womenscure in all means

Not able to conceive??? Tests to be performed !!!!!

When should infertility be investigated ?

Unable to conceive after one year of unprotected intercourse calls for investigation

Clinical  assessment of both partners gives more information required

Assesment of female partner :

  1.  Body mass index : High BMI decrease the fertility rate .Average BMI 25 kg / m2 .BMI more than 28 kg/m2 requires treatment
  2.  Day 3 FSH & LH : Increased levels indicates low ovarian reserve and poor pregnancy outcomes after ovulation induction.Anti mullarian hormone provides information about ovarian reserve
  3.  BASE LINE TVS : Transvaginal ultrasound or ultrasound pelvis gives the information regarding structural abnormalities of uterus ,endometrium and ovaries. ET , antral follicular count and follicular study helps in assessment of fertility
  4.  Hormone assays : 21 day progesterone level ,thyroid profile,serum prolactin levels gives the information regarding fertility rate
  5.  Endometrial biopsy : In developing countries,where tuberculosis is suspected,a thin endometrium is seen in Pelvic scan , there is a role for endometrial  curettage .Curetted material send for bacteriological evaluation for acid fast bacilli and PCR for mycobacterium tuberculosis.Endometrial aspiration or biopsy taken in the premenstrual phase .
  6. Tubal patency test : These tests done between 8-10 th day of menstrual cycle .Hysterosalpingography,hysterocontrast sonography are the methods to know about tubal patency . In 15% of cases it shows bilateral tubal occlusion.          Procedure should be avoided- during & immediately before menses,after curettage ,in active tubal infection( salpingitis) ,suspicion of active TB endometrium ,lower genital tract infection with purulent vaginal discharge 
  7.  Hysteroscopy and laproscopy : These are now used as the principal method of assessment of pelvic organs and of tubal patency .30-50% of women previously regarded as having normal genetelia ,on laparoscopy an infertility factor will be found
  8.  Other tests : Screening for chlamydia trachomatis ,viral screen , blood sugar , CBP,serum vitamin D  etc

 

Assesment of male partner :
Semen analysis : The specimen is best collected after 3 days of abstinence,masturbating directly into a dry & clean wide mouthed glass container in the laboratory

  • According  to WHO criteria –
  • volume -2-6 ml ,
  • liquefaction complete in 30 min ,
  • sperm count should be 20 million /ml or more ,
  • 60% should have forward progressive motility
  • 25% or more should show rapid progression with in 60 min of ejaculation
  • 70% or more must be morphologically normal
  • fewer than 1 million white blood cells per ml should be present
    Hormone assessment :Up to 10% of subfertile males have endocrine abnormalities.FSH,LH ,testosterone,thyroid hormone levels helpful in this assessment
    General screening : CBP,RBS,CUE,LFT,RFT ,viral screen ,chest X ray,serum vitamin D provides information regarding health status of person
    Other tests : USG scrotum ,sperm function tests ,sperm antibodies,testicular biopsy ,chromosomal analysis are the other tests of male partner,done depending on the individual 

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