  evaluating the uterus as well as the uterine walls using ultrasound
•    Diagnostic laparoscopy is the most invasive fertility test but many doctors still do this routinely for all infertile women.

Male Fertility Tests

The primary fertility test for men is a semen analysis, and usually this is all the testing the man will need. The man just has to provide his semen sample and the lab will evaluate it. Typically, only a simple semen analysis is required to diagnose male infertility. However, there are lots of “specialists” who perform lots of exotic and expensive tests for infertile men. These include:

•    General physical exam
•    Specialized analysis on the sperm, which includes testing for DNA fragmentation and FISH)
•    Blood work to check the hormone levels, generally of testosterone and FSH; at times also LH, estradiol, or prolactin
•    Doppler Ultrasound, to look for a varicocele
•    TRUS ( transrectal ultrasound) to check the seminal vesicles
•    STD testing
•    Post-ejaculatory urinalysis (urine-testing), to check for possible retrograde ejaculation
•    Testicular biopsy involves the removal of the testicular tissue- this is a minor surgical procedure
•    Vasography is a type of X-ray that helps us check for obstructions in the male reproductive organs

Fertility Tests for the Couple

Certain fertility tests involve both the partners. In case the woman has been facing recurrent miscarriage we may conduct genetic karyotyping to look for any genetic disorders that are causing the miscarriage. This is done via a simple blood test.

Once the fertility testing has been complete, we discuss with  you what  the results mean and the treatment that should  be followed as well as the next step that has to be taken.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!



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