Infertility is pretty self-explanatory as far as signs/symptoms go, with the most common symptom being that the patient is unable to conceive. Females may begin to notice irregular menses, or loss of menses altogether. It is important that any female concerned about infertility, be diligent in charting their menses and any changes that they observe so that they can report that to their physician in order to better determine the specific cause of their individual infertility. Men who experience infertility will experience symptoms if the cause of the infertility is a result of per-testicular factors that result from abnormalities in the hypothalamus-pituitary axis. If the male patient has an independent illness then symptoms such as changes in hair growth or sexual libido may manifest. Otherwise, many men will not experience any symptoms associated with infertility.
Diagnosis of Infertility:
In order to get a definitive diagnosis of infertility, it is imperative to get a proper workup from your physician. Both individuals within the couple must be evaluated to ensure that the proper therapies be initiated once infertility is diagnosed.
There are many different tests for men to rule out infertility. First, the patient should undergo a proper physical examination by a board-certified physician. The laboratory work will include; semen analysis, hormone laboratory work, and genetic testing. There may be an indication for a testicular biopsy or imaging studies such as MRI, bone scans, ultrasounds or vasography, to better evaluate the cause of infertility.
Semen analysis is performed to evaluate the sperm count. There is a specific threshold of sperm that must be present before an egg can be fertilized; resulting in pregnancy. If that threshold is not met, then that is likely the cause of infertility.
Hormone testing and genetic testing can help determine if there are any hormonal imbalances that can contribute to infertility. In some cases, a testicular biopsy may be recommended if other more evident causes of infertility are not present. In a testicular biopsy, sperm can be retrieved to evaluate them in more depth. Imaging studies may be recommended, especially a vasography, which is a test to evaluate the vas deferens. These studies will help to determine the root cause of infertility.
Women must also be tested to determine the underlying cause of infertility. The first step is to analyze the patient through a thorough physical examination. This will include both a bimanual and speculum exam. Because the most common reason for infertility is an-ovulation, hormones will be tested to determine if the patient is actually ovulating or not. If the hormone levels are abnormal then that could indicate that the patient is not ovulating on a monthly basis and that could be the sole reason for infertility. Laboratory work that evaluates the hypothalamus-pituitary axis can also be helpful in determining other causes of infertility.
A Hysterosalpingography is an x-ray imaging study with contrast dye that evaluates the uterus and fallopian tubes. It ensures that the uterine cavity and fallopian tubes are normal, and there is not anything disrupting the proper anatomic flow. Ovarian reserve testing can also be completed to evaluate how many eggs are actually present and available for ovulation. The ovarian reserve testing determines the number and quality of the eggs present and their availability for ovulation. This test must occur early on in the menstrual cycle.
Imaging studies such as a transvaginal ultrasound can help to ensure that the female reproductive anatomy is within normal limits. In some cases, a Hysteroscopy or Laparoscopy may be required to further evaluate the female reproductive tract and any abnormalities that may interfere with conception.
