Aakash Fertility Centre & Hospital Sky 18years
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When male factor infertility is suspected, the initial test performed is a semen analysis. A semen analysis allows the doctor to examine the count, motility and morphology of the sperm. At Aakash, we prefer a formal semen analysis over the post-coital test and consider the semen analysis to be more useful in the fertility evaluation.
Sperm count - The normal range for sperm is between 40 and 300 million sperm per milliliter of ejaculate. A low sperm count is fewer than 20 million per milliliter of ejaculate.

Motility - Low sperm motility (movement) may reduce the chances of conception, especially when paired with low sperm count. In a normal semen sample, at least half of the sperm have typical movement.

Morphology - Sperm that do not have normal morphology (shape) are often unable to swim effectively or penetrate an egg. A normal sperm has an oval head, slender midsection and tail that moves in a wave-like motion.

In order for a physician to evaluate the count, motility and morphology of sperm, a semen sample must be provided. The sample is most often collected by masturbation in a private, comfortable room in the fertility center. In some cases, the sample may be collected at home by masturbation or during intercourse with the use of a special condom provided by the physician. In some cases, the test results are not normal due to problems during sample collection and the test must be repeated.

Depending on the results of the semen analysis, more tests can be ordered to diagnose specific causes of infertility. If the semen analysis shows clumping or signs of infection, a semen culture, prostate fluid culture and urinalysis may be ordered. An antisperm antibody test may also be ordered to evaluate potential immune system disorders. A fructose test can be used to evaluate structural problem or a blockage of the seminal vesicles.
LABORATORY INVESTIGATIONS
Everyday newer lab tests are being launched capable of testing issueless couples. Still, most of the tests are meant only to test the female. Even treatment modalities are more for females than males.

This is because women who are incapable of conceiving usually manifest certain symptoms. Based on these symptoms they approach the doctors for treatment. But do not exhibit any such symptoms. This is the reason why they do not come forward for checkups and treatments.

Even globally, gynecologists or medical practioners who have specialized in female reproductive system and their infertility problems outnumber others. Those specializing andrology or male reproductive system and functions are much less. This is why in most places only semen analysis is done to test male fertility.

The right time for check-ups
Failure of the female to conceive up to six months of regular sex is not a matter of concern.

Women who are less than 30 can wait up to  2 years after marriage for conceiving. Women, who are above 30, should not delay check up in case of their not conceiving.

Some women are capable of guessing their problem on the basis of the symptoms they observe and seek tests related to those problems. Some much common problems

Women
  • Delayed periods – may be due to complication associated with ovulation.
  • Cycle after a long gap – failure to produce mature ovum continuously.
  • Painful periods or pain during intercourse – Inflammation or tissue growth in the uterus.
  • Sudden excessive bleeding – uterus problem.
  • In case of previous surgery for ovarian cysts – fusion of the ovarian walls.
  • Previous history of colon rupture – infection and block of the uterine tubes.
  • Infection due to intra uterine contraceptives – improper or incomplete removal of the foreign body
  • Previous history of infection immediately after conception – inflammation in the pelvic region.
Men
  • Measles infection during teenage – insufficient production of sperms
  • Injury to the scrotal sac – impairment of sperm production.
  • Failure of the testicle to descend from the stomachcavity – impairment of sperm production or total failure to produce sperms.
  • If these symptoms are observed, then you need not wait till the doctor advices you to do so; instead, you can go ahead and get yourself checked up
    Other problems that are not recongnizable outwardly can be diagnosed earlier by the doctor and confirmed by lab tests.
Knowing the causes
Infertility is not a  disease nor is it incurable. This is only an expression of the defect in either one or both partners.

Before opting for treatment it would be ideal to confirm the defect through lab tests. It would be too dangerous to seek self-prescribed medicines without knowing the causes.

Such behavior not only delays conception but also could result in severe irreparable side effects. This may permanently eliminate all chances of conception.

It is as bad as someone going to the pharmacist and asking for medicines for heart attack just because he had chest pain and he presumed it to be a stroke.

Confirming the cause of infertility
One should not stop with doing the check up only once. They should repeat the check up again after sometime .

Doing the test once and seeking medical treatment after sometime may be very misleading. In the intermittent time. The intensity of the problem could have increased or some other associated problem may have occurred. When one problem is detected it should be totally eliminated by treatment before going to the next problem. Simultaneous treatment may completely destroy the dream of a baby permanently.

Any treatment given or taken without keeping these factors in mind may lead to improper treatment and further complications.

When the doctor suspects a particular problem to be responsible for infertility, then the patients should cooperate in getting it confirmed by tests. It would be pointless to blame the doctor saying that he is getting unnecessary tests done.

Tests should be done in dependable or standard laboratories. Ignoring qualified practitioners and seeking the help of ‘quacking’ (unqualified self- proclaiming traditional practitioners) results in false declaration of their own assumptions as the real causes. People should avoid believing them or else they find themselves duped in the end.
Tests for men
Semen analysis
This is the first test prescribed by any doctor for a male to rule out infertility problems.

We have read that sperm production is not uniform throughout even in the same individual.

Factors like depression can alter the characteristics of the sperm significantly. All the sperms from a person need not have the same qualities.

Each one may differ or some of them may be normal and some abnormal.

These defects may also vary with time. Some times the semen may not have sperms at all. All these or even one of these factors may interfere with conception.

It is essential to find the cause of the problem by repeated semen analysis.
The test can definitely say whether a male is capable of fertilizing a female or not.

Method
It would be better for men who propose to do semen analysis to know a few details.

It is essential to abstain from sex at least for two days prior to the test.

The fluid should be collected in a wide mouthed contained and handed over to the lab for analysis within 2 hours of collection.

Any spillage or loss of the fluid during collection should be intimated to the lab person and the doctor. Otherwise, the result may be wrongly interpreted.

Seminal fluid should not be collected in condoms for testing. The chemicals in the article may kill the sperms and result in a wrong count.

In the lab the following analyses of the semen are done;
  • Consistency of the fluid
  • Sperm count
  • Motility of the sperm
  • Normal or abnormal nature of the sperms
  • Presence of microorganisms
  • Chemicals and antibodies
The normal sperm count is   about 40 million per milliliter of the fluid.  Anything less than 20 million per ml mean low count. It should be noted that some men are capable of fertilizing the female even with counts as low as 2-3 million.

Motility of the sperms are tested since at least 40% of the total number should be capable of moving. Only then it would mean that sufficient number would reach the ovum within the female’s body. Any number less than this, showing motility indicates faulty sperms.

At least  65% of the sperms should took normal. A less percentage indicates problem.
It is essential to test the presence of biochemical constituents of the sperm through chemical tests.
Presence of microorganisms indicates infection. This would have altered the sperms considerably.
Presence of antibodies could indicate auto immune reactions where the  antibodies in the blood of the person kill his own sperms.
 Since all these provide vital information, one should not be careless about semen analysis.
Any kind of result outcome should be accepted. Even anxiety can alter and make the sperms faulty. So keep your mind relaxed and calm.

Tests after intercourse
This test is done between 6 to 36 hours after intercourse. Sample of the  fluid from the cervix of the female’s uterus is removed and tested for presence of sperms under the microscope.

It would be ideal to perform this test 14 days after the menstrual cycle. Since there is a chance for ovulation during this time, the cervical fluid would be watery allowing the easy movement of the sperms through the fluid.

This test is not essentially a test for the male alone. Questions related to the female like, Has ovulation occurred? Is the cervical fluid normal? Are the sperms normal in this region? Are they able to swim through the fluid? Etc are also bound to be answered by this test. But most couples hesitate to undergo this test.
  • If it is too long after ovulation, the uterine secretions would have dried up
  • It is not ideal to perform the test at a time when its secretion is not yet stimulated by the hormone estrogen. Since the quantity of the fluid would be too less it may not give the the actual picture.
  • When the egg has not been released
  • When the sperms are abnormal or defective
  • When sufficient numbers of sperms are not present or when most of them are damaged
  • Impairment of timely ovulation
  • When the mouth of the uterus is large, the secretions re also more in quantity. This also can give a false result.
  • Infection of the cervical area, fowl smell of the cervical fluid
  • Release of antibodies  by any one of the partners
  • Failure to release the sperms (ejaculation) properly in the vaging of the female.
All the above conditions are likely to influence the result of the test. Different opinions exist amon doctors regarding the validity of the test.
Tests for Females
We have already said that lab tests for females are in plenty. Women should know certain facts before going for these tests. This would help them understand the treatment methods and their importance. This would help them prepare themselves for treatment.

Blood tests

This is an important test done to find out if ovulation has occurred.

The ovary secretes the hormone progesterone 2 weeks after the menstrual cycle. High level of this hormone in blood indicates successful ovulation.

The level is highest on the 21st day after the cycle. Hence, the test is also done on the 21st day only. Sometimes the test is done repeatedly at different time point to find any increase in the level of the hormone.

Some doctors advice the test to be done on the 2nd or 3rd day after the cycle and declare them to have low hormone level, which leaves the couple depressed.

Those who use contraceptive pills are known to have fluctuating levels of the hormone progesterone in the blood. In some women, the hormone level increases even if there has been no ovulation.

Many doctors tend to ignore this fact and there is delay in conception.

Commonoly recommended  tests
  • Ovulation testing-- to confirm if ovulation is occurring by looking through your temperature charts, using ovulation predictor kits and blood tests and ultrasound.
  • Ovarian function tests--These tests are looking to see how the hormones are functioning and working during your ovulation cycle. Tests include the Day 3 FSH (measuring follicle stimulating hormone), Day 3 Estradiol (measuring estrogen), ultrasound (to confirm ovulation occurred) and blood tests to determine the levels of inhibin B.
  • Luteal Phase Testing- Testing will evaluate progesterone levels, more extensive hormone testing, and possibly a endometrial biopsy ( see below for more info on this procedure.)
  • Hormone Tests: Most all of this testing will revolve around thorough hormone tests. These hormone tests include the following:
  • Luteinizing Hormone
  • Follicle Stimulating Hormone
  • Estradiol
  • Progesterone
  • Anti mullerian hormone
  • Prolactin
  • Free T3
  • Total Testosterone
  • Free Testosterone
  • DHEAS
  • Androstenedione
Temperature Monitoring

This test can be done by the woman independently without the help of the doctor. It is simple and requires recording the early morning temperature as soon as getting out of bed even before coffee or tea is being taken.

Record the temperature by keeping the thermometer under the tongue for about a minute.

Continue doing this for about a month. The body temperature is constant in the first two weeks after menstrual cycle.

During the time of release of the ovum, the body temperature dips a little and then becomes normal the next day or the third day. The rise in temperature could be anything between 0.4 to 0.8* Fahrenheit. This way the body temperature of the woman is stable before menstrual cycle at one particular temperature and at a different temperature after the cycle.

This recording of temperature should be done at least for two months to confirm the possible time of ovulation between the cycles. Based on this table, doctors suggest the ideal time for sexual intercourse to ensure conception. But ideally couples should involve in sexual intercourse at least 12 to 48 hours before ovulation that too repeatedly.

Proper use of this table can help in conceiving even without the help and expense of the doctor.

Women who monitor their temperature can accurately calculate their timing and ovulation timing. Some women are known to use the table very efficiently. Sometimes the table may tend to go wrong. So it should be used only in consultation with the doctor. Let us now see under what circumstances the test could go wrong. Those who are on travel, those who remain awake work in early or late hours, When the couple get involved in sex in a hurry so as not to miss the time of ovulation.

Dilation and curettage

A tiny portion of the endometrial tissue is scraped and tested. The endometrial lining develops and become secretary only when ovulation has occurred. Or else, it will still remain unchanged without any change.
In women who have cycles once every 28 days, the test can reveal whether ovulation has occurred but may not be able to tell when it would occur.

Testing the uterus and the Fallopian tube ( HSG)

Uterus and the Fallopian tubes are tested by means of an X-ray called ‘Histerosal pingogram’.

A small amount of dye is injected into the uterus and the path of the infected dye is monitored to find if there is any block in Fallopian tube.

Since the inner structures are clearly revealed, any blocks in the uterus or uterine tube, cysts, ulcers and scars can be easily detected. The X-ray reveals the complete picture of the uterus and the uterine tube. This helps to detect any defect in growth, size, nature and damage to any of the two. The location of the fault is also accurately detected. Any such detected fault can be eliminated or rectified by surgery later.

The test when taken during menstrual cycle can result in undesirable excess growth of the Endometrium. On the other hand, conception might have occurred during the second week after the cycle. So the test should be done ideally, in the first two weeks of the cycle.

In a situation demanding postponement of the X-ray for two weeks, contraceptives should be used to avoid any pregnancy.

The test takes about 10 minutes to complete. The dye is injected in to the uterus and X-ray is taken. Many people do not even realize that the test is finished.

Many doctors perform this test after testing by laparoscope.

If both the semen analysis and the above testing return normal results, there is also additional testing that your fertility specialists may recommend. These tests include any of the following:
  • Cervical Mucus Tests : This involves a post coital test (PCT) which determines if the sperm is able to penetrate and survive in the cervical mucus. It also involves a bacterial screening.
  • Ultrasound Tests : This is used to assess the thickness of the lining of the uterus (Endometrium), to monitor follicle development and to check the condition of the uterus and ovaries. An ultrasound may be conducted two to three days later to confirm that an egg has been released.
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