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Infertility

Infertility

The process of diagnosing infertility begins by talking to a woman. Anamnesis of a woman (a case history established by interviewing a woman) with infertility problems, among others, includes the following:

  • Time of first period (menarche), the length of the cycle, duration of menstrual flow, average blood loss, painfulness, irregular bleeding (intermenstrual, spotting, postcoital)
  • Number and outcome of previous pregnancies in current or previous relationship(s). The outcome of a pregnancy can be a delivery, a spontaneous (miscarriage) or induced abortion, an ectopic pregnancy or a molar pregnancy
  • Previous contraceptive methods. Birth control methods fall into natural methods, barrier methods, hormonal or postcoital contraception, intrauterine device (IUD), sterilization
  • Previous testing and/or treatment(s) of infertility. Couple´s education – issues of fertility calculation, frequency of intercourse, frequency of intercourse during ovulating periods, amount of attempts. Dyspareunia (painful sexual intercourse)
  • Conditions potentially impairing fertility: diabetes, thyroid disorders, tuberculosis, etc.
  • Potential malignant diseases or diseases that required hospitalization or medical treatment
  • Previous abdominal surgeries
  • Inflammatory diseases, particularly of a pelvic region. STDs.
  • Galactorrhea (discharge of milk-like substance from the breast not associated with pregnancy or breastfeeding)
  • Exposure to toxins in working or living environment
  • Alcohol or drug abuse

If infertility of a couple is suspected, the basic analysis will be performed:

  • Gynecological exam
  • Pap test
  • Transvaginal ultrasound
  • Cervical smears for aerobic and anaerobic cultures, Chlamydia, Mycoplasma, Ureaplasma
  • Basic hormonal status – FSH (follicle-stimulating hormone), LH (luteinizing hormone), E2 (estradiol), PRL (prolactin), TSH (thyroid stimulating hormone) on day 2-5 of the cycle
  • Semen analysis and microbiological examination of the ejaculate
  • Testing of tubal patency
  • Blood tests:
    •  Blood Type, Rh factor
    •  HBsAg (Hepatitis Bs Antigen), anti-HBs + Anti HBc total
    •  HCVAg (Hepatitis C), anti-HCV
    •  anti-treponemal screen
    •  HIV-1/-2 Antibody Evaluation

Using the above tests and detailed case studying some of the following diagnoses can be established:

  • Infection
  • Sexual dysfunction
  • Hyperprolactinemia
  • Hypothalamus and hypophysis (pituitary gland) disorders
  • Irregular periods due to high levels of FSH – premature menopause
  • Absence of ovulation
  • Anomalies of female reproduction organs
  • Fallopian tube blockage
  • Adhesions in the pelvic region
  • Endometriosis
  • Other conditions – diabetes, thyroid disorders, hepatitis, AIDS
  • Male factor