What tests should be taken to detect infertility. Analysis for infertility in women
Diagnosis of infertility in women is an important step towards determining the cause of an infertile marriage. To date, there are many diagnostic methods and in this article we will talk about them in great detail.
Diagnosis of female infertility begins with a preliminary examination of the patient in the clinic and a antenatal clinic. In some cases, after this stage, it is possible to identify the problem and prescribe effective therapy. In polyclinic conditions, types of infertility caused by ovulation disorders and gynecological diseases that are not associated with occlusion of the fallopian tubes respond well to treatment.
If there are indications, they proceed to the second stage of examinations. The patient is prescribed specialized diagnostic methods (hardware non-invasive, endoscopy, study of hormonal levels). Treatment in such cases, depending on the identified pathology, can be both conservative and surgical (using laparoscopic, laparotomic and hysteroscopic methods).
In some cases, the only way out for the patient is assisted reproductive technologies (ART). These include IVF procedures, as well as artificial insemination (these activities can be performed in various modifications).
Specialized medical care can be obtained at the state center for reproduction and family planning, gynecological departments of medical institutions, private centers for the treatment of infertility, at the clinical bases of research institutes and departments dealing with these problems.
Plan for diagnosing infertility in women
1. Collection of anamnesis of a woman (somatic, gynecological and reproductive).
2. General examination (weight, height, skin, examination of the mammary glands).
3. Gynecological examination.
4. Analysis of the husband's sperm.
5. Blood test: general and biochemical blood test, coagulogram, RW, HIV, HbsAg, blood test for glucose, blood type and Rh factor.
6. General analysis of urine.
7. Comprehensive examination for STDs.
8. Ultrasound of the pelvic organs.
9. Colposcopy.
10. Hysterosalpingography.
11. Functional diagnostics of ovarian activity:
Measurement of basal temperature within 2-3 months;
Weekly hormonal colpocytology;
Daily study of the phenomenon of mucus arborization;
To determine the diameter of the follicle, an ultrasound is done on the 12-14-16th day of the cycle;
In blood plasma, the levels of estrogen, testosterone, prolactin, FSH, LH are determined;
On the 3rd-5th day of the menstrual cycle, in the middle of the cycle and in the 2nd phase, the level of progesterone in the blood and pregnandiol in the urine is determined;
2 times a month determine the level of 17-KS in the urine.
12. Hormonal tests.
13. Application of additional research methods according to indications:
Hormonal examination: cortisol, DHEA-S (dehydroepiandrosterone - sulfate), insulin, T3, T4, TSH, antibodies to thyroglobulin;
Postcoital test Shuvarsky-Guner;
Determination of antisperm antibodies in women in the mucus of the cervical canal on preovulatory days (the levels of immunoglobulins IgG, IgA, IgM are determined);
Kurzrock-Miller test (penetration of spermatozoa into the cervical mucus of a woman during the period of ovulation);
Friberg's test (determination of antibodies to spermatozoa using a microagglutination reaction);
Kremer's test (detection of local antibodies in the husband during contact of sperm with cervical mucus;
Izojima immobilization test;
immunological tests.
14. Examination by a mammologist, mammography.
15. X-ray of the Turkish saddle and skull.
16. Examination of the fundus and visual fields.
18. Laparoscopy.
History taking in female infertility
Examination of a woman suffering from infertility begins with a thorough history taking. The first interview with the patient is carried out in accordance with WHO recommendations. In this case, the doctor should clarify such points:
Does the patient have children and how many at the moment.
How long does infertility last?
How many pregnancies and births have there been in the past and what was their outcome.
Complications after childbirth and abortion.
What methods of contraception did the woman use and for how long.
Are there any chronic diseases (problems in the work of the adrenal glands, thyroid gland, diabetes mellitus, tuberculosis, etc.).
What medications have you taken or are taking (tranquilizers, psychotropic drugs, cytotoxic drugs).
Did you undergo surgery associated with the risk of adhesions (interventions on the ovaries, uterus and its tubes, kidneys, urinary tract, intestines, surgery for appendicitis).
Have you had pelvic inflammatory disease and sexually transmitted infections in the past? (If such diseases have occurred, it is necessary to clarify the type of pathogen and details of treatment).
Whether galactorrhea was observed and whether it was associated with lactation.
Were there any violations of sexual function, such as contact bleeding, dyspareunia.
What diseases of the cervix were diagnosed and what therapy was prescribed (conservative, electrocoagulation, cryotherapy, laser).
It is also necessary to inquire about the patient's lifestyle, the presence of bad habits (smoking, addiction to alcohol or drugs), to clarify the influence of industrial, epidemic and hereditary factors (to find out the presence of hereditary diseases in the patient's relatives of the 1st and 2nd degree of kinship).
Of great importance in the diagnosis of female infertility is the menstrual history of an infertile woman (menarche, cycle features, cycle disorders, discharge between menstruation, sensations during menstruation).
Physical examination in women with infertility
At this stage of the examination, the following diagnostic measures are carried out:
The patient's height and weight are measured.
Calculate the body mass index (weight in kilograms divided by the square of height in meters). The normal values of this indicator are from 20 to 26. If obesity is noted (mass index exceeds 30), find out when obesity appeared, how quickly it developed and what could be the cause.
Carefully study the condition of the skin (dry skin or oily, wet), pay attention to the presence of traces of sprains, acne. Evaluate the nature of hair growth. If there is hypertrichosis, its degree is determined using the D. Ferriman, J. Galwey scale. Find out when excessive hair growth occurred.
They examine the mammary glands, assess the degree of their development, conduct a study on the subject of discharge from the nipples and palpable formations.
A bimanual gynecological examination is carried out, the state of the cervix is examined with the help of mirrors, and colposcopy is performed.
At this stage, a physician's medical opinion is also required on the possibility of a successful pregnancy and successful delivery. If signs of mental, endocrine or any other diseases, malformations are found, then it will be necessary to consult a specialized doctor - a psychiatrist, endocrinologist, geneticist, etc.
Laboratory diagnostic methods for female infertility
Infectious screening for infertility in women
In accordance with the order of the Ministry of Health of the Russian Federation No. 572n, infectious screening is carried out. It includes the following activities:
Taking a smear from the cervix for cytological analysis.
- A smear on the flora from the cervical canal and urethra.
Study on the degree of purity of the vagina.
PCR analysis for 12 infections: chlamydia, human papillomavirus infection, mycoplasmosis, ureaplasmosis, trichomoniasis, gonorrhea, etc. To do this, take a swab from the cervical canal.
The use of the cultural method (when samples from the vagina and cervical canal are cultured to study the flora and assess its sensitivity to antibacterial drugs).
Blood tests for HIV, syphilis, hepatitis B and C.
If the patient has been diagnosed with one of the infections mentioned above, a course of etiotropic therapy will be required, followed by another (control) examination. At this stage, the patient may be referred for specialized treatment to an immunologist (if HIV is detected) or a dermatovenereologist (in case of gonorrhea or syphilis).
TORCH-complex
The TORCH-complex includes:
Detection of antibodies (immunoglobulins - Ig) G and M to rubella, cytomegalovirus, toxoplasmosis, herpes simplex virus (1 and 2 types). If rubella IgG antibodies are not detected, the patient needs to be vaccinated.
Hormonal screening
In order to confirm or exclude the endocrine nature of the pathology (anovulatory infertility), hormonal screening is performed as part of a standard outpatient examination program. With cycle disorders and ovulatory function disorders, a study of the hormonal background helps to identify the cause of the pathology.
Hormonal screening includes an assessment of the level of such hormones: luteinizing and follicle-stimulating hormones, prolactin, estradiol, cortisol, testosterone, 17-hydroxyprogesterone, thyroid-stimulating hormone, dehydroepiandrosterone sulfate, free thyroxine (on the 2nd or 3rd day with a normal cycle and at any time in case of a disturbed cycle) and progesterone (on the 21-23rd day of the cycle).
If studies have shown deviations in the level of hormones, the patient will need further diagnostics aimed at finding out the causes of hormonal imbalance. At this stage, specialized instrumental and laboratory diagnostic methods can be used:
Computed tomography of the Turkish saddle area.
Ultrasound examination of the thyroid gland.
Hormonal tests.
Such diagnostics belongs to the competence of a specialized specialist - a gynecologist-endocrinologist. The same doctor, based on the results of examinations, determines the treatment regimen.
Immunological methods for diagnosing female infertility
Also, the diagnosis of infertility in women is resorted to immunological studies - the detection of antibodies in samples from the cervical canal (IgG, IgM, IgA).
Instrumental methods for diagnosing infertility in women
During the outpatient examination of patients suffering from infertility, an obligatory method is ultrasound of the small pelvis. Ultrasound is also recommended to assess the condition of the mammary glands and exclude neoplasms in them (up to 36 years). If indicated, an ultrasound of the thyroid gland is performed.
If there are suspicions of intrauterine or tubal causes of infertility, the patient undergoes hysterosalpingography (HSG). The study is performed in the period from the 5th to the 7th day of the cycle with normal menstruation or oligomenorrhea. For patients with amenorrhea, HSG can be performed at any time.
At the same time, the diagnostic capabilities of HSG in the study of the fallopian tubes cannot be considered satisfactory. The fact is that during the study of tubal patency, there is a significant discrepancy between the results (up to 50%) of HSG and laparoscopic examination, supplemented by chromosalpingoscopy with methylene blue. And this means that it is possible to diagnose tubal-peritoneal infertility (TPB) and completely clarify the picture of tubal changes only by the laparoscopic method. As for the HSG, this method is informative in the diagnosis of intrauterine diseases.
X-ray diagnostic methods for female infertility include:
Tomography (computer or magnetic resonance).
Craniogram.
Hysterosalpingography.
Mammography (after 36 years).
Tomography of the skull and the area of the Turkish saddle is performed for endocrine infertility, which is associated with hyperprolactinemia or pituitary insufficiency (with a low level of FSH). This method allows physicians to detect macro- and microprolactinomas of the pituitary gland. In addition, it makes it possible to diagnose the syndrome of an empty Turkish saddle.
If there is a suspicion of surgical pathology of the genital organs, the patient may be referred for a spiral CT scan of the pelvis. Such a study allows you to get complete information about the state of the organs, after which you can plan a surgical intervention. Instead of spiral tomography in such cases, the use of MRI is also allowed. However, it must be taken into account that the diagnostic potential of this method is not so high, and it will take more time to obtain images.
Patients who have signs of hypo- or hyperthyroidism, deviations in the level of thyroid hormones, and hyperprolactinemia are referred for an ultrasound examination of the thyroid gland.
Ultrasound of the adrenal glands is indicated for elevated levels of adrenal androgens and hyperandrogenism. If necessary, perform CT scan of the adrenal glands.
Endoscopic diagnosis in female infertility
Endoscopic diagnostics involves laparoscopy and hysteroscopy. If there is an endometrial pathology, a biopsy is performed during the procedure.
Laparoscopy is considered the most informative method for peritoneal and tubal infertility factors. Moreover, it makes it possible to correct the detected pathologies: restore tubal patency, separate adhesions, remove fibroids (intramural, subserous) and retention formations in the ovaries, and perform coagulation of endometrioid heterotopias.
The method of hysteroscopy is resorted to in such cases:
Suspicion of intrauterine pathology based on the results of the survey, examination and ultrasound.
The patient has dysfunctional uterine bleeding, regardless of their intensity.
Hysteroscopy of the uterus helps to identify many different pathologies: polyps, adenomyosis, myomatous nodes, GPE, chronic endometritis, synechia, malformations, and the presence of a foreign body. During this procedure, a specialist for diagnostic purposes can perform curettage of the cervical canal and uterine cavity. In addition, under hysteroscopic control, it is possible to perform surgical interventions for various intrauterine pathologies.
Diagnostics of the sexual partner
In parallel with the examination, the patient is sent for diagnosis and her partner. This is necessary in order to exclude the possibility of a male infertility factor. The main study in this case is spermogram. If the analysis showed deviations in sperm counts, the man must be examined by an andrologist without fail. After that, you can decide on possible ways to solve the problem (treatment of a man or IVF).
In addition to the spermogram, when examining men, the MAP test method (detection of antibodies to spermatozoa) is used. If the indicator of this test exceeds 30%, we can say that the infertility of a man is of an immune nature. In such cases, IVF or the method of artificial insemination is indicated.
If there is a suspicion of one of the surgical pathologies (ovarian cyst, tubal occlusion, uterine malformations, endometrioid or myomatous process, intrauterine synechia, peritoneal adhesions), the patient should be referred to a specialized medical institution. There they will carry out further diagnostics, make a final diagnosis and carry out the necessary treatment (surgical or endoscopic method). The diagnosis of male infertility is described in detail in another article on our website.
If a woman has not passed the full range of necessary studies, it is impossible to make a final diagnosis. Therefore, therapy will be ineffective. It is important to take into account this point: the maximum duration of any conservative treatment is two years (this also applies to treatment after surgical interventions to eliminate a particular gynecological pathology). If pregnancy does not occur after two years of therapy, the woman is referred without delay to an ART center. It is also not worth postponing a visit to the center because the age of the patient (from 35 years old) can make it difficult to successfully apply such techniques. It must be remembered: in infertile women of this age category, the stage of therapy, which involves the use of techniques aimed at restoring the natural ability to conceive (the outpatient stage), should be excluded altogether.
Primary diagnosis of infertility: examination for infertility in women, men and what tests to take
For a perfectly healthy woman under the age of 25, the probability of becoming pregnant in 1 menstrual cycle (MC) is 22-25%. In a married couple with a regular sexual life (with a frequency of 2-3 times a week), pregnancy occurs within 1 year in 75% of cases.
Therefore, primary infertility is considered to be the absence of pregnancy in a woman of reproductive age within 12 months of regular sexual activity without the use of contraception. We will analyze where to start the examination for infertility, what diagnostic methods exist and where to go.
It should be noted that the period of diagnosing infertility, from the initial visit to a specialist to determining the cause, should not be more than 2 months. The period of examination and treatment of infertility should not exceed 2 years in women under 35 and 1 year in patients over 35. With age, the effectiveness of treatment only decreases. After these two periods, treatment with the method is recommended.
- What is infertility and how does it happen
- When to start testing
- First consultation: what you need to know
- How to start diagnosing
- Examination for female infertility
- What will the doctor ask
- Clinical examination
- Ultrasound diagnostics
- Assessment of the hormonal background
- Tests for infections
- genetic research
- Treatment
What is infertility? Types and classification
One of the partners should not be blamed for infertility, it can be both female and male, but the combined form is more common. So if you or your doctor suspect that the reason for the lack of pregnancy lies precisely in it, then the diagnosis of infertility should be carried out for both a man and a woman. It is necessary to undergo a series of examinations and pass tests.
There are 3 types of infertility:
- - the inability of the male germ cells of a mature male body to conceive (there can be many reasons, but male infertility is reversible in most cases). The incidence of true male factor infertility is 30%.
- Female infertility is the absence of pregnancy, which is associated with problems in women's reproductive health. The frequency is 40%.
- Combined infertility is 30%.
Therefore, the infertility examination algorithm provides for the diagnostics of reproductive health in both partners.
Infertility is further subdivided into:
- primary, when there was no pregnancy at all;
- secondary, when the fact of pregnancy was in the past and no matter how it ended - childbirth, miscarriage, ectopic pregnancy, abortion in youth.
When should you start screening for infertility?
You need to start an examination for infertility with your own or local gynecologist. You can also contact the reproductive medicine clinic. Women under the age of 35 should seek medical help after 1 year of regular sexual activity (remember that without the use of methods and means of contraception), after 35 years - after 6 months.
The reduction in time is due to the fact that the older the patient, the lower the pregnancy rate in both natural cycles and when applied. Delaying an examination for infertility after 35 reduces the chances of pregnancy in principle and reduces the chances of having healthy offspring.
First consultation with a specialist in infertility
During the initial treatment, the doctor will find out whether or not there are contraindications for pregnancy. Since there are such diseases (genital and extragenital, not related to the reproductive system), the course of pregnancy in which carries a potential risk to a woman's life. Therefore, the doctor will collect an anamnesis - ask about the following:
- whether there are problems with the heart (defects);
- anomalies in the development of the genital organs (two-horned,);
- from a woman and close relatives, etc.
The second stage is the correction of identified and confirmed diseases (fat metabolism disorders, obesity, diabetes mellitus, etc.)
Contraindications for pregnancy can be: mental illness, oncological formations.
How to start an examination for infertility?
Any examination of a married couple regarding infertility is complex, but begins with a man. First, it's easier and faster. Secondly, the exclusion of the male factor is already the first (albeit intermediate) result. Thirdly, it is possible to restore fertility to a man in 70% of cases after medical correction, lifestyle correction or elimination of harmful factors. For the diagnosis of infertility, a man needs to pass a semen analysis. It's called a spermogram.
Diagnosis of male infertility
An assessment of the reproductive ability of a husband or partner begins with an anamnesis - questioning. The doctor will find out:
- age;
- the presence or absence of injury;
- the number of marriages and the presence of children (and their age);
- past illnesses;
- what were the operations;
- professional hazards;
- desire to have children.
Then, according to the plan, you will need to pass an analysis - a spermogram. This study is mandatory, it allows you to evaluate the concentration of spermatozoa, their mobility, the correctness of the structure.
- infectious screening;
- (antilobulin mixing reaction).
If deviations from the norm are found in the spermogram, an andrologist's consultation is prescribed. When the husband passed, then it makes sense to deal only with the health of the woman.
Diagnosis of infertility in women
Basic examination of patients with infertility includes the following steps:
- collection of information (anamnesis) about a woman;
- clinical examination (general blood and urine tests, hormonal panel, blood glucose, etc.);
- ultrasound diagnostics of the pelvic organs;
- blood tests for hormones;
- research (there are several methods for diagnosis).
What is important in collecting information about a woman with infertility?
Age is important for making a diagnosis. If a woman aged 25 is compared with a woman aged 43-45, then the pregnancy rate is higher in a young woman. A closer diagnosis awaits women of older reproductive age.
The second equally important factor for treatment is the duration of infertility. If a couple has not been able to get pregnant for 10 years and has a history of, for example, several, then the tactics of preparation and the method of treatment and diagnosis will be different.
When collecting an anamnesis, it is necessary to take into account the presence of chronic general diseases, operations in the abdominal cavity and the pelvic cavity with the use of drainage. These surgical interventions can lead to the development of adhesive disease, and this is one of the factors that can.
Standard in gynecology for the diagnosis of infertility is assessed:
- menstrual function: when the first menstruation began, the date of the beginning of the last cycle, ;
- time of onset and intensity of sexual activity;
- childbearing function:, (natural or artificial), abortions, miscarriages, intrauterine fetal death, inflammatory complications after them;
- the use of contraception (physiological, medical, condoms): it is especially important for the diagnosis of infertility - long-term wearing of an intrauterine device, which can cause;
- sexually transmitted infections, their treatment regimens;
- surgical operations on the pelvic organs for,.
Operations on the ovaries are fundamentally important. They may be the cause.
Clinical examination for infertility
Diagnosis of female infertility consists of a general examination, during which attention is paid to:
- On the body type, the distribution of subcutaneous fat. If problems with weight are identified, correction is required. With a small weight, it is recommended to get better, with an excess - to lose weight. In some cases, this allows you to solve the problem of normalizing the menstrual cycle and, and, therefore, if there are no other violations.
- On the degree of hairiness. With an excess of hair on the female body, hyperandrogenism (an excess of male sex hormones) or can be suspected.
- development of the mammary glands.
Then a gynecological examination is carried out, smears are taken for.
During the examination, the psycho-emotional state is assessed. A woman may, on a subconscious level, not want a child, despite the fact that her closest relatives are pushing her to this, but emotionally she is not ready for his appearance. It plays an important role in pregnancy.
Ultrasound examination of a woman with infertility
Ultrasound is prescribed in the first phase of the menstrual cycle - 2-5 days. During ultrasound diagnosis, the presence or absence of uterine pathology (, intrauterine synechia) is assessed.
Without fail, the ovaries are examined - the size of the ovaries and the number of antral follicles.
Assessment of hormonal status in infertility
Assessment of the hormonal background consists of the following steps:
- Laboratory blood tests for hormones. Screening is carried out on days 2-4 of the MC (LH, FSH, E2 - estradiol, testosterone, DHA-sulfate, TSH, T4, which is a marker of ovarian reserve).
- Evaluation of ovulation: measurement of basal temperature, urinary tests for ovulation, folliculometry - ultrasound monitoring of the development of follicles.
Tests for infections
An infectious agent can also be the cause of female infertility. For diagnosis, a swab is taken from the vagina during a gynecological examination.
Specific analyses:
- Cervical mucus (cervical smear) is analyzed for the presence of chlamydia, myco-, ureaplasma, herpes and cytomegalovirus by PCR.
- Blood test for TORCH-complex: determined to the pathogens of toxoplasmosis, rubella virus, cytomegalovirus and herpes.
Genetic testing for infertility
Sometimes a doctor may prescribe a genetic examination - a study of the karyotype. A genotype is a set of human chromosomes. Women have 46 XX, men have 46 XY. This is the genetic "passport" of a person. Often there are deviations in the form of mutations, translocations (the location of the shoulder or section changes), the absence of a chromosome or the presence of additional ones.
Indications for the study of karyotype in infertility:
- primary amenorrhea - absence of menstruation;
- secondary amenorrhea - premature menopause;
- delayed sexual development;
- (examine both spouses).
- prolonged primary infertility of unknown origin.
Genetic analysis for both spouses is also prescribed in case of several ineffective IVF cycles.
Infertility treatment
Restoration of reproductive function can be achieved with:
- methods (therapeutic and surgical - laparoscopy);
- assisted reproduction method - IVF.
Tests for female infertility
Tests for female infertility
To identify the causes of infertility in women, reproductologists prescribe laboratory tests.
Some studies are mandatory for all groups of patients (clinical and biochemical studies of blood and urine, analysis of the blood coagulation system, hormonal studies, analysis for infections).
Additional studies may also be prescribed, which include genetic blood tests, histological studies of the endometrium, tumor markers, and additional hormonal studies.
Patients often ask if there is any special test for infertility in women? According to one analysis, the diagnosis of "infertility" is not made. The survey is always complex.
In addition to tests for the most common causes of infertility, an examination using ultrasound, instrumental methods (echohysteroscopy, hysteroscopy, laparoscopy) is mandatory. The purpose of the survey: to identify the cause of infertility to determine the tactics of treatment.
! We draw your attention to the fact that the correct diagnosis can be made only with high-quality analyzes. That is why on the territory of our clinic there is a sampling point for the analysis of the DiaLab diagnostic laboratory, which has the international ISO quality standard, which was selected from many other laboratories for the quality of the analyzes performed.Hormone testing for women
When determining the causes of infertility in women, fertility doctors prescribe tests for hormones that reflect the reproductive function of the female body.
The list of tests for hormones necessary for making a diagnosis is determined by the fertility specialist individually, based on the clinical situation.
1) Sex hormones
With a decrease in the production of follicle-stimulating hormone (FSH) by the pituitary gland, the entire work of the ovaries is disrupted: they do not produce eggs and ovarian hormones - estrogen and progesterone. Low FSH levels disrupt the menstrual cycle.
Luteinizing hormone (LH) is produced by the pituitary gland and affects the production of progesterone in the ovaries. A high reading indicates the presence of endometriosis, polycystic disease, or ovarian failure.
With deviations in the level of prolactin, the growth of follicles and the process of ovulation are disrupted.
The male sex hormone, testosterone, is also present in the female body. In excess, it disrupts ovulation and can lead to miscarriage.
Normal progesterone levels affect the growth and development of the endometrium in the uterus. This is necessary for the successful implantation of the embryo into the uterine cavity and the development of pregnancy. An increase in the level of this hormone can signal ovarian diseases (for example, an ovarian cyst), with a decrease, ovulation does not occur in women.
Elevated numbers of 17-OP indicate the presence of adrenogenital syndrome. Against this background, the hormone testosterone rises and ovulation does not occur.
AMH (Anti-Müllerian Hormone) reflects ovarian reserve ovaries. Low readings indicate ovarian exhaustion. The lower the AMH, the lower the chance of pregnancy.
Estradiol (estrogen) affects the menstrual cycle, egg maturation. It also affects the growth of the endometrium and prepares the uterine mucosa for implantation of the embryo.
Blood for sex hormones must be taken strictly on an empty stomach and on a certain day of the menstrual cycle.
On day 2-3 of the menstrual cycle - FSH, LH, prolactin, AMH.
On the 8th-10th day of the menstrual cycle - testosterone, 17-OP.
On the 19-21st day of the cycle - estradiol, progesterone.
2) Thyroid hormones
Changes in the normal levels of thyroid hormones in women have a negative effect on ovulation and follicle growth.
On the eve of the test, you should exclude training and stress. It is advisable to take it in the morning, on an empty stomach. An hour before the test, it is desirable to be in a calm state.
3) Hormones of the adrenal cortex
An increase in the level of these hormones leads to a violation of the development of follicles, delayed ovulation and negatively affects the production of cervical mucus.
On the eve of the test, fatty foods and alcohol should be excluded from the diet. It is advisable to take it in the morning, on an empty stomach. Do not smoke one hour before the test.
Very often, one of the causes of infertility is sexual infections. They lead to a chronic inflammatory process, the formation of adhesions, obstruction of the fallopian tubes.
In time, untreated or untreated infectious diseases of the reproductive system become chronic, the clinical picture is erased, and the woman may not know that the disease has become latent. However, she can remain a carrier of this infection.
In order to identify diseases or the carriage of infections, examination for sexual infections is mandatory and is included in the standard examination for infertility or before pregnancy planning.
Tests for infections are carried out on swabs from the female genital tract (smears for flora and PCR diagnostics) and on venous blood (for the presence of antibodies and antigens in the blood).
In "VitroClinic" you can take tests for all types of infections, including the study of the complete biocenosis (quantitative and qualitative composition of the microflora) of the vagina using the modern Femoflor analysis.VitroClinic specialists adhere to the tactics of prescribing the optimal number of additional tests to clarify the diagnosis. Therefore, such analyzes that have lost their relevance as HLA typing and the postcoital test are not prescribed.
Biochemical blood tests
These blood tests reflect the work of the internal organs of a person, and by the slightest deviations, the presence of a pathology can be detected and treatment can be carried out in time. The mandatory study includes: total protein, albumin, glucose, creatinine, cholesterol, ALT, AST, potassium, sodium, total bilirubin, urea.
All happy love relationships logically end with the birth of a baby. However, not all couples manage to conceive a child at the planned time. To understand the reasons for unsuccessful attempts, you need to go through a series of diagnostic tests, among which an important component is infertility tests.
Why can't women who have never complained about health problems conceive a baby?
The reasons may be different. Perhaps the reason for this phenomenon is a typically feminine desire to get what you want "here and immediately." No matter how paradoxical it may sound, the fact has long been known: the more a woman wants to get pregnant, the less often she succeeds. But as soon as she relaxes and “let the situation take its course”, the desired conception magically comes.
If you can’t relax in any way or there are serious reasons to doubt the success of conception, it is better to consult a doctor to establish the reasons for childlessness. In any case, it must be remembered that a statement of female infertility can only be in the absence of conception after a year of regular unprotected sexual activity. Such a diagnosis is made after passing through numerous hardware and laboratory studies, with the help of which certain violations were identified.
Diagnosis of infertility in women takes place in several stages, each of which is extremely important. The doctor will have to find out the presence or absence of the main factors that do not allow a woman to conceive a baby:
- ovulation disorder;
- Obstruction in the fallopian tubes;
- endometriosis;
- Hormonal disorders;
- Violations of the shape of the uterus or education on it;
- Inflammatory processes in the pelvic organs;
- Infectious diseases.
In addition, many external factors influence unsuccessful attempts to get pregnant:
- Age;
- Body weight (overweight or underweight);
- Frequent stress, accompanied by nervous exhaustion;
- Psychological rejection;
- immunological reasons.
With infertility in women, several factors can be identified at once that prevent the appearance of the long-awaited two strips on the test. In addition, approximately 10% of infertile couples do not reveal any violations of either a physiological or psychological order. In this case, they speak of infertility of unknown etiology.
Collection of anamnesis
Before the examination and treatment of infertile couples, the doctor will definitely conduct a conversation that will identify possible health problems in the spouses. It will also exclude the presence of a psychosexual factor, which also affects the fact that conception does not occur.
The gynecologist needs to find out the following factors:
- Whether the spouses suffered from sexually transmitted diseases;
- Has the woman used an intrauterine device;
- Whether hormonal contraception was used, for how long;
- Whether surgical intervention was performed on the pelvic organs;
- What is the duration of the menstrual cycle, its regularity;
- Is there pain during and before menstruation;
- The nature and regularity of intimate life.
There are two types of infertility:
- A fruitless marriage when there are no children in the couple;
- Secondary infertility, when the spouses already have one child, but it is not possible to conceive a second.
Infertility screening takes place in two stages. Diagnosis at the first stage does not require hospitalization. Some of the techniques are done on an outpatient basis (screenings, ultrasound, endometrial biopsy, MSH). And part (for example, measuring basal temperature) can be done at home.
The second stage of research is carried out if the previous methods did not reveal the cause of infertility. These include endoscopic techniques (laparoscopy and hyteroscopy).
The work carried out with a married couple allows us to draw up a preliminary plan for the examination, determine how to check for possible deviations and what tests should be taken if it is not possible to get pregnant.
Husband examination
Despite the widespread belief that the "culprit" of the absence of a couple of children is a woman, this is not at all the case. Male infertility is as common as female infertility. Therefore, if it is not possible to conceive a baby, a man also needs to be tested for infertility.
The main goal of men's research is to determine the activity of their spermatozoa. For this purpose, they need to make a spermogram. This simple and inexpensive procedure is completely painless. However, many men are embarrassed by the method of collecting sperm for analysis. Therefore, spouses should very delicately explain the necessity and importance of this procedure.
In order for the results of the spermogram to be accurate, the following rules must be observed:
- The collection of biological material is carried out after 4-5 days of abstinence from intimate life;
- It is forbidden to take water procedures at high temperatures before the study.
The presence of antibodies in the sperm of a man is a disappointing result of the study. No matter how paradoxical it may sound, but spermatozoa are foreign elements for the body, so the immune system in the form of antibodies “gets rid of” them. In a healthy male body, they are isolated. In case of injury, surgery, illness, spermatozoa enter the bloodstream, and antibodies begin to “get rid of” them urgently. That is, the male sperm loses its ability to fertilize the female egg. And there is infertility.
What tests should a woman take if she can’t get pregnant
Unlike men who need to donate only sperm in case of infertility, the range of “female” problems is much wider.
To make the correct diagnosis, the doctor will prescribe a whole range of diagnostic techniques. Necessary examinations are mandatory, since often several factors are the cause of the impossibility of conception.
Consider what mandatory tests for infertility in women are prescribed at all diagnostic stages, the rules and features of their conduct.
Hormonal screening
An important factor in determining the properly functioning hormones in the female body is the day of the test.
So, on what days should you take hormones for infertility?
If a woman has a regular menstrual cycle, hormonal screening is prescribed at the beginning of the follicular phase (3-8 days of the cycle). With irregular menstruation, studies are carried out at any time. An exception is the study of the amount of progesterone. It is carried out on the 20-22nd day of the cycle.
We list which hormones are checked in the diagnosis of infertility:
- FSH (follicle stimulating hormone);
- LH (luteinizing hormone);
- Progesterone;
- Prolactin;
- Testosterone;
- Estradiol;
- Hormones produced by the thyroid gland (T3, T4, TSH).
If a hormonal analysis for infertility in women has revealed abnormalities, diagnostic studies will continue with instrumental and laboratory methods. According to their results, a treatment plan will be developed.
Infection screening
Sexually transmitted infections are another common cause of infertility. Therefore, it is important to identify these diseases in the early stages of diagnosis.
Infectious tests for infertility include the following studies:
- A smear from the urethra and cervical canal (natural flora is determined);
- Vaginal smear;
- PCR (detection of 12 sexually transmitted infections: gonorrhea, mycoplasmosis, chlamydia, etc.);
- TORCH - complex;
- A blood test to detect hepatitis, HIV and syphilis.
If any of the above infections is detected, a course of treatment is required, after which control tests are taken.
Ovulation confirmation
The presence of ovulation is an important factor for the onset of pregnancy. Therefore, it is necessary to conduct surveys that will confirm its regular onset.
Diagnostics can be carried out in three ways:
- Do ;
- Within a few months;
- Conduct research at all phases of the menstrual cycle using ultrasound.
Not every woman can afford. This method is quite expensive, but it is considered the most reliable and reliable.
Immunological screening
Sometimes the cause of infertility is the immunological incompatibility of the spouses: the female body produces special antibodies against the husband's spermatozoa. To detect the presence of antisperm antibodies, they take an analysis for infertility from the cervical canal. For diagnosis, two test options are used:
- Postcoital test (Shuvarsky test);
- MAP test.
Examination of the endometrium
This can be an aspirate (the second name for this type of diagnosis is endometrial aspiration biopsy), or endometrial hysteroscopy. This study helps to assess the endometrium: the general condition and the ability of its recipes to fully function.
Examination of the patency of the fallopian tubes
Even with successful ovulation, a woman will not be able to get pregnant if she has blocked fallopian tubes. In this case, the egg simply will not be able to get into the uterus.
In order to determine the condition of the fallopian tubes, use metrosalpingography. The second name for this procedure is hysterosalpingography.
This diagnostic procedure is carried out using X-rays. It allows not only to determine the condition of the tubes, but also to identify pathological changes in the endometrium, as well as malformations of the uterus itself.
The condition of the tubes filled with a contrast agent is assessed using images that allow you to identify pathological changes: if there is no obstruction, the substance will be in the pelvic area.
The procedure is carried out on the 8-10th day of the menstrual cycle.
Consultation of narrow specialists
Standard diagnostics includes consultations of narrow specialists. And if violations are detected at any stage of the study, a woman is sent for a consultation with an endocrinologist, psychiatrist, psychologist, venereologist.
Couples over 35 years of age, as well as spouses in whose families there are cases of genetic diseases, a consultation with a geneticist is required.
How much does an infertility test cost?
You can take tests to determine the cause of infertility both in a public health institution and in paid clinics. In this case, a woman can make a choice on her own.
But keep in mind that each of the numerous tests is not cheap. And given the need for a comprehensive examination, such a diagnosis may be unbearable for a family with an average income.
So, for example, the delivery of a spermogram in a paid clinic will cost about 1,000 rubles, the price for a comprehensive infectious screening reaches 3,800 rubles. As for instrumental diagnostic methods, they are even more expensive: their cost can exceed 20,000 per procedure.
Therefore, it is advisable not to rush to go to a private clinic. Indeed, in public medical institutions, you can absolutely free of charge to pass many tests and undergo examinations. It is best to go to the Family Planning Center, these are the centers that specialize in the treatment of infertility. Or just go to the gynecologist at the place of residence.
And yet, be prepared for the fact that you will have to pay for many tests and examinations. Alas, domestic medicine is imperfect. It is unlikely that it will be possible to be examined from and to under the MHI policy. And yet, for your wallet, this is a much more sparing option.
To find out the reasons for the decline in fertility, tests are taken. The cost of the examination depends on the number and type of diagnostic measures assigned to you. The price of infertility analysis in women differs depending on the type of study. There is no universal cost for all tests.
Analysis for infertility in women
Since it is not possible to determine infertility in women based on symptoms or history data, laboratory tests are required. These include: blood and urine tests, blood typing and Rh factor, syphilis and hepatitis tests, and some types of viral infections.
Examination for the presence of genital infections
The examination is performed to identify pathogens of sexual infections, such as gardnerella, ureaplasma, chlamydia and mycoplasma. It is very important to detect and treat them in time, since they are often the cause of infertility or fetal death.
immune tests
To identify antisperm bodies that interfere with conception, the MAP test and the PCT (postcoital) test are used. The essence of the latter is to determine the effect of mucus inside the cervix on sperm activity a couple of hours after intercourse.
Measurement of basal temperature
This test should be carried out for at least 3-4 cycles. It is the most inexpensive and has sufficient accuracy. With it, you can determine whether a woman is ovulating or not.
A preliminary examination allows our specialists to identify the causes of infertility and develop an optimal plan that will achieve the best treatment results and give birth to a healthy baby.
The test for infertility in women makes it possible to understand where the source of the problem lies. Perhaps the culprit for the lack of conception is the partner; according to statistics, about 40% of couples do not have children as a result of male infertility. Therefore, both partners should be tested.
Diagnosis of infertility in women includes various procedures, from the simplest standard tests to complex invasive manipulations. In some cases, during the intervention, it is possible not only to detect the cause of the violations that have arisen, but also to eliminate it, for example, with hysteroscopy or laparoscopy.
In most cases, the problem of infertility that occurs in a couple is associated with 4 main objects that play a decisive role in conceiving a child: sperm, ovaries, uterus and fallopian tubes. The probability of detecting violations in the work of these organs in men and women is approximately the same - 40%. In 10% of cases, both partners have problems. The remaining 10% are cases where no obvious violations in the work of the organs were found, and the reason was not clarified. Such situations are called idiopathic or infertility of unknown origin.
