If you are having difficulty conceiving after one year of unprotected sex, without the use of any contraceptives, then your doctor may conduct various fertility tests to identify the possible causes of infertility, both in the male and female partner. Based on these findings, appropriate fertility treatments or procedures may be considered. Before conducting any tests to identify specific aspects of infertility, it is important to exclude the presence of other diseases or medical conditions. If the body is not in a healthy state, there is a good chance that reproductive health will be affected.
Your doctor may decided to test for different sexually transmitted diseases (STD’s), like syphilis, chlamydia, hepatitis B as well as HIV, thyroid tests to identify hypothyroidism, autoimmune testing for conditions like SLE (lupus) and blood grouping. Other tests like a full blood count and insulin testing may also be conducted. If these tests do not reveal any abnormalities or infection, then individual testing for reproductive health will be considered. It is important to note that the above tests would only be requested based on your medical history and other clinical findings.
Fertility Tests for Men and Women
Men will have to undergo a semen analysis where a semen sample is taken and then sperm are observed with a microscope. The size, shape, motility (movement) and sperm count is recorded and any abnormalities will be reported. Hormone testing to monitor the level of testosterone may also need to be done.
Women having a difficulty falling pregnant will have to undergo tests to identify the following :
- Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
These hormones play a role on different aspects of the menstrual cycle, egg formation and release (ovulation). These tests are collectively called a female hormone screen or fertility screen and may be done on different days of the menstrual cycle. After the blood tests, your doctor may consider one of the following procedures to confirm a diagnosis or exclude other contributing factors that may be causing infertility. These procedures may include :
- Pelvic ultrasound and other imaging techniques like a CT scan or x-ray.
- Biopsy of the endometrium, which is the lining of the uterus.
Fertility Treatment Options and Procedures
After careful assessment and based on the results of the fertility tests, your doctor may present a host of fertility treatment options. It is important to bear in mind that these treatment options will vary among individuals and couples based on the doctor’s diagnosis and assessment. A procedure that may have worked for one person or couple, may not necessarily be an option for another.
The most common treatment options include :
- Hormone treatments, either injections or oral medication, for the male or female partner. This may include hormones to improve sperm or egg quality or stimulate egg release from the ovaries (ovulation). Clomiphene or clomifene (brand name Clomid) may be administered to women to stimulate the ovaries. This is one of the most widely used fertility drugs globally.
- Sexual problems in males, like erectile dysfunction, may have to be treated. Insulin resistance in females, which affects fertility, may have to be treated using drugs like metformin.
Your doctor may also decide upon certain fertility procedures to correct conditions that may be affecting conception. Fallopian tube blockage or adhesions may require laprascopic surgery to remove any blockage. Large cysts in polycystic ovarian syndrome (PCOS) may also require surgery. After correcting these disorders, the couple is encouraged to continue trying to conceive naturally or with the use of fertility drugs. Failure to conceive may require further procedures, known as assisted reproductive technology (ART).
- Artificial insemination is when sperm from the male partner is introduced to the egg. Donor sperm may be necessary if the quality of sperm from the male partner is poor.
- In-vitro fertilisation (IVF) is the fertilisation of eggs in a laboratory. The fertilised eggs are then implanted into the uterus.
The two procedures above are common when assisted reproductive technology is required. However there are other options, should the above procedures not be feasible or fail.
ZIFT or zygote intrafallopian transfer is the transfer of the fertilized egg into the fallopian tube. GIFT or gamete intrafallopian transfer is the implantation or the eggs and sperm into the fallopian tube. The GIFT procedure allows for natural fertilization and is widely used in South Africa by fertility specialists. If none of the options can be considered, then donor eggs may be used or surrogacy may have to be considered.
It is important to consult with a specialist like a gynaecologist (females) or urologist (males) for fertility problems. There are a number of fertility specialists throughout the country, who have years of experience and the relevant training in infertility and these specialists may be a better option should you not experience any success in conceiving.