INFERTILITY TREATMENTS - FEMALE
Infertility is an issue that affects many couples. A woman may be diagnosed as infertile if she is not able to conceive a child for over a year despite having well-timed, unprotected sexual intercourse. The good news is that infertility can be treated. The first step towards fertility treatment is to understand the factors causing infertility. A number of fertility tests may be used to confirm an infertility diagnosis in women.
When you see us for the first time, you will be registered with Dr Rekha Sagar Fertility. We will note your history in detail including menstrual history, coital history, medical & surgical history. We will review your previous reports and past treatments and therefore recommend that you carry your previous treatment details with you when you visit us.
When testing for infertility, the doctors will first conduct a physical examination of the patient and ask questions to understand her medical history and lifestyle. In addition, one or more of the below tests may be advised:
What is Ovarian Reserve Testing?
Ovarian reserve testing allows doctors to help women predict their fertility potential. These tests provide useful information about the amount of time left to conceive, and the number of eggs that have reached an advanced stage of development. Some simple blood tests, namely - AMH, E2, FSH - can be used to check the hormone levels and evaluate the quality and quantity of eggs.
Ovarian Reserve Tests
Here is a list of ovarian reserve tests that doctors normally suggest:
AMH (Anti Mullerian Hormone)
The anti mullerian hormone is produced by the cells in the follicles (sacs that contain the eggs) in the woman's ovary. If the AMH levels are high, it is an indicator of a large number of follicles which means more eggs. As a woman ages, the number of eggs decreases and the AMH levels fall too. This blood test can be done any time and gives a realistic projection on the number of eggs.
FSH (Follicle Stimulating Hormone)
FSH, produced by the pituitary gland (in the brain), is responsible for maturing the eggs in the ovary. This blood test is drawn on the 2nd or 3rd day of the menstrual cycle. Contradictory to AMH levels, high levels of FSH means poor ovarian reserves, and low levels of FSH indicates a good ovarian reserve.
Estradiol is tested along with FSH. It is an important form of oestrogen which is responsible for developing healthy eggs in a womans ovaries. If the E2 test shows high levels of estradiol, it may indicate a problem with the egg quantity or quality.
AFC (Antral Follicle Count)
AFC is probably the best indicator of ovarian reserves since it measures the quantity and quality of eggs. Antral follicles are found in the ovaries and they contain immature eggs that have the potential to develop into mature eggs. A vaginal ultrasound is an accurate way to count the number of antral follicles. High AFC indicates a solid ovarian reserve, while low AFC indicates a weak fertility potential.
Ovarian reserve testing
Ovarian reserve testing is not the ultimate and absolute infertility indicator, but a noticeable change in hormone levels does help doctors in creating a treatment plan.
Doctors usually recommended recording your Basal Body Temperature when one is trying to conceive. A rise in BBT indicates ovulation and can be used to determine the best time to have sexual intercourse. This charting can be done at home.
A couple may be told to have unprotected sexual intercourse and visit the doctor a few hours later. The doctor will then take a sample of the cervical mucus for testing so as to understand how the sperm cells interact with the cervical mucus. This test is also used to check sperm motility.
Transvaginal (pelvic) Ultrasound Exam
Unlike a normal, external ultrasound, this involves inserting a special device into the vagina. It uses high-frequency sound waves to create an image of the uterus and other reproductive organs on a screen. The doctor can then identify any structural abnormalities, fibroids etc. that may be interfering with pregnancy. This is not painful and is usually conducted 2 weeks before the patient's menstrual period.
This is also known as a tubogram or HSG. It is used to check for blockages in the fallopian tubes and defects in the uterus. An HSG is usually performed between the 6th and 13th day of a menstrual cycle. The test involves injecting a liquid dye into the uterus through the vagina. A series of X-ray images are then used to check the progress of the dye through the fallopian tubes. In the case of an obstruction or blockage, the dye will not be able to pass through.
This is usually advised only if an obstruction is seen in the Hysterosalpinogram along with laparoscope. A Hysteroscopy involves inserting a thin, flexible telescope like device through the vagina into the uterus. This device allows the doctors to see the insides of the uterus and check for structural problems. It is not important for all of the above tests to be conducted. In some cases, even after testing, there may be no identifiable cause of infertility.