1. Full Medical History and Physical examination including pap smear to ascertain the cause of infertility
2. Ultrasound of the pelvis (transvagina/transabdomen)
3. Blood Examination and hormonal profile check
4. Hysteroscopy (to check the cavity of the uterus)
5. Hysterosalphingogram (HSG) – tubal patency screening
6. Diagnostic laparoscopy and hydrotubation – to evaluate the pelvis and check the tubal patency
7. Semen Analysis
What we can do for you?
About infertility problem and fertility treatment
What is infertility?
Infertility is defined as the inability of a couple to get pregnant after a year of unprotected sex.
The definition of infertility can be further broken down into 3 groups:
Primary infertility refers to women who have never achieved pregnancy in the past.
Secondary infertility refers to women who have achieved pregnancy and given birth in the past, but is now having difficulty to conceive.
Women who experience recurrent miscarriages may also receive a diagnosis of infertility if they experience three or more successive miscarriages.
Risk Factors associated with infertility
Infertility is not limited to women. Infertility affects women and men equally.
According to the American Society of Reproductive Medicine, one-third of infertility cases are due to female factor infertility, one-third are due to male factor infertility, and the remaining third due to problems from both sides, or unexplained reasons.
Here are some early warning signs that suggest a fertility problem:
- Irregular cycles
- Bleed extremely heavily or lightly or excessive cramps
- Older than 35
- Partner experiences impotence or ejaculatory problems
- Underweight or overweight
- Chronic illnesses like diabetes, thyroid problems or hypertension
- History of STDs
- Smoke or drink alcohol
Causes of Infertility
Infertility may be due to male or female factors.
Causes of male infertility include:
- Low sperm count
- Poor sperm motility
- Poor morphology or shape, so that the sperm is unable to penetrate the egg
Causes of female infertility include:
- Hormonal disorders in particular polycystic ovarian syndrome resulting in anovulation or a failure of egg follicles to grow and be released
- Blocked fallopian tubes, which will prevent an egg and sperm meeting
- Endometriosis, in which tissue of the lining of the womb invades and damages neighbouring reproductive tissue
Often, there is a mixture of both male and female factors. In some cases, there appears to be no obvious reason and this is termed ‘unexplained infertility’.
Basic investigations include a semen analysis and, for the female partner, hormone tests and an ultrasound scan of the pelvis. Depending on the medical history and basic investigation results, advise will be given on the method of testing for patency of the Fallopian tubes.
Options for testing tubal patency include:
- a radiological dye test called ‘hysterosalphingography’ or
- hydrotubation at the time of minimally invasive laparoscopic surgery
Some women may be recommended a test to assess the cavity of the womb called ‘saline sonography’. This test involves infusion of normal saline into the cavity of the womb to ensure that the cavity of the womb is healthy without the presence of polyps.
Based on the investigation results, appropriate treatment will be recommended.
In cases of anovulation, ovulation induction medication may be given.
In some cases of tubal obstruction, minimally invasive laparoscopic reproductive surgery may be advised. Laparoscopic surgery may also be useful in treating pelvic adhesions, endometriosis, removing cysts, fibroids and polyps. Treatment of such conditions may help to enhance your fertility and increase your chances of getting pregnant.
Intra- uterine insemination (IUI)
This method is suitable for couples with mild male factory infertility, mild endometriosis, cervical factor infertility and unexplained infertility. Normal healthy fallopian tubes are essential for this method.
With IUI, the semen sample is prepared and sperms are placed directly into the uterus. This may be combined with superovulation (SO IUI) to improve the chances of conception.In SO- IUI, medicines are given to stimulate the ovaries to produce several eggs. Ultrasound scans are performed to determine the size and number of eggs growing within the ovary. Insemination is performed around the time of ovulation. On the day of insemination, the couple has to bring the husband’s semen sample to the hospital. The semen undergoes special preparation so that the quality of the sperm to be inseminated is enhanced. This sample is then placed into the womb using a fine catheter. Pregnancy support is given to improve the chances of pregnancy. You should return to the Centre 17 days after the insemination for a pregnancy test.
Assisted Reproductive Techniques
Assisted Reproductive Techniques or ART refers to the use of laboratory techniques to bring the egg and sperm together (fertilisation) outside of the woman’s body. ART used to be called In-Vitro Fertilisation (IVF), which is the medical term for the technique. Nowadays, intra- cytoplasmic sperm injection (ICSI) is often utilized to enable the sperm to be directly injected into the egg.
ART is a complex and stressful process. It is usually recommended only if simpler treatment procedures have not worked unless there is severe male factor infertility with abnormal sperm count or quality, or if you are close to 40 years. Before starting the programme, the steps involved will be explained and you will need to sign a consent form.