INFERTILITY | Diagnostic Methods in Infertility Konusu

Diagnostic Methods in Infertility

Female Infertility

Hormone Tests: On the 3rd day of the period, reproductive hormones such as FSH, LH, E2, PRL, TSH, Testosterone, DHEA-S are requested. Further testing for the determination of the ovarian reserve, if necessary, may also require the determination of Inhibin and AMH (Anti-Müllerian Hormone) concentrations.

Ultrasonography: Ultrasonographic examination is performed on the 2nd or 3rd day of menstruation for the evaluation of the ovarian reserve, ovarian pathologies and the uterus.

Sonohysterography: A process done to detect adhesions in the uterus (polyps, uterine fibroids, curtains in the uterus, etc.). It is evaluated in ultrasonography by giving a serum with the help of a thin catheter.

Hysterosalpingography (HSG) (X-ray of Uterus andTubes): The uterus and tubes are visualized by spraying a contrast material through the cervix and the films are shot in succession. Cervical insufficiency, space-occupying formations in the uterus, adhesions, congenital structural defects, and especially whether the tubes are open can be determined.

Hysteroscopy: The uterine cavity is observed with an illuminated camera and the problems of the uterus are detected and treated in the same session.

Laparoscopy: It is the process of examining the organs in the abdomen with a light camera by entering through a small incision in the navel under general anesthesia. It allows diagnosis and treatment in the same session. In cases where clear information cannot be obtained by other diagnostic methods, laparoscopy is used for diagnosis and treatment of intra-abdominal adhesions, endometriosis (when the cells lining the uterus grow outside the uterus), inflammatory conditions of the tubes, ovarian cysts, pain in infertility and infertility cases.

Male Infertility

Semen Analysis (Spermiogram): The most important test for male infertility. Since the production of sperm is affected by many factors such as cigarettes, alcohol, heat, drugs and infections, the analysis of abnormal samples should be repeated at least twice a month. If a fertility problem is detected in the sperm analysis, a further examination of the physical and hormonal aspects of the man is started. The sperm production cycle is repeated every 2-3 months so, the sperm produced will be secreted into the semen after 2-3 months. Likewise, harmful factors (severe fever diseases, stress, fatigue, environmental factors) or useful drugs used for treatment may affect the sperm properties after 3 months. This should be kept in mind when evaluating the results of semen analysis. If a drug is not used and no fever is experienced, it is necessary to evaluate at least two sperm samples with an interval of 3-4 weeks and decide on the average of these samples. Preferably, the sample to be examined should be given in a location close to the laboratory.

When is semen analysis done? This test should be performed after an unrelated period, i.e. 3-5 days of sexual abstinence. The sperm concentration was found to be low in the samples taken in less than 2 days. The samples given after 7 days of sexual abstinence are not preferred because of decreased sperm motility. Semen samples to be examined should not be exposed to ambient temperatures below 20 ° C and above 40 ° C. Cold and hot shock causes serious changes in sperm motility.

How is the sample collection done? Sample collection should be done by masturbation method; condoms, soap and cream should not be used, sterile containers should be preferred. Since the first part of the given semen sample contains more sperm cells; If the first part flows out or is lost during sperm delivery, this should be reported to the laboratory staff.

Spermiogram; It gives information about the volume of semen (volume of the sperm), color, pH, liquefaction time (melting time), viscosity, number of sperm, mobility rate and morphology (shape).

Volume: Volume should be> 1.5 ml.

Color: Normally, the semen is opaque and greyish in color, with long-term sexual abstinence it’s yellow, red-brown in the presence of erythrocytes (semen) in semen and after the long-term use of antibiotics it can be seen colorless.

pH: Normal semen pH is between 7.2-8. Conditions above pH 8 indicate acute infection or late measurement. In patients with azoospermia where pH is below 6.5; obstruction of drainage channels, non-development of accessory glands, chronic infections and urine having been mixed with semen should be considered.

Liquefaction (Solubility of semen): a failure such as the prolongation of the liquefaction period; it indicates that the viscosity of the semen is increased, which is undesirable; it may be due to a change in the functions of the prostate gland or infection.

Viscosity: Normally the semen is slightly viscous. In chronic infections such as prostatitis, vesiculitis, viscosity may be increased.

Normal values in the spermiogram according to World Health Organization (WHO) criteria:

Volume: > 1.5 ml

Sperm concentration: 15 million / ml and above. Higher values do not necessarily indicate the occurrence of pregnancy. For example, while pregnancy may occur with the spouses of men with a sperm concentration of 10 million / ml, the spouses of men with a sperm concentration of 80 million / ml may not become pregnant.

Sperm mobility (motility): 32% or more (Grade A + B)

Classification according to movement types:

A grade (+4) = fast movement forward (normal movement)

B degree (+3) = slow, nonlinear motion

C degree (+2) = in-situ motion

D degree (+1) = immobile

Sperm motion is associated with the anatomical and functional strength of the middle and tail. Infections, queuing abnormalities, varicocele, alcohol, anti-sperm antibodies, immotile cilia syndrome can cause sperm movement disorder.

Sperm structure (morphology): 4% and above should be normal structure (Kruger criteria). There are several different criteria in sperm evaluation. 'Kruger criteria' is a microscopic evaluation method that takes into account the deformities in the sperm. After special staining, sperm shape (morphology) characteristics are examined and fertilization capacity of sperm sample is determined. The sperm cell with a length of 0.05 mm consists of three parts: head, neck and tail. The head contains genetic material, the neck provides the energy necessary for the sperm movement, while the tail part provides the sperm movement.

Azoospermia: No sperm in semen

Oligospermia: Low sperm count

Asthenospermia: Decrease in mobility rate

Teratospermia: Figure (structure, morphology) disorder

Testis Doppler Sonography: It is an important examination method in determining the presence of varicose in varicose veins which, if present, means the presence of varicocele and according to the result, whether surgery is required. It’s applied by radiologists.