Basic Workup for Female Infertility at PRC Dubai
For women age 34 and younger, infertility is defined as inability for a couple to achieve pregnancy after 12 months of unprotected intercourse. For women age 35 and older, the timeframe is six months. Approximately 15% of couples in the U.S. suffer from infertility. According to a recent study, around 37% of infertility is related to female problems, whereas only 8% can be traced to male problems. In addition, 35% are related to issues involving both the female and male partners. For 5% of couples, the cause of infertility is unknown.
The fertility workup for the woman begins with a medical history. This includes:
- Gathering information regarding anatomic problems with fallopian tubes, such as painful menses, history of sexually transmitted infections, and previous pelvic or abdominal surgery.
- A review of the menstrual cycle pattern, which helps determine if or not ovulation occurs as well as other problems (uterine defects, fibroids, polyps, and aging of the ovary).
- A social history to assess for social habits and environmental exposures, including drinking alcohol, smoking, excessive exercise, and drug use.
- A review of systems to evaluate for endocrine abnormalities, such as thyroid disease or diabetes.
- Questions about abnormal pap smears and surgery on the cervix/uterus.
A physical examination is used to evaluate the pelvic organs and assess for certain hormone problems. This includes a pelvic examination, so the fertility specialist can assess for signs of low hormone levels and abnormalities of the reproductive tract.
Many hormonal imbalances and endocrine conditions contribute to infertility. Tests used to assess infertility include:
- Day 3 FSH
- Lupus anticoagulant
- Thyroid hormone levels
- Anti-cardiolipin antibody (ACL)
- Ultrasounds – Used to assess for polyps and fibroids of the uterus.
- Hysterosalpingogram (HSG) – Test used to evaluate inside the uterus and the fallopian tubes.
- Laparoscopy – Surgical procedure used to evaluate the reproductive organs and structures in more detail.
- Ovulation test – Ovulation is the release of an egg from the woman’s ovary. Any abnormalities in ovulation are detected with hormone levels and menstrual history, such as LH surgery and luteal phase progesterone.
Genetic tests are done when the fertility specialist suspects a chromosomal or genetic abnormality that could cause infertility. These tests are done through bloodwork, which is evaluated in the laboratory setting.
The inability to become pregnant creates many psychological problems, such as guilt, shame, anger, depression, and anxiety. Around 40% of infertile patients suffer some form of emotional disorder.
Infectious Disease Testing and Immunity Screening
Certain infectious diseases and antibodies may interfere with pregnancy. Test done to assess immunity and for infectious disease include:
- Hepatitis B surface antigen
- Hepatitis C antibody
- Human immunodeficiency virus (HIV)
- Syphilis (RPR)
- Rubella titer
- Blood type and Rh factor