CREDENCE HOSPITAL Trivandrum, Kerala
   
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Diagnosing Infertility
 
  Ultrasound scanning (USS) and Doppler scan
An Ultrasound scan can give basic diagnostic information of the female anatomical problems and with a transvaginal scan we can know whether apart from anatomical remarkability there is ovulation,size of ovulation and also the time of ovulation. A color Doppler scan can give much more detailed and indepth information than the regular USS. The resolution and quality of a doppler scan machine can prove crucial in follicular studies and the treatment schedule for an Assisted Reproduction program.

Endometrial biopsy and Post Coital test (PCT)
Endometrial biopsy is to done to see whether the woman has a healthy endometrium, favourable for a pregnancy. Implantation of the embryo depends on the quality and thickness of the endometrial lining.
Conditions like Luteal Phase Defect (LPD), which is due to progesterone deficiency, can lead to early miscarriage.
The Post Coital Test (PCT) is used to determine whether you are producing good quality mucus at the time of ovulation and whether your husband's sperm can live normally in this mucus. In cases such as the wife having anti-sperm antibodies (ASA), a PCT will be negative. Which means healthy and actively motile sperms will not be found in sufficient numbers in the cervical mucus sample.

Hormone Assays and Blood tests
A hormone study of the patient is crucial to diagnose the cause as well as to the treatment of infertility. Cases such as polycystic ovarian disease (PCOD),prolactinomas and other diseases due to hormonal imbalance can be detected easily. During an IVF or ICSI program, regular hormonal assays are done to see the body's response and to decide on further treatment. Hormones routinely evaluated include Estradiol, Progesterone, LH, FSH, Thyroid hormones ( T3, T4, TSH) and Prolactin.
Blood tests will include routine hematological examination as well as tests to rule out diseases such as HIV, Hepatitis B and C, VDRL, immunological disease screening tests and other tests.

Hysterosalpingograms (HSG)
A Hysterosalpingogram (HSG) can give information about the tubal patency and is a very important diagnostic tool. It is a procedure that can detect abnormalities such as scar tissue, polyps and fibroids in the uterine cavity and congenital defects of the uterus. The HSG is performed right after menstruation stops but before ovulation. A small catheter is placed in the cervix and a dye visible to X-ray is injected into the uterus. As the dye fills the uterus, fallopian tubes and pelvic cavity, X-rays are taken, allowing us to see the shape of these organs. If the tubes are damaged or closed, the dye will not travel into them or spill out through the fimbrial end. If an HSG indicates an abnormality, a laparoscopy with a chromotubation may be necessary to confirm it. If the tubes do not fill, a proximal tubal cannulation may be attempted.

Semen Analysis (SA)
The male factor can be easily detected by a series of Semen Analyses. The semen is evaluated mainly for volume, pH, number of sperm, motility and shape. However, a normal looking sperm sample does not necessarily rule out other abnormalities. Together with a Fructose test, cases of obstructive and non-obstructive male factors can be diagnosed. While obstructive factors can be corrected by surgical procedures, other severe factors may require direct aspiration of sperm from the testes,epidydimis, vas or sperm retrieval from a testicular biopsy together with an ICSI program. Worst cases may require Donor programmes.

Hysteroscopy
Hysteroscopy provides a very definitive diagnosis of intra uterine anomalies. This involves using the hysteroscope, a long narrow lighted television camera, to view the inside of the uterine cavity and cervical canal. Any fibroid, septae or band may be diagnosed and attempted to be corrected immediately.

Laparoscopy
In most cases of infertility, a diagnostic laparoscopy is required to rule out anatomical problems, endometriosis and other subtle causes; and also to make a definitive statement of the female factor. Laparoscopy is a common surgical procedure that allows us to directly view the uterus, tubes and ovaries. It is a relatively minor operation, usually performed under general anesthesia in a day surgery unit. A small incision is made below the navel and a laparoscope, a long narrow lighted television camera, is inserted into the abdominal cavity. The doctor can then see if any significant adhesions, scar tissue, endometriosis or fibroids affecting fertility exists. However, laparoscopy may miss microscopic tubal damage. Chromotubation is also be done along with a diagnostic laparoscopy routinely. Other problems including poly cystic ovaries and other ovarian cysts may be required to be corrected via the laparoscope before attempting an IVF program.
 
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