Steps Involved in Infertility Evaluation.
Remember,
it is important to be conscious that in the equation of conception, it takes
two to achieve pregnancy, the infertility journey should be embarked on by both
parties supporting each other towards the desired goal---- A healthy live
baby!!!
Steps Involved in Infertility Evaluation.
Now
that you have decided to seek help to address infertility, the following
information highlights the steps to expect in a typical fertility evaluation
with the Fertility experts.
1. Medical History --- This initial consultation with
the doctor helps to determine possible causes of infertility to be able to
channel into specific investigations. It is important as a patient to give all
necessary information accurately as this is vital in determining the course of
treatment because fertility treatment is not a one-size fits all approach. The
information required here includes
a.
Age-
as previously stated, age determines timing of fertility work-up especially for
the female, for <35 years evaluation is advised after 12 months or >35
years evaluation is considered after 6 months of inability to conceive.
i.
Also,
advanced maternal age from about mid 40s is unlikely to achieve conception
without donated oocytes.
b.
Menstrual
history—this would include questions like
i.
Age
at menarche (at what age did the female start menstrual flow)
ii.
Menstrual
cycle length and duration (how many days between the end of a menstrual flow
and start of another, how many days of menstrual flow on an average)
iii.
Regularity
of menstrual cycle (how predictable is your menstrual cycle)
iv.
Menstrual
symptoms (heavy and prolonged period? Irregular bleeding between cycles?
Excessive menstrual pain?)
c.
Sexual
history—painful sexual intercourse? Sexually transmitted diseases STDs such as
Chlamydia and gonorrhea may result in tubal- factor infertility.
d.
Pregnancy
history- this includes history of all pregnancies, partners, delivery method
and complications (vaginal births? Caesarean sections? Spontaneous abortions?
Ectopic pregnancies? Gestational diabetes which may be suggestive of insulin
resistance of polycystic ovarian syndrome PCOS?)
e.
Surgical
history
f.
Medications
g.
Lifestyle
2. Physical and Visualization
Examination- It is
important to prepare your mind for a physical examination, especially the
female partner which can involve vaginal examination. The physical examination
is to determine presence of structural and/or mechanical disorders or
abnormalities within the reproductive organs.
a.
Weight,
Body mass Index BMI
b.
Skin
examination- Acanthosis nigricans (dry, dark patches of skin that usually
appear in the armpits, neck, or groin) could point to insulin resistance,
Hirsutism (a condition in women that results in excessive growth of dark or
coarse hair in a male-like pattern — face, chest and back), acne, male pattern
alopecia (hair loss) could point to likely high male hormone (androgen) in a
woman.
c.
Breast
Exam- to check for masses, tenderness, or breast discharge (galactorrhea)
d.
Pelvic
Exam- to assess the clitoris, vagina, uterus, ovaries, and fallopian tube
3. Biochemical Testing- Includes veinous blood tests such
as the Day 3 FSH (veinous blood taken day 3 of the menstrual cycle) and
Estradiol (E2) to determine the functionality of the reproductive system and
detect presence of systemic or hormonal disorders if any.
4. Infectious Screening tests- Blood tests for infectious
diseases such as HIV, Syphilis, Chlamydia, Hepatitis is done to determine the
infectious status of intending parents for the safety of all including the
unborn baby. However, not to worry, if one or more partner is found to test
positive to any of the infectious diseases, fertility treatments can still be
completed with some modifications to ensure safety for all parties.
5. Genetic screening—this may involve blood tests,
buccal swap if necessary.
Factors
Affecting Fertility:
Couple specific Factors
v
Genetic
factors- some conditions such as premature ovarian failure have been linked to
genetic inheritance.
v
Occupational
factors—some occupation exposes to some chemicals and substances that affect fertility
potential.
v
STDs—chlamydia,
gonorrhea
v
Lifestyle
factors
o
Drug
use
o
Smoking
o
Excessive
exercise
o
Inadequate
diet
o
Obesity
o
Extreme
weight loss/gain
Female Specific Factors
v
Advanced
age, a woman is born with all the eggs she needs in her lifetime, as she ages,
her ovarian reserve diminishes.
v
Endocrine
factors—hormonal imbalance.
v
Uterine
factors- Fibroids (not all fibroids cause infertility depends on size and
location, Polyps, uterine adhesions).
v
Tubal
factors—fallopian tubes play a major role in natural conception; however, the
fallopian tubes are not necessary in achieving pregnancy via IVF.
v
Oogenesis-
dysfunction in the production of egg.
v
Endometriosis-
which is commonly referred to as the “masquerade of disease” because it is very
tricky to diagnose however, it a chronic disease that roughly affects 1 in 10
of reproductive aged women globally.
Male Specific Factors
v Testicular—factors which could be
obstructions.
v Spermatogenesis--- dysfunctional
production of sperm cells.
v Ejaculatory – issues such as
erectile dysfunction, retrograde/ backward ejaculation.
v Anti-sperm antibodies- within the
body killing the sperm cells.
@yourivfembryologist is a world renowned and certified Senior Clinical embryologist, highly skilled and experienced, widely travelled, internationally trained with over a decade of experience in the IVF lab. Knowledgeable in all aspects of reproductive science and genetics. A University College of London and University of Leeds Alumni. First-class and distinction degree holder. Passionate about spreading knowledge of IVF, ensure continuity of knowledge amongst embryologists and helping patients through the IVF journey.
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