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What is infertility?



The 'diagnosis' of a true cause of infertility has become less important today than it was a few years ago, and our tests today are as much 'prognostic' as 'diagnostic'. But investigation is still necessary to determine whether the infertility is of male or female cause, and of what duration. These questions can be largely answered by a semen analysis test and by a careful history-taking in discussion with your consultant. It will be important, for example, to know how long you have been trying to conceive, your cycle regularity, or fluctuations in weight. And of course your age will be an important indicator - both of your fertility status and likely outcome to treatment.

Further Tests

Even if the male partner's sperm is normal (of adequate sperm count and motility) and we assume a 'female' cause, further invasive tests are rarely necessary. Keyhole laparoscopy, for example, would allow visualisation and treatment of the reproductive tubes or uterus, but, if IVF is the likely treatment, laparoscopy will rarely be helpful. A pelvic examination, however, will be performed on the female partner, as well as an ultrasound scan to check the presence of ovarian cysts.

Blood tests will be necessary to measure hormone levels: FSH, for example, will provide an indication of ovarian function, while the measurement of Anti-Mullerian Hormone will provide an evaluation of ovarian reserve. These tests will also help your consultant decide on the most appropriate treatment and the likelihood of success. A Chlamydia screening test may be useful to suggest the possibility of pelvic inflammatory disease and damaged Fallopian tubes. Such a suspicion may mean that diagnostic laparoscopy is necessary, which is performed under general anaesthetic. An above-normal level of (male) androgen hormones may also be suggestive of polycystic ovary syndrome.

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