Comprehensive Fertility Assessment
With a comprehensive fertility investigation, we have a full assessment of your ability to conceive and identify any underlying factors that could prevent you from conceiving naturally.
At Sunfert, we offer a full range of fertility investigations and diagnostic tests using a combination of a thorough medical history review and physical examination, blood tests, pelvic ultrasound scans and minor surgical procedures, if necessary. These tests enable the fertility specialist to inform the couple the likely causes of the subfertility and recommend possible treatments.
It is important to note that subfertility may be contributed by both male and female partners. Therefore it is important that the assessment of the subfertile couple must be carried out on both partners.
Private Room for Semen Collection
Medical History Review
Existing medical conditions, gynaecological history and any known problems, such as
- Ovulatory Irregularities
- Menstrual Cycle
- Past Pelvic Surgery
- Presence of Pelvic Pain
- Difficulties With Intercourse
- Any Symptoms Suggestive Of Other Medical Conditions
All conditions will be noted during the review with the Fertility Specialist. Very often, if the woman has irregular menstrual cycles, the problem is likely to be related to ovulation.
As for the male partner, any past history of surgery to his genital area such as hernia or undescended testis is obtained. History of heavy smoking or drinking is also significant.
If the couple has previously sought fertility treatment elsewhere, it is important to review the records of previous treatments and investigations so that unnecessary procedures can be avoided.
Studies have shown that even women who ovulate regularly, can experience fertility problems when their BMI is in the underweight, overweight or obese category. Some overweight women have male features such as excessive facial hair, acne and are likely to have a condition called Polycystic Ovarian Syndrome (PCOS).
A full physical examination and specifically, an internal pelvic examination are performed to identify physical problems causing infertility, such as a large fibroid and a fixed position womb suggestive of scarring of the tubes. Sometimes tender nodules can be felt which could point to the presence of endometriosis.
It is rarely necessary to examine the man, unless the semen analysis is extremely abnormal. Examination concentrates on detecting small volume testicles or a condition called varicocele, where dilated testicular blood vessels lead to overheating of the testicles.
Semen Analysis is an essential part of fertility testing. The male partner produces a semen sample through self-mastrubation in our comfortable and secluded Private Room.
The semen is then analysed shortly under miscroscope for abnormalities in sperm concentration, motility (movement) and morphology (appearance).
• Pelvic Ultrasound Scan
For further confirmation of the woman’s reproductive health, an assessment of your uterus, ovaries and fallopian tubes by ultrasound scan is performed. This is not meant to be diagnostic, however, if abnormalities are noted, further diagnostic testing will be required. Ultrasound assessment of the pelvic organs is the cornerstone of fertility investigations.
A properly conducted transvaginal ultrasound will identify most causes of infertility in females. The shape and size of the womb, as well as the regularity of the cavity of the womb is important. Sometimes the Fertility Specialist may instil some fluid into the uterine cavity to have a better view. The appearance of the ovaries, as well the number of potential eggs that are available (antral follicle count) gives the Fertility Specialist an idea of the woman’s egg reserve.
Occasionally the woman maybe advised to undergo an x-ray examination (HSG) to assess the patency of the Fallopian tubes. However, HSG is uncomfortable and is associated with radiation risk. SonoHSG, is a simpler outpatient examination which involves instillation of a special solution to outline the womb cavity and fallopian tubes and is an important investigative tool performed at Sunfert.
Laboratory Blood Tests
A blood hormonal profile is usually for women with irregular menstrual cycles. A full hormonal profile which includes Follicular Stimulation Hormone (FSH), Luteinising Hormone (LH), Prolactin, Oestradiol levels are performed. For women with regular menstrual cycles, it is not necessary as it does not offer any additional advantage.
For couples with recurrent pregnancy losses or IVF failures, it may be necessary to run a battery of tests, which includes a screening of the couples’ chromosome make-up (karyotyping) and immune system (antiphospholipid syndrome screen).
For women aged more than 38 or are suspected to have low ovarian reserves, a blood test called Anti Mullerian Hormone (AMH) is performed. This is the most accurate test available at the moment to assess a woman’s ovarian reserve and is used to predicate her response to medications and the type of stimulation protocol needed for IVF.