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Fertility



The Female

It is possible, during this visit, to go over the patients history which may have affected the woman's fertility:

  • Past pregnancies (births, miscarriages, ectopic pregnancies, abortions).

  • Menstruation regularity, or maybe its absence.

  • Surgical interventions undergone by the woman, such as appendectomy, abortions, etc…

  • Infections in the cervix, the womb, the tubes, etc…

Inquire about her lifestyle:

  • Smokes, consumes alcohol.

  • Takes medication.

  • Works night shifts, works long hours, many trips.

Examination includes:

  • Gynecological and breast check up.

  • Temperature curve.

  • Ultra Sound.

  • Blood tests for hormonal levels and immunological state (serologies).

  • Hysteroscopy and sampling of the endometrium (biopsy).

  • Post Coital Test (PCT).

Secondary Inquiry:

  • X-ray of the uterus.

  • Laparoscopy.

Basic Inquiry for the woman:

Temperature curve:

The woman checks her rectal temperature (in the rectum), in the morning before she gets out of bed. Temperature rises after ovulation and remains even for 14 days.

Ultra Sound (US) Scan:

A simple test that can reveal problems in the uterus, the ovaries or the fallopian tubes. Searching mainly for polyps, myomas or poly-cystic ovaries, cysts and fallopian expansions (salpinx).

The Ultra Sound Scan enables tracking ovulation:

US scans every two days enable tracking the development of the follicle/s until maturation and release of the ovum during ovulation. At the same time the thickening of the endometrium is measured, which predicts the possibility of the ovum being rooted in the uterine membrane.
Often hormonal levels are followed up parallel to the follicle follow up. 

Blood tests for hormonal levels:

The following hormone levels are checked around ovulation and 7 days after it:
FSH, LH, E2, TSH, PROLACTINE, PROGESTERONE, TESTOSTERONE TOTAL, FREE TESTOSTERONE, D4, 17-OH-PROGESTERONE, DHEA-SO4

Blood tests for serologies:

Essential before fertility treatment or insemination.
RUBELLA, CMV, TOXOPLASMOSIS, SYPHILLIS, HIV, CHLAMIDIAE, MYCOPLASMA, HERPES, HEPATITIS B & C, VARICELLA, MEASLE.

Hysteroscopy:

Essential for any fertility inquiry or when an US scan or X-ray of the uterus showed the possibility of a defect, before a laparoscopy or when the ovum fails to root. The hysteroscopy is performed in the clinic with no need of hospitalization, by means of optical fibers. The flow of CO2 may release mucous obstructions in the fallopian tube leaving free passage, thus helping the conception process.

Biopsy of the uterine mucous (Pipelle):(PCT)

This test is performed at the second half of the menstruation cycle, preferably between the 21st and 23rd day from the beginning of menstruation. It can show inappropriateness of the mucous or inflammed mucous. Under the same procedure, the depth of the uterus can be measured and the freedom of passage within the cervix canal can be checked.

Post Coital Test

This examination verifies the behavior of the spermatozoa in the cervix mucous secreted by the cervical glands. The test is performed very near ovulation but before it. Intercourse takes place between 2 to 12 hours before the test.

The mucous is tested for quantity, viscosity, transparency, elasticity, etc… and then under the microscope the spermatozoa are checked for quantity and motility. 

Post Coital Test

X-ray of the uterus:

Always performed in the first half of the woman's cycle and after infection and pregnancy have been ruled out.
It allows the detection of abnormalities in the cervix, the isthmus, within the uterine cavity, the fallopian tubes, the passage of contrast substance with the abdominal cavity.

In the case of blockage in one or both fallopian tubes, catheterization of the tubes should be considered. 

As hysteroscopy, it allows for the release of mucous blockage in the fallopian tubes, and thus helps in conception.

Laparoscopy:

View into the abdominal cavity, through the opening of the umbilical skin (performed under general anesthesia).

It can display adherences in the small pelvis, which could not be detected without this procedure, as well as focuses of endometriosis, common in women who suffer of infertility.

Contrast substance is circulated within the fallopian tubes to ensure they are intact.

A look at the ovaries may reveal the characteristic appearance of the polycystic ovary. 


 

The Male:

Risk factors may be detected by checking the existence of the following background features:

  • Testicular Torsion.

  • Testicular Varicose Veins (Varicocele).

  • Undescended Testicle (Testicle or Testicles which have not descended into the Scrotum to take their place).

  • Diabetes, Hypertension, etc...

Also, inquire about their lifestyle, just as for the female, with the addition of asking whether they usually take hot baths or wear tight underwear.

An orderly inquiry is required:
Basic Tests:

  • Physical exam.

  • Blood test for hormonal levels.

  • Serologies.

  • Post Coital Test (PCT).

Secondary Tests:

  • Basic Sperm check.

  • Extensive Sperm check.

  • Doplex for Testicular Veins.

  • US of Prostate and glands.

  • Testicular Biopsy.

Basic Tests details:

  • Tests for Hormonal levels:

    • FSH: when high points at a deficiency in spermatozoa production in the testicle.
      PRL.
      TSH.

  • Serologies: as for female.

  • Post Coital Test (PCT): if the test was performed under ideal conditions, and the number of spermatozoa is low, and/or their motility is low, or no spermatozoa were detected during testing, then a sperm test must be performed without delay.

Secondary Tests details:

Sperm Test:

sperm collection to be performed after one or two days of abstinence, by means of masturbation at the Lab or by use of a special condom designated for the test. Sperm check to be performed immediately after collection, while checking for volume, appearance, odour, viscosity, fluidity, number of spermatozoa, number of live spermatozoa, their motility and shape.

Normal sperm contains:

  • Between 20 – 200 spermatozoa per milliliter.

  • Over 50% live cells, mobile and correctly shaped.

  • Liquid volume lies between 2 cc and 5cc.

Abnormal sperm is defined as follows:

  • Azoospermia: absolute sperm absence.

  • Oligospermia: less than 20 million spermatozoa.

  • Polyzoospermia: more than 200 million spermatozoa.

  • Asthenozoospermia: less than 50% motile spermatozoa.

  • Teratozoospermia: more than 50% abnormally shaped spermatozoa.

The presence of white cells in the sperm may indicate an infection.

The presence of clusters of stuck together spermatozoa may indicate an immunologic problem.

Extensive sperm check:

A more thorough examination of biochemistry, motility, immunology of the sperm and sperm culture.

Testicular Vein Doplex:

Attempts to locate varicose veins around the testicle (Varicocele).

Testicle Biopsy:

Usually performed during an operation to reattach or open the Vas Deferens tubes and/or parallely to suction spermatozoa from the testicle for micro-insemination.

Testicular Vein Doplex:

Attempts to locate varicose veins around the testicle (Varicocele).

Testicle Biopsy:

Usually performed during an operation to reattach or open the Vas Deferens tubes and/or parallely to suction spermatozoa from the testicle for micro-insemination.

 

Tests to be performed by the Couple:

Karyotype:

Usually necessary in case of recurrent miscarriages, and/or in case of very abnormal sperm.

Usually chromosomal problems are located in chromosomes X and Y.

Sometimes it is necessary to check for CF mutation in order to complete the inquiry.

Cell Classification:

This test verifies the cell compatibility between the couple. It is usually required when recurrent miscarriages occur.

          

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