Polycystic Ovary Syndrome (PCOS)
Overview
The infertility evaluation is individually catered for each patient and begins with a detailed history and physical examination in an effort to focus on the responsible factor(s). The leading causes of infertility that will be evaluated include ovulatory dysfunction, hormonal irregularities, egg quality, tubal pathology, uterine factors, and male factors.
Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is one of the leading causes of irregular ovulation and infertility. If PCOS is suspected the physician may take a medical history, perform a physical exam, check blood levels for male hormones, cholesterol, and blood sugar levels, and perform a transvaginal ultrasound.
Ovulatory Dysfunction Testing
When menstrual history alone is not sufficient to establish a diagnosis of ovulatory dysfunction serum progesterone concentration, urinary LH excretion, and endometrial biopsies are common methods to evaluate ovulation.
Endometriosis
Endometriosis is a condition that can cause mild to severe pain during the menstrual period, “dysmenorrhea”, and may lead to infertility. Endometriosis is a condition in which endometrial tissue grows in areas other than the uterus, some of which can be visualized by transvaginal ultrasound. The severity of the disease can be confirmed by looking inside the body during a laparoscopy. There are no tests available to accurately determine whether a person has endometriosis. Diagnosis can only be made surgically, although sometimes clinical or ultrasound signs and symptoms can be quite helpful in suggesting the presence of endometriosis.
Uterine/Tubal Evaluation
Transvaginal ultrasound examinations allow the physician to check the endometrial lining, measure the length and diameter of the uterus, and check for many ovarian or uterine abnormalities, but is not a very good test to evaluate the inside of the uterine cavity. An “intra-uterine” evaluation is essential to every fertility evaluation.
A hysterosalpingogram (HSG) allows the physician to check for blockage or damage to the fallopian tubes or growths inside the cavity of the uterus. During this test, an iodine based contrast fluid is injected into the uterine cavity and tubes, and X-ray pictures are taken over the abdomen. Pictures are taken of the dye filling the cavity and tubes. It is an excellent exam to determine the caliber of the fallopian tubes and their patency, however it only does a fair job of evaluating the inside of the uterine cavity.
Saline infusion sonohysterography (SIS) effectively reveals the presence of intra-uterine abnormalities. SIS is an ultrasound procedure performed to assess the direction of the neck of the endocervical canal, and ensure that there are no uterine polyps or fibroids or abnormalities of the shape of the uterine cavity. Hysteroscopic surgery is the gold standard in evaluating the uterine cavity, where a small camera is placed across the vagina into the cervix and the cavity of the uterus is directly visualized.
Semen Analysis
A semen analysis measures the amount of semen a man produces and determines the number and quality of sperm in the semen sample. The semen analysis clinical report may include volume, concentration, motility, grade of activity, forward progression, liquefaction time, viscosity, presence of WBC’s, or white blood cells, semen fructose, and sperm morphologies.