Fertility assessment for couple

When a couple has been unable to achieve pregnancy after one year in less than 35 years of age and after 6 months in more than 35 years of age, both partners need to go through a comprehensive physical and medical assessment. It affects approximately 15% of couples of reproductive age. About 15% of cases of infertility are due to male factor.  About 40% of cases of infertility are due to female factor. About 30% of cases of infertility are due to problems in both the man and the woman. About 15% of cases are due to unexplained causes.

Female fertility testing

Healthy females are fertile from puberty until the menopause, although fertility is typically much reduced towards the extremes of this period. For a female to be fertile, the ovaries must release healthy eggs regularly, and her reproductive tract must allow the eggs and sperm to pass into her fallopian tubes to become fertilized by a sperm. Specific fertility tests may include:

1. Ovarian reserve test – There is age related decline in female fertility which starts at 30 years of age and virtually zero at mid 40s.This is due to decrease in oocyte quantity and quality which affects the response to ovarian stimulation and chance of pregnancy. Various blood tests are performed to measure hormonal levels to determine ovarian reserve.
2. Pelvic ultrasound – This shows status of uterus, endometrium and ovaries and identifies the pathology.
3. Hysterosalpingography/Sonosalpingography - This test evaluates the condition of fallopian tubes and uterus. Blockage or problems often can be located and may be corrected with surgery.
4. Endoscopic procedures – This includes laparoscopy and hysteroscopy. Laparoscopy is the procedure in which telescope is inserted into abdomen through belly button by very small cut and exact condition of uterus; tubes and surrounding structures can be made out. In hysteroscopy uterine cavity is inspected by endoscopy with access through vaginal route and intrauterine pathologies can be identified.
5. Endometrial Biopsy – Uterine tissue is taken to rule tuberculosis of genital tract as tuberculosis is very common in India for affecting female fertility by causing damage to fallopian tubes and uterus.

Male fertility tests - Males who have gone through puberty should be fertile throughout life. For a male to be fertile, the testis must produce enough healthy sperms, and the sperm must be ejaculated effectively into the woman's vagina. Various fertility tests may include:

1. General physical examination - This includes examination of genitals and questions concerning medical history, illnesses and disabilities, medications, and sexual habits. The physical exam should ideally be performed by a urologist.
2. Semen analysis - This is a very important test for the male partner. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating semen into a clean container. A laboratory analyzes the semen specimen for sperm count, sperm motility, pH, sperm morphology, volume, fructose content, and acrosome activity.
3. Hormone testing - A blood test is performed to determine the level of testosterone and other male hormones.
4. Transrectal and scrotal ultrasound - Ultrasound can help to determine the evidence of conditions such as retrograde ejaculation and ejaculatory duct obstruction.

In summary, as we know, in modern era, everybody is having busy lifestyle, working in stressful atmosphere, becoming over ambitious, doing marriage in advanced ages, planning late for baby, consuming alcohol/smoking. All these factors affect the fertility of female and male. Though infertility is common in today’s world, it is preventable and easily curable by an expert at an early age.