The first step that needs to be taken when up against a fertility problem is a correct diagnosis. In many cases there is more than one factor impeding conception, so it is essential to perform a correct and complete evaluation.
The medical team will review the patient’s history and necessary testing will be prescribed to achieve an accurate diagnosis. If a male factor is diagnosed, consultation with our urologist may be recommended.
Most people that come to us have already spent some time trying to achieve pregnancy and are anxious to begin treatment. Our goal is to start as soon as a complete diagnosis has been reached, which is usually after one menstrual cycle.
There are 4 elements to evaluate in the initial phase of a fertility study:
1. Ovulation
2. Egg quality
3. Fallopian Tubes
4. Sperm quality and quantity
Ovulation
In normal conditions, at the beginning of each cycle a follicle begins to grow with an egg inside. This egg is later discharged into the Fallopian tube in a process called ovulation. After ovulation, progesterone increases. This makes the endometrium more hospitable for the embryo. If we measure the progesterone level in blood 7-8 days after ovulation, we can see if the patient has ovulated or not. Other hormone levels are also measured (Prolactin and TSH) that can also interfere with the normal growth process of the follicle, the maturing of the egg and ovulation.
Egg quality
At the beginning of the cycle FSH begins to rise. FSH is the hormone that is secreted to stimulate the growth of the egg. To evaluate egg quality, FSH and Estradiol levels are studied on day 2 or 3 of the cycle. These hormone levels will give us a basic idea of the egg quality.
The egg quality also can be indirectly determined by the number of antral follicles (usually more follicles indicates better egg quality) visualized by a transvaginal sonogram on day 3 of the cycle. There are no absolutes here, but at present the best indicators of egg quality are FSH level, the number of antral follicles on the transvaginal sonogram and the age of the patient.
Fallopian tubes
To achieve a spontaneous pregnancy, the Fallopian tubes must be patent. To study tube patency a hyterosalpingogram is performed. A hysterosalpingogram is a series of x-rays of the pelvis that are taken after having injected contrast through the cervical canal into the uterus. This outlines the inside of the uterus and the Fallopian tubes. This process takes 5-10 minutes and is sometimes painful.
Sperm Quality and Quantity
Sperm evaluation: SPERM ANALYSIS, four parameters are evaluated in a sperm specimen:
1. The volume of the specimen, measured in ml.
2. The number of sperm, measured in each ml of the specimen.
3. Motility, the percentage of sperm with rapid and forward progression.
4. Morphology; the percentage of sperm that have normal morphology.
Normal values are as follows: volume greater than 2 ml, 20x106 spermatozoa/ml or more, 50% or more with forward progression or 25% or more with rapid progression within 60 min after collection and 50% or more with normal morphology. The presence of white blood cells in the specimen sometimes indicates a prostate or urethra infection even though the man reports no apparent symptoms.
SPERM SURVIVAL TEST
This test studies the motility of the sperm after 24 hours.
Infectious Diseases
The patients will all be tested for infectious diseases: Hepatitis B, Hepatitis C, Syphilis, HIV and women will be tested for measles antibodies.
