Diagnostics of male and female infertility reasons
First step towards success
Ngc clinic carries out diagnostic testing for women and men, as infertility can be male, female or mixed.
When visiting a fertility specialist or urologist, bring all previous tests and examination reports with you. This will save time avoiding unnecessary follow-ups and will help to focus on real reasons for infertility.
If no preliminary examination was carried out, spouses will need to see relevant specialists, undergo ultrasonography and a range of analyses.
Diagnostics of female infertility causes
Female examination procedure in ngc clinic includes four successive stages, starting with an examination by a fertility specialist. And even if you have already consulted geneticists, gynecologists and fertility specialists in other clinics, anyway you will be asked to visit a doctor in the clinic, bringing all the conclusions of other doctors with you: as a treatment order depends on completeness of information about a disease, which can be obtained by a doctor only after a personal examination.
1. Visit of an in-house fertility specialist
Medical history includes information about hereditary diseases, including those associated with infertility. It is also important to obtain information on past diseases, surgical procedures, especially related to pelvic organs, analysis of patient’s complaints, information on disease’s duration, problems.
If a patient was treated for sexually transmitted infections (std), which are the main cause of a tubal infertility, then a doctor needs to know when a disease occurred, a type of disease and treatment procedure. It is also important to know a duration and frequency of menses onset.
If there are cases of amenorrhea, dysmenorrhea, oligomenorrhea, uterine bleeding, etc., details with regard to their history, duration and nature shall be clarified.
Physical examination determines a body weight, body build is assessed, mammary glands, pelvic organs, thyroid gland are examined.
Ultrasound examination is carried out for all female patients with infertility in order to clarify a status of endometrium, presence of uterus and ovarian tumors, which are not diagnosed during a bimanual examination. Ultrasound breast examination should be performed for all female patients with infertility for early diagnosis of focal lesions.
2. Methods of laboratory diagnostics
Hormonal examination shows a functional state of ovaries to a fertility specialist. It is assessed following results of hormonal examinations and determination of prolactin (prl), luteinizing hormone (lh), follicle-stimulating hormone (fsh) hormone, estradiol, cortisol, 17-hydroxyprogesterone (17-hp) and dehydroepiandrosterone sulfate (dheas) levels.
At suspicion on a thyroid dysfunction, thyroid stimulating hormone (tth), free t4 and antibodies to thyroglobulin are to be determined.
According to the statistics, about 30-40% of couples, applied to fertility clinics, suffer from urogenital infections, despite a long-term examination and treatment, due to the peculiarities of some diseases - such as chlamydia. Infection screening is required.
Doctors recommend undergoing a hysteroscopy by an endometrial biopsy – an examination which is a checkup of uterine walls using a hysteroscope, a thin optics device. A biopsy is needed for a pathomorphological study. If required, a doctor sends a patient to an in-patient department for a laparoscopy.
"An immunological examination is followed by a genetic one, which includes karyotype analysis and consultation of a geneticist."
Diagnostics of male infertility causes
Male examination procedure in ngc clinic includes five successive stages, starting with an examination by an urologist. And even if you have already consulted andrologists and urologists in other clinics, anyway you will be asked to visit a doctor in the clinic, bringing all the conclusions of other doctors with you: after the appointment of treatment depends on the completeness of the information about the disease, your doctor may be obtained only by personal inspection.
1. Consultation of an urologist
The first step is to document complaints. As a rule, the most frequent complaints are infertility, feeling unwell (weakness, fatigue, sleep disturbances), changes in body weight, abnormalities of hair growth on a face and body, pains, radiating (shooting down) into a scrotum, perineum or lower back, painful urination, potency dysfunction.
Medical history necessarily reflects possible causes of infertility: hereditary diseases, infertility cases among relatives, oncological, mental and endocrine diseases. When taking history, it is important to provide the most complete information on past diagnosis and treatment, especially in the area of urological pathologies, stds, surgical interferences into a function of genital organs (such as elimination of cryptorchidism), inguinal and umbilical hernia, administration of hormone replacement therapy.
Also, a medical history takes into account sexual history: its beginning and end, frequency of sexual intercourse, ejaculate abundance and ejaculation frequency, nature of erection and ejaculation. A variety of ejaculation abnormalities result in a number of pathologies.
Examination of genitals and urethra is palpation of a scrotum by a description of testes, appendages, and spermoducts location, their condition. Prader orchidometer is used to determine testicles size (the norm - 15 ml or more). In case varicocele is diagnosed, spermatogenesis peculiarities are to be determined.
2. Laboratory and diagnostic examination
Infection screening includes bacteriological examination of urethra discharge, prostatic fluid and seminal gland fluid to virus infections and sexually transmitted diseases.
In case of male infertility semen examination is the most important method to identify causes. Semen analysis (spermogram) should be carried out in compliance of certain rules of preparation.
If semen analysis results establish that one ml of semen contains less than 5 million of spermatozoa with a normal testicular volume, hormone level is to be tested. Hormonal examination includes analyzes on prl (prolactin), fsh (follicle stimulating hormone) and testosterone.
Ultrasound examination is performed to assess anatomical and functional state of prostata gland and seminal vesicles in sagittal and transverse planes using an external or transrectal probe.
Immunoassay for men includes mar test, which detects presence or absence of antisperm antibodies of class g, being formed on spermatozoa surface. It is used in the absence of other obvious signs of patient’s reproductive disorders, and duration of infertility for more than 5 years.
4. Medical and genetic consultation
Medical and genetic consultation is for patients with oligo, terato- and azoospermia. It determines a tactics of treatment for spouses depending on peculiarities of spermatogenesis.
5. Testicular biopsy
Testicular biopsy (withdrawal of semen from patient’s testes) is performed for patients with azoospermia, with normal testicular volume and normal fsh concentration in blood plasma.