Step by Step Guide To Fertility Assessment
Very often we get to see women walking alone into the clinic of a Fertility specialist to get herself checked as she is unable to conceive after many years of marriage. Since both male and female partner are responsible for procreation, it is critical that both of them should be assessed simultaneously. In 40% cases of infertility, it is the female factor, and for another 40% it is the male factor and 15% cases are due to combination of both male & female factors and for the remaining 5% the cause is unexplainable.
When to get a Fertility Assessment?
Fertility assessment is the first step when considering having a baby. This is also necessary, if you are considering trying to get pregnant and have been trying for more than 12 months if you are less than 35 years, and less than 6 months if you are over 35 years, since with AGE reproductive capacity goes down especially for women.
It is also recommended for anyone who has already had a miscarriage, diagnosis of a fertility issue, such PCOS, or has been advised by their doctor to do further investigations. A routine infertility evaluation is valuable in determining the cause of infertility, and provides key information when designing your personalized treatment plan.
What is included in Fertility Assessment?
It is crucial to assess the husband before the wife is taken up for any investigations as there have been instances where the wife has undergone an array of tests with no conclusive diagnosis and failure to conceive as the assessment of the husband was not undertaken.
- Male fertility assessment
- Semen Analysis
- Female fertility assessment
- Anti Mullerian Hormone(AMH) Test
- Body Mass Index Assessment
- Ultrasound on Day 2 of period
- Hysterosalpingogram or HSG
- Review with Fertility Specialist
Semen Analysis – A semen analysis is the single most important piece of information needed to assess male fertility. It measures the quantity and quality of a man’s semen and sperm – assessing characteristics such as sperm count, motility(movement) and shape. Smoking, alcohol, certain chemicals like steroids and muscle building supplements can affect the health of sperm.
Semen analysis should be done in an infertility clinic with an andrology laboratory as the results are more conclusive while deciding the future course of action.
According to WHO, male factor infertility is an alteration in one or more of the following parameters in one of the two samples collected 4 weeks apart:
- Sperm count – 15 million/ ml of semen
- Motility – 40% sperms should be motile
- Morphology (shape) – 4% normal forms
Semen freezing is a procedure to cryopreserve sperm cells. Sperm cryopreservation is recommended to preserve fertility in men staying away from their family or undergoing cancer therapy.
If semen analysis report is normal, then the female partner is taken up for assessment accordingly.
Anti Mullerian Hormone (AMH) levels are assessed by a simple blood test that can be done on any day of the cycle and helps to know the capacity of a woman to produce eggs at any given point of time. The lesser the no of eggs in the ovary, lower will be the AMH level. Each woman is born with fixed number of eggs which decrease with age. At birth, there are approximately 1 million eggs; and by the time of puberty, only about 300,000 remain. Of these, only 300 to 400 will be ovulated during a woman’s reproductive lifetime.
Woman with diminished ovarian reserves are at a risk of fertility problems and an increased risk of miscarriages. This test provides a snapshot of the woman’s fertility, therefore is instrumental in planning fertility treatment.
- AMH Levels Interpretation
- Less than 1.0 ng/ml Low ovarian reserves
- 1.0 -3.0 ng/ml Normal
- More than 3.0ng/ml PCOS
If AMH levels are found to be on the lower side, it is recommended that the treatment should be initiated early.
Body Mass Index Assessment – Being overweight or underweight impacts fertility in both men and women thereby reducing the chances of pregnancy. Maintaining BMI between 18.5 to 24.9 is ideal for conception and increases the chance of a healthy pregnancy and baby.
Ultrasound on Day 2 of period: Fertility specialists often use a combination of fertility tests to best assess a woman’s ovarian reserve, including a transvaginal ultrasound to count the number of antral follicles. Ovarian reserve testing by Scan is recommended on day 2 of the cycle. An ultrasound also helps rule out any anatomical abnormality like bicornuate uterus and pathologies like fibroids, endometrosis, adenomysis etc as these may act as a hindrance to conception.
Hysterosalpingogram or HSG: In young patients (less than 30 years) with good ovarian reserve and with normal semen analysis report of husband, HSG is advised to see whether the tubes are open. It is an X-ray test done by the fertility specialist by injecting a harmless dye into the womb, which should flow into the fallopian tubes. The dye is visible on an X-ray showing whether the tubes are open or blocked. And if the tubes are blocked or any filling defect seen on X-Ray, the next step would be laproscopy along with hysteroscopy.
A laparoscopy/hysteroscopy is the gold standard to assess the uterine cavity, tubo-ovarian relationship and patency of the fallopian tubes.
Review with a Fertility Specialist: Once all the investigations are done, your fertility specialist will explain the fertility potential. It is vital that you understand the cause of infertility and the line of treatment to be followed. In case, all your reports are normal, the fertility specialist might recommend further investigations.
A fertility assessment gives us a clear picture of the reproductive ability of the couple along with reassuring them that medical technology can help them become parents if there are any factors causing infertility.
To know more about ‘Fertility Assessment’, please feel free to contact BabySoon Fertility & IVF Clinic by visiting our website www.babysoon.co.in