Investigations of female infertility include:
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
- 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.
• 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)
• 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.