There are various methods to diagnose and reach a conclusion for the best treatment for a particular infertile couple. A complete medical history and/or a physical examination are the first steps in diagnosing a fertility problem. The husband and wife need to be evaluated. The couple may also need blood tests, semen specimens from the husband, and ultrasound exams or exploratory surgery for the wife. In your first visit to the hospital you should remember to bring along any previous records and reports if any. That may help the Doctor understand your problem and the avoid any repetition of tests. Your Doctor will need information about the couple's sexual and medical history.
They should be prepared for these questions:
What medical conditions have you had?
What medications do you take?
Have you had any past surgeries?
How often do you have intercourse?
When do you have intercourse?
is there any discomfort during intercourse?
Do you feel anxious or depressed about being unable to conceive?
For the woman:When did your periods begin? How regularly do your periods occur, and how long do they last?
For the man:Do you experience any erection or other sexual problems during intercourse?
Further diagnostic tests for the wife may involve-
Blood tests/ urine tests
An endometrial biopsy
An ultrasound to look for fibroids and cysts in the uterus and ovaries.
A laparoscopy- If the doctor suspects ovarian or fallopian tube scarring or endometriosis, a woman may undergo a laparoscopy. The doctor makes two small incisions at the pubic bone and navel, and carbon dioxide gas is injected into the stomach to enlarge it.
Then the doctor inserts a laparoscope, a long tube with lenses and a fiberoptic light, into one incision and a long probe through the other opening in the skin. With the probe, the doctor can view the ovaries, fallopian tubes and uterus to check for scar tissue. In some cases, he may cut away scar tissue discovered during this operation.
A hysterosalpingogram (HSG): This test checks the condition of the woman's fallopian tubes. The doctor clamps the cervix and injects a needle filled with dye into the woman's uterus. An X-ray is taken to determine whether the dye passes through the open ends of the fallopian tubes. If the dye emerges from the end of the tubes, they are not blocked. The test may also reveal other fertility problems, such as fibroid tumors, structural abnormalities and endometrial polyps. In some cases, the dye actually clears away blockages in the fallopian tubes, and restores the woman's fertility. The dye is harmless and is absorbed by the woman's body after going through her tubes. The test may be uncomfortable, but is rarely painful.
A Hysteroscopy: It is the visualization of the inside of your womb (uterus) to establish that it is structurally normal and that there are no abnormal findings within the cavity of the uterus, such as fibroids, polyps or adhesions. The investigation will usually allow the doctor to see the openings to the Fallopian tubes at the top of the uterine cavity on each side (i.e. the tubal ostia).A solution of saline is used to distend the cavity to give a clear picture. The findings are normally recorded on videotape, which can be viewed afterwards at your follow-up consultation.
Further diagnostic tests for the husband may involve- After a medical history and an examination, the man's sperm are tested. He'll be asked to ejaculate into a cup, and this specimen will be evaluated. The man should not ejaculate for several days before he takes the test, because each ejaculation may reduce the sperm count.
Several factors checked in the semen- sperm count , movement, maturity and shape of the sperm (which reveal its quality), the amount of sperm produced (one teaspoon is sufficient), acidity (the semen should be slightly acidic)
Hormonal blood tests.
Imaging tests that check for swollen veins or reproductive system blockages.
A testicular biopsy- The doctor takes bits of tissue from the testes, and this tissue is examined to see whether the cells that produce the sperm are working properly.
Anti-sperm antibody tests, which check whether the woman's mucous rejects the man's sperm. These tests also show whether the man produces antibodies to reject his own sperm.