Evaluation of the male
Following a thorough patient history, an important part of the evaluation includes the semen analysis. To obtain a good specimen, we advise the patient to avoid ejaculation for 2-5 days before the appointment. The sample is usually obtained in the lab, but can also be obtained at home if kept warm and brought to the lab within a half-hour of collection. The specimen is then examined for the following features:
 Sperm Concentration - This is the total number of sperm per volume of semen, counted in millions/milliliter.
Motility (Movement) - This is the percentage of forward-swimming sperm in the sample.
Morphology (Shape) - Sperm can have a number of different shapes. This is the percentage of normally-shaped
sperm in the specimen.
Infection - The presence of many white blood cells may indicate that infection is present, which is treated with a
course of antibiotics.
When an abnormality is noted, the patient will typically obtain a repeat specimen. If it remains abnormal, a referral to an urologist is sometimes recommended for a physical examination and further work-up.
Evaluation of the female
This evaluation starts with a detailed patient history and physical examination. Major points in the history include past illnesses and surgeries, menstrual cycle characteristics, previous pregnancies, and contraception (birth control). For women with irregular or infrequent cycles, the first step is to determine if ovulation (monthly release of an egg) is taking place. This can be done in several ways, with the first two listed below used most commonly:
Ovulation Predictor Kit - Using a home urine testing kit, we can measure luteinizing hormone (LH), a hormone that causes ovulation. If the test is positive, it means ovulation will occur within 24-40 h.
Progesterone Level - When a woman ovulates, the ovaries produce the hormone progesterone. One week after ovulation, the patient has blood drawn to test for this hormone. If it is above a certain level, this would indicate that ovulation has occurred.
Basal Body Temperature - After ovulation, there is a small increase in a woman's body temperature, which lasts through the second half of her cycle. To measure basal body temperature, a woman takes her temperature by mouth every morning before she gets out of bed and records it on a chart. This record is usually kept for 2-3 menstrual cycles to see if ovulation is occurring regularly.
Ultrasound - Using a vaginal ultrasound probe, an ultrasound has the ability to see a follicle (cyst with an egg inside). Susequent collapse of a mature follicle would confirm ovulation. Typically, ultrasound is used for monitoring and timing of fertility treatment.
Endometrial Biopsy - The lining of the uterus (endometrium) changes at ovulation. Using a narrow plastic catheter (tube), an office biopsy can be obtained during the second half of the cycle and sent to the lab for study. This test is no longer routinely used in the basic infertility work-up.
If the above tests demonstrate that a woman is ovulating, further tests and procedures may be performed to look for other causes of female infertility. These include:
Hysterosalpingogram (HSG) - An X-ray test that shows the inside of the uterus and fallopian tubes, performed right after the menstrual period is completed. A small amount of dye is placed in the uterus through a thin tube inserted through
the cervix. An X-ray is then taken. The fluid will fill the inside of the uterus and show its shape. We can also tell whether the fallopian tubes are open by looking for fill and spill of dye.
Laparoscopy - A laparoscope is a small telescope that is placed through a small incision made in the navel. A video camera is attached to this telescope, allowing us to examine all the pelvic organs and to look for any abnormal findings,
such as endometriosis or adhesions (scar tissue). If these problems are found, they are usually treated at the same time.
Dye can also be injected through the cervix to determine if the fallopian tubes are open. This is an outpatient
surgical procedure that requires general anesthesia.
Hysteroscopy - A hysteroscope is a small telescope that is attached to a video camera. It is placed through the cervix, and the uterus is filled with fluid. This allows us to see the inside of the uterus. Abnormalities that are found at this time can be corrected. This procedure can be performed in the office, or in the operating room in conjunction with a laparoscopy.
Saline Infusion Sonography (SIS) - This is a simple ultrasound procedure to determine whether or not the uterine
cavity is normal, and can be performed in the office. It involves placement of a small catheter just inside of the cervical
opening to the uterus. Approximately 5 cc of saline is injected into the uterine cavity and a pelvic ultrasound is then performed.
|
