Semen analysis is performed for the male. If the first analysis is abnormal then a repeat test is performed.
If the first test is normal then no further testing is needed for the male.

Non-invasive Doppler examination is done to assess the presence of varicocele.

Female infertility is primarily due to ovulatory dysfunction, fallopian tube dysfunction, uterine or pelvic pathologies.

Ovulation and associated problems can be detected by Ultrasound Examination including colour Doppler study, this clinical tool helps in imaging the dynamic changes in the ovary and uterine endometrium. Follicular study is best-performed using vaginal transducer. Ultrasound examination is performed between day 3 – 5 of the menstrual cycle to check the uterus, the ovaries and the pelvic organs for any pathology.

Hysterosalpingogram (HSG)- an x-ray of the uterine cavity and fallopian tubes using a radiographic dye to detect structural abnormalities of the uterine cavity and fallopian tubes. Also Sonosalpingography is done to rule out tubalr blockade.(Photo Normal HSG)

LAPAROSCOPIC / HYSTEROSCOPIC SURGERY

Diagnostic laparoscopy- a minimally invasive surgical procedure typically performed as an outpatient day surgery. It permits direct visual assessment of the uterus, fallopian tubes, ovaries, and lower pelvis. it is particularly useful in diagnosing endometriosis, tubular disorders, or pelvic adhesions and generally is performed at the end of a work-up, but may be performed earlier if deemed appropriate by the patients history and referral diagnosis.

This involves an operation in which a telescope is inserted through the belly button (5 mm incision) so that the tubes and ovaries can be observed clearly.

Dye is injected to check that the tubes are patent (open).

Laparoscopic Surgery

The laparoscope (telescope) is inserted into the abdomen via a small incision made in the umbilicus. Other instruments can then be inserted through additional small incisions (usually 2 or 3) so that surgery can be performed under laparoscopic  vision.

Most surgical infertility treatment can now be carried out by laparoscopic or hysteroscopic surgery.

Hysteroscopic Surgery

Hysteroscopy is often done in conjunction with laparoscopy or separately to visualize the interior of the uterine cavity for -  scar tissue, adhesions, polyps, tumors, and other abnormalities .

. . Hysteroscope (telescope) is inserted through the cervix into the uterus This procedure is usually performed between day 6 and day 10 of the menstrual cycle, following the initial blood test and ultrasound scan. Other instruments can then be inserted through channels in the hysteroscope to remove polyps, fibroids, adhesions, scarring etc. Many patients have problems within their uterus and nearly all these are treatable by hysteroscopic surgery.

Hormonal evaluation

A blood test for the female partner  is performed between day 2- 3 of menstruation to check FSH, LH, Prolactin, Testosterone, T4, TSH.

These are all hormones that orchestrate the menstrual cycle and can affect egg quality.

Follicle stimulating hormone (FSH ) is produced by the anterior pituitary gland and stimulates the ovary to develop a follicle for ovulation. Progesterone hormone is produced after ovulation has occurred and it prepares the uterus for pregnancy. Luteinizing hormone and follicle stimulating hormone levels are checked for hypothalamic pituitary dysfunction. It should be done on the 2nd day of a naturally occurring periods. Prolactin ( a hormone that stimulates breast milk production) levels are checked to see for it’s excess (hyperprolactinemia) a condition that interferes with ovulation. Progesterone levels are performed to determine if inadequate levels are interfering with the development of the endometrium, the lining of the uterus that prepares itself for embryo implantation.