Blood Tests
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All
biochemical tests, Hormonal Essays & Microbiological
tests
Semen
Analysis
The semen analysis is the single most
important test in the evaluation of a man's fertility.
It provides information about a number of issues related
to male fertility. Semen quality and quantity may impact
the ability of sperm to successfully fertilize the egg.
Sperm motility appears to be one of the most important
factors in determining the fertilizing capability of
sperm. Even with a low sperm count, many men with highly
motile sperm may still be fertile
A
semen analysis is the study of a freshly ejaculated
semen sample. This analysis measures the number of sperm
present in the ejaculate (sperm count) and checks the
shape and size (morphology) of sperm and their motility.
The semen analysis is not an absolute test for fertility
because it does not test certain important aspects of
sperm function, such as whether sperm can actually
penetrate the egg; however, it is very useful in
initially determining if the cause of infertility is an
obvious male factor.
Semen
testing is performed using a fresh semen specimen within
2 hours of collection. The specimen is obtained through
masturbation and is collected in a container provided by
the physician. Semen for this analysis should not be
obtained by interrupted intercourse or by use of an
ordinary condom. Ordinary condoms contain substances
that are toxic to sperm. If religious or personal
practices prohibit masturbation or if the patient feels
uncomfortable, the physician may suggest using a special
condom designed for specimen collection that does not
damage sperm. Feeling anxious about producing a specimen
is common. Any questions or concerns should be discussed
with a physician.
The
information gathered during the semen analysis depends
on proper collection of the specimen, as well as the
skill of the technician or physician performing the
test. Before testing, a standard period of sexual
abstinence is recommended. Often, this is 2 to 3 days or
the "usual" number of days between intercourse
for the couple. This helps the physician obtain an idea
of what the normal seminal fluid exposure is for the
female partner. Because sperm counts and quality can
vary, at least two or three samples will usually be
obtained to establish a baseline. Evaluation of semen is
based on standards established for fertile males. When a
patient has values below these limits, a male factor
does not necessarily exist, but the probability is
significantly increased. It is important to remember
that, despite an overall low sperm count, men with
high-quality sperm may still be fertile. High quality
sperm is defined as having a high percentage of motile
sperm with good forward movement. Sperm motility appears
to be one of the most important factors in determining
the fertilizing capability of sperm.
PCT-
Postcoital test
This test assesses several factors: the
quality and quantity of cervical mucus and the number
and motility of sperm in the mucus. A sample of the
cervical mucus is taken 4 to 12 hours after sexual
intercourse and just before expected ovulation. The
sample is examined under a microscope and sperm number
and movement are assessed. Improper timing may cause a
poor result because only preovulatory mucus will nourish
sperm and allow them to remain active. Consequently,
this test may have to be repeated. Because the couple is
required to perform sexually on demand for this test, it
is also a frequently rescheduled test. Some impotence
and sexual dysfunction are common at this time. Usually,
two abnormal postcoital test results suggest that a more
thorough evaluation of sperm and mucus quality is
needed.
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Ovulation
Induction and IUI
Intrauterine insemination
(IUI) is a process by which a
husband’s or a donor’s semen sample is processed and
a concentrated preparation of sperms is directly
injected into the uterus with the help of very thin
flexible tubing. Is a treatment option for pts with
minor semen abnormalities & in women whom post
coital test is negative, have cervical hostility to
sperms, & those couples having sexual dysfunction.
IVF-ET
In vitro fertilization is effective in overcoming
a variety of infertility problems, particularly tubal
problems or marked sperm problems. In this procedure the
ova are fertilized outside the body using partners
sperms & then the fertilized embryos are placed back
into the uterus transvaginally.
IVF
is a four-stage procedure:
Stage
One – Hormonal injections are given to stimulate the
development of multiple follicles.
Stage
Two-Once mature, the eggs are removed (or retrieved)
from the woman's ovaries using a fine needle.
Stage
Three-The eggs are transferred to a laboratory dish
where they are fertilized by sperm collected from the
male partner.
Stage
Four-Several days later, the fertilized embryo is
inserted back into the uterus.
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Fertilized
Embryos
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Embryo
Transfer Under Sonographic Guidance
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ICSI
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ICSI
Procedure
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PN-stage
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Human embryo at 8-cell stage
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ICSI is a micromanipulation procedure whereby a single
sperm is injected into the egg. This technique may
provide men who have very small amounts of weak sperm
(too small for routine IVF) a chance to fertilize
individual eggs. If the egg is fertilized, the embryo is
inserted into the uterus.
Cryopresevation
Embryos which are not used in a particular ART
cycle are preserved for future use. Once embryos are
frozen and stored, they remain viable for long periods
of time. About half of frozen embryos will survive
thawing and can be transferred. Cryopreservation enables
some embryos to be used in the ART cycle and some to be
stored for future use in a natural cycle (a cycle
without hormonal stimulation). Cryopreservation may also
lower the cost of subsequent ART procedures because the
first few stages (ovarian stimulation, egg retrieval) do
not have to be repeated when the frozen embryos are
used.
TESA/MESA
When sperm cannot move through the male genital tract
due to an uncorrectable blockage, sperm can be extracted
directly from the epididymis or the testicle by
microsurgical techniques. Congenital absence of the vas
deferens or seminal vesicles, failed vasovasostomy or
epididymovasostomy are all conditions where MESA might
be used. Usually performed as an outpatient procedure,
MESA can provide sperm for in vitro fertilization
cycles. Epididymal sperm are usually not fully motile
and, therefore, cannot be inseminated into the uterus or
cervix successfully without sophisticated techniques
that place the egg and sperm in direct contact so
fertilization can occur. If MESA is done in conjunction
with an IVF cycle, it will be performed around the same
time as egg retrieval from the female partner. Sperm
obtained from the epididymis are usually placed directly
into the egg.
GIFT
Gamete
Intrafallopian Transfer (GIFT), developed in 1984. In
this procedure mixture of sperm and eggs
is placed directly into one of the woman's fallopian
tubes during a laparoscopy. Conception occurs in the
fallopian tube. Once fertilized, the embryo then travels
into the uterus, just as in a natural cycle.
As with other ART procedures, GIFT requires that the
woman's ovaries first be stimulated with hormonal
medication to encourage the development of multiple
oocytes. This enhances the possibility of fertilization.
With GIFT, fertilization takes place inside the woman's
body. However, GIFT can only be used in patients with
healthy fallopian tubes ( atleast one).
ZIFT
Zygote
Intrafallopian Transfer (ZIFT) combines aspects
of both IVF and GIFT. Protocols for ovarian stimulation
are similar to those used for IVF and GIFT. Eggs are
collected and fertilized by the partner’s sperm in the
laboratory. What makes ZIFT different from IVF is that
the embryo is placed into the woman's fallopian tube via
laparoscopy instead of the uterus.
Assisted
Hatching
This is a form of embryo micromanipulation
whereby a hole is artificially produced in the embryo's
covering, which may increase the chance of embryo
development. Selective assisted hatching may increase
the chance of pregnancy in women age 39 or older, women
with elevated basal FSH levels, women with a history of
implantation failure or in women with embryos having a
thick zona pellucida (a layer or envelope that surrounds
the oocyte).
Thermal
Balloon Therapy-Endometrial ablation (EA) involves
removing the lining of a woman's uterus. EA is an
alternative to hysterectomy for women who have excessive
menstrual or uterine bleeding. Ablation procedures can
prevent the need for 80%-90% of currently performed
hysterectomies based on extensive review of the
published literature. In contrast to a hysterectomy
(removal of the uterus), an ablation procedure is
performed either in your gynecologist's office or as an
outpatient surgery, with patient's returning home the
same day, and without the need for an abdominal or
vaginal incision.
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First,
a soft, flexible balloon attached to a thin
catheter (tube) is inserted into the vagina,
through the cervix,and placed gently into the
uterus.
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Then
the balloon is inflated with a sterile fluid
that expands to fit the size and shape of the
uterus.
The fluid in the balloon is heated to 87°C, or
188°F, and the temperature is maintained for
8minutes while the uterine lining is treated.
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Minutes
while the Uterine Lining is treated
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When
the treatment cycle is completed, all the fluid is
withdrawn from the balloon and the catheter is removed.
Nothing stays in the uterus.
Advanced
Laparoscopic Surgeries
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Testicular
Biopsy
Ultrasonography/
Colour Doppler
This
painless test is by applying a probe to the outside of
the abdomen, or by inserting a diagnostic instrument
into the vagina. High-frequency sound waves produce
pictures that reveal information. The pelvic organs
(uterus and ovaries) can be examined in detail and both
normal and or problem pregnancies can be monitored.
Abnormalities including cysts, tumors and infections
seen, cyclical development of the ovarian follicles and
uterine lining can be monitored.
HSG- Hysterosalpingography
Structural problems,
blockages and other disorders of the uterus, the
fallopian tubes and the pelvis may be diagnosed through
a sophisticated x-ray study (or film). A small tube is
inserted into the cervix and a dye is injected slowly.
The flow of the dye into the uterus, out through the
fallopian tubes and into the pelvis can then be viewed
on a screen.
This test is performed after a menstrual period but
before ovulation. During the injection of the dye, the
woman may feel uterine cramping that may last several
hours. After the test, there may be a sticky discharge
for several hours as the dye is expelled from the
uterus. A sanitary napkin is worn instead of a tampon to
allow the fluid to escape. Whatever fluid remains in the
pelvic cavity is absorbed by the body without harmful
effects. One positive potential side effect of HSG
testing is that the chance of conception appears to
increase for several cycles after an oil dye is used.
Because of this, some physicians may prefer to wait
several cycles before proceeding to the next test, a
diagnostic laparoscopy.
Hysteroscopy
Its
visualisation of the interior of the uterus to look for
tumors, scars and/or abnormalities may also be done at
the time of the laparoscopy. This is done done under
general anesthesia where in a fiber optic scope is
inserted through the cervix and into the uterus.
Laparoscopy
Performed under general anesthesia, this test enables
direct visualisation of outside of the uterus, the
fallopian tubes, the ovaries and the pelvic cavity. An
instrument is passed into the abdomen through a tiny
incision below the navel. A second instrument is
inserted through an incision at the pubic hairline. This
procedure enables more detailed information to be
obtained about these organs and detection of scar tissue
that might be located on the fallopian tubes. It also
helps to identify endometriosis, the presence of normal
uterine tissue in abnormal places outside the uterus.
Sometimes even minimal endometriosis can cause
infertility. Laparoscopy is performed if endometriosis,
tubal disorders or adhesions (scar tissue) are
suspected, and it is generally reserved for the end of
the work-up. The incision is closed with several
stitches that absorb within weeks. The procedure is
scheduled before ovulation and is usually done as a
1-day surgery, enabling the woman to go home later that
day. A sore throat, shoulder pain, a feeling of a
bloated or swollen abdomen and general stiffness and
soreness are commonly experienced for a day or two.
Normal activities and work can soon be resumed.
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