Home » Pathology » Investigations of Female Infertility

Investigations of Female Infertility

Investigations of female infertility include:

Initial Evaluation

The initial evaluation of a case of female infertility must include:
•    Exclusion of male infertility.
•    Detailed History including:

  • Menstrual history (amenorrhea, oligomenorrhea, menorrhagia, menstrual irregularity)
  • sexual history (coital frequency, impotence, dyspareunia)
  • medical history (use of oral contraceptives, cytotoxic chemotherapy, radiotherapy)
  • family history (congenital anomalies of reproductive organs)
  • H/O galactorrhea
  • H/O weight loss
  • H/O hirsutism
  • H/O hot flashes
  • H/O severe psychological stress

Detailed Examination 

Look for:

  • Signs of hypo or hyperthyroidism to exclude any thyroid disease
  • Obesity to have an idea about hormonal imbalance
  • Hirsutism to rule out polycystic ovarian syndrome
  • Examination of genitelia to look for clitromegaly and virilization

•    Vaginal and Cervical Pap Smears (with appropriate cervical and endocervical cultures)
•    Postcoital Test (if positive) gives a quick opinion of:

  • Coital sufficiency
  • Probable ovulation
  • Nonhostile cervical mucus
  • Normal male fertility test

•    Evaluation of ovulation by using following measures:

  • Charting of basal body temperature
  • Determination of midcycle LH surge by using urine dipstick method (LH appears in urine just after serum LH surge,24-36hrs before ovulation)
  • Ultrasound documentation to look for follicle development and ovulation.

•    Luteal phase assessment by doing:

  • Estimation of Serum Progesterone levels (midluteal progesterone levels >10 ng/ml indicate normal ovulation while progesterone levels <10 ng/ml suggest: anovulation, inadequate luteal phase progesterone production or inappropriate timing of sample collection).
  • Endometrial Biopsy to look for luteal phase defect by histological examination of biopsy specimen.

Endocrinal Evaluation

•    Serum FSH Estimation (increased serum FSH levels=decreased chances of successful pregnancies)
•    Serum LH Estimation (raised serum levels of both LH & FSH=Ovarian Failure while normal FSH but raised LH=Polycystic Ovaries)
•    Serum Prolactin Estimation: It is an important cause of infertility in both males and females. Other common causes of Hyperprolactinemia should be excluded including Pregnancy, Lactation, Drug-Induced, Primary Hypothyroidism, and Renal Insufficiency.
•    Serum Estrogen and Progesterone Estimation
•    Serum Cortisol Estimation (to exclude hypercortisolaemia)
•    Serum TSH, Total or T3 and Free or T4 Estimation (to exclude any thyroid disease)

Other Tests

•    Hysterosalpingography to rule out:

  • Congenital uterine abnormality
  • Intrauterine adhesions
  • Submucous fibroid
  • Intrauterine polyps
  • Tubal tuberculosis
  • Tubal block

•    Laparoscopy is done when semen analysis, ovulation indicators, postcoital test and hysterosalpingogram are all normal.
Appropriate surgical procedures can also be done during laparoscopy e.g. tuboplasty.

Check Also

Aging process

Cellular Aging

Cellular death due to aging is caused by accumulation of injurious events and genetically controlled …

Leave a Reply

Your email address will not be published. Required fields are marked *