Did you know approximately 8% of currently married women suffered from infertility in India and around 8–12 percent of couples suffer from infertility all over the world[1]? Infertility is undoubtedly an emergent health concern in India. The factors that may lead to infertility may be genetic, environmental, infectious or parasitic diseases. The incidence of infertility among couples can be associated with the lifestyle, stress, postponing parenthood, obesity, genetic or hormonal problems. If you are planning to get pregnant but are not able to conceive, then consult your doctor who can help you to figure out the exact cause of it and get it treated.
In this article, we have explained the tests for diagnosis of infertility in women which in turn can help to decide the treatment options currently available in the country.
Diagnosis Of Infertility In Women
While diagnosing infertility, the first and the foremost thing a doctor will ask is your clinical history which includes earlier pregnancies, miscarriages, menstrual irregularities, or pelvic inflammation. The initial screening usually involves a physical examination, pelvic exam and blood tests to know about the factors which can affect fertility. The common tests that your doctor may recommend to detect female infertility include:
Ovulation Tests: These tests for female infertility include detection of hormones such as luteinizing hormone and follicle stimulating hormone. For example, there is a surge in luteinizing hormone (LH) before ovulation, which can help to know if ovulation is proper and thus, help in the diagnosis of infertility. High levels of FSH may indicate ovarian failure or perimenopause, whereas low levels of FSH may signify that the woman has stopped producing the eggs. Also, the detection of the hormone progesterone post ovulation can also signify whether you are ovulating or not. You can even check ovulation at home with the help of an over the counter (OTC) ovulation kit.
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Anti-Mullerian Hormone (AMH) Test: This is a simple test that helps to know the ovarian reserve in a woman. The anti-mullerian hormone is secreted by ovarian follicular cells. The blood level of this hormone indicates the presence of growing follicles, which acts as a good indicator of the ovarian reserve or egg supply.
Hysterosalpingography: It is one of the common tests which is used to examine the fallopian tubes and help in the detection of any blockage or damage of the fallopian tubes and uterine cavity. This can help a doctor to know whether the blockage is restricting the movement of the egg from the ovaries to the uterus, which could be the reason for not getting pregnant.
In this, your doctor might inject a dye into the cervix to fill the uterus. This dye will travel up through the fallopian tubes. The movement of the dye is monitored through X-ray fluoroscopy. If the fallopian tubes are clear of blockage, then the dye will come out of the tubes into the peritoneal cavity. If the flow of the dye through the tubes is blocked or reduced, it could be a sign of an abnormality in the tubes, which should be further evaluated.
Saline sonohysterogram: This is a female infertility test in which your doctor will inject sterile saline and air into the cervix to fill the uterus. Once the cavity is full, it becomes easy to observe the inner lining of the uterus. The pelvic organs are visualized through a transvaginal ultrasound. It helps to see the fluid movement into the peritoneal cavity through the fallopian tubes, which indicates that the tubes are open.
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Laparoscopy: Just like the hysterosalpingogram, this test also helps to detect any abnormalities in the fallopian tubes. In this test, a small instrument known as a laparoscope is inserted into the body through a cut in the abdomen. The instrument helps to view and examine the female reproductive organs. In some cases, it can be used to remove the blockages, if any, found in the body. For example, if during a laparoscopy, blockages in the fallopian tubes are identified, then with the help of an instrument attached to the laparoscope, the blockages can be surgically removed. It can help identify conditions such as endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus which could be the reason for infertility in women.
Vaginal ultrasound: It is an ultrasound test which helps the doctor to look inside the uterus for abnormalities such as scarring, fibroids or polyps. In this, a wand which is inserted into the vagina produces sound waves which give a clear picture of the reproductive organs including the ovaries and uterus.
Other tests: Depending upon your condition, your doctor might also recommend certain other tests to know the exact cause of infertility. These include:
– Hormonal tests: In addition to hormones such as FSH and LH, your doctor might advise to get your thyroid levels, glucose levels, and pituitary level checked. This is because, these hormones are also known to control reproductive processes and thus, affect the chances of getting pregnant.
– Hysteroscopy: Based on the symptoms you experience, your doctor can recommend hysteroscopy which helps to examine and check abnormalities related to uterus or cervix. It contains a hysteroscope, which is a thin lighted tube that is inserted into the vagina to observe the cervix and uterus.
– Genetic testing: In rare cases, genetic testing is also recommended to check if there is any genetic defect that could be causing infertility. This is mostly recommended in a woman with a family history of infertility.
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Female Infertility: Tips To Prepare For An Appointment
When planning to consult a doctor, preferably a gynecologist or a reproductive specialist/endocrinologist, there are few things you need to be prepared of. These include:
– Keep a tab of your menstrual cycles and symptoms (if any) in the last few months. As it will be difficult to remember the details by heart, it is a good idea to chart it out. You can either use your mobile to record the start and end date of your periods and the associated symptoms. Also, write down the days when you had intercourse for the doctor’s reference.
– Inform your doctor about the medications and supplements (if any) you are taking along with the list of herbal medicine and home remedies. Also, explain about the doses and the frequency of the medications you are taking.
– Do carry your medical reports that include all your clinical history right from the lab tests you have undergone to the treatments you might have already undergone.
– Prepare a list of questions that you want your doctor to answer as it can help you to clarify your doubts and know about the available treatment options for you.
(The article is reviewed by Dr. Lalit Kanodia, General Physician)
References:
1. Sarkar S, Gupta P. Socio-Demographic Correlates of Women’s Infertility and Treatment Seeking Behavior in India. J Reprod Infertil. 2016 Apr-Jun;17(2):123-32.
2. Mahey R, Gupta M, Kandpal S, Malhotra N, Vanamail P, Singh N, Kriplani A. Fertility awareness and knowledge among Indian women attending an infertility clinic: a cross-sectional study. BMC Womens Health. 2018 Oct 29;18(1):177.
3. How is infertility diagnosed? Infertility and fertility. US National Institute of Child Health and Human Development.