Understanding infertility within a couple can often bring psychological pressure and feelings of guilt, which can complicate the relationship and even impact treatment success. Rather than focusing on "who" has the issue, addressing "what" the issue is and moving promptly towards treatment is the best step forward.
The causes of infertility are distributed as follows:
- 40% attributed to female factors
- 40% to male factors
- 10% to both partners
- 10% unexplained (no identifiable cause)
Tests for Male Infertility Evaluation
After a detailed medical history, a sperm analysis (spermiogram) is typically requested.
- Spermiogram: The man provides a semen sample via masturbation in a designated room. In the lab, the sample is analyzed to assess sperm count, motility, and morphology. Sometimes additional tests, such as sperm antibody tests, are conducted.
Factors that may reduce sperm fertilizing ability include:
- Complete absence of sperm production in the testes
- Blockages preventing sperm from being released
- Reduced sperm count and motility
- Abnormal sperm morphology
- Retrograde ejaculation (sperm flows into the bladder)
- Genetic factors
- Childhood illnesses, such as high fevers or mumps
- Undescended testicles
- Hormonal issues, such as low testosterone
- Varicocele (enlarged veins in the testes)
- Some sexually transmitted diseases
- Cancer treatments (chemotherapy, radiation therapy)
- Sexual dysfunctions, such as erectile dysfunction
- Systemic conditions like diabetes and infections
- Environmental factors: smoking, alcohol, toxins, stress
Tests for Female Infertility Evaluation
For female infertility, a comprehensive medical history should be taken, covering previous pregnancies, treatments, known health conditions, family history of disease, menstrual patterns, and the partner’s age. A thorough physical examination and gynecological assessment follow:
- Physical and Gynecological Exam: Includes weight, height, and general health check. If a cervical smear (Pap test) has not been done in the last three years, it should be performed. A cervical-vaginal culture may also be collected.
- Ovarian Reserve Testing: Blood hormone levels (FSH, LH, Estradiol, AMH) should be checked between the 2nd and 4th days of the menstrual cycle. Ovarian reserve tests provide insight into egg quantity and quality. An ultrasound follicle count, along with blood tests, can help predict ovarian response to medication.
- Additional Blood Tests: If not done in the past six months, a full blood count, PRL, TSH (thyroid tests), Hepatitis B and C, HIV, and sexually transmitted disease screening should be conducted. Blood type should also be identified.
- Ultrasound Examination: Beyond follicle assessment, the uterus and fallopian tubes should be examined.
- Hysterosalpingography (HSG): Provides a view of the uterine lining and checks for blocked or swollen fallopian tubes (hydrosalpinx).
- Sonohysterography or Hysteroscopy: These are used if there is suspicion of uterine pathology. Hysteroscopy is not a routine IVF pre-treatment but is done if deemed necessary.
For further evaluation, advanced imaging like MRI or hysteroscopy may be recommended if a specific pathology is suspected. Your doctor will guide you on the best diagnostic approach.
Is a Hysterosalpingography (HSG) Necessary for Infertility Treatment?
Yes, an HSG, or hysterosalpingography, is essential in infertility evaluations. This imaging test allows for the detection of uterine adhesions, polyps, fibroids, and anatomical abnormalities, as well as blockages or swelling in the fallopian tubes, often due to prior infections. This condition, known as hydrosalpinx, may require a minimally invasive surgery to either block or remove the affected tube for women planning to conceive.
Why Perform Surgery for Hydrosalpinx if IVF is Planned?
During IVF treatment, fluid from swollen tubes can flow back into the uterus after embryo transfer, potentially causing miscarriage. Surgery to prevent this fluid from entering the uterus helps improve IVF success rates.
Surgical Options for Infertility
- Laparoscopy: This minimally invasive surgery uses small incisions in the lower abdomen and navel, allowing a camera and specialized tools to access the pelvic area. It leaves minimal or no scarring and allows quicker recovery. Procedures such as fibroid removal, endometriosis treatment, adhesiolysis, and removal of damaged tubes can all be done via laparoscopy.
- Laparotomy: In cases where laparoscopy is not feasible, an open surgery (laparotomy) may be performed, such as for larger or multiple fibroids, in patients with extensive abdominal surgery history, or where laparoscopy poses anesthesia risks.
- Hysteroscopy: This technique uses a camera-equipped instrument inserted through the vagina to visualize and treat the uterine cavity. It is performed under general or local anesthesia and allows for the removal of polyps, fibroids, adhesions, and septa.
- Robotic Surgery: Robotic-assisted surgery can be an option to reopen blocked tubes, offering precision and minimally invasive techniques.
Do Fibroids Prevent Pregnancy?
Fibroids are benign muscular tumors in the uterus that may impact fertility depending on their size and location. Approximately 1 in 10 women may undergo myomectomy (fibroid removal) for symptoms such as recurrent miscarriage, infertility, irregular bleeding, abdominal discomfort, or frequent urination.
If fibroids press on the endometrial lining or are located where embryo implantation occurs, they may increase the risk of miscarriage and require removal. Fibroids near the fallopian tubes may also obstruct sperm passage, impeding conception. Fibroid removal can be performed via open surgery (laparotomy), minimally invasive laparoscopy, or hysteroscopic resection.
Advanced Techniques in Male Infertility
For male infertility, procedures such as Micro-TESE (microsurgical sperm extraction from the testicle) can retrieve sperm directly from the testicles. High-quality sperm selection is further enhanced through techniques like microchip sperm selection and genetic diagnosis testing to identify healthy sperm. Collected sperm can also be frozen for future use.
