INDORE

Female Fertility Test

Female Fertility Test in Yaami Fertility and IVF Indore

Tubal Patency Test

  • Tubal disease can account for 25-35 % of female factor infertility.
  • Tubal patency test is done to check if fallopian tubes are open.
  • It can be done if couple have fair chance of pregnancy by natural sexual intercourse or by intra uterine insemination ( IUI )
  • Basic procedure in all types of tubal patency test involves pushing a liquid into0 uterocervical canal & checking if it is coming out through fallopian tubes into peritoneal cavity.

What are various methods of tubal patency test ?

There are 3 main type of tubal patency tests-

  • Hystero -salpingography(HSG): A radio opaque dye is pushed into uterine cavity & its flow is visualized using X ray.
  • Sono -Salpingography (SSG): Here pre medicated normal saline is pushed into uterine cavity & its flow is visualized using ultrasonography.
  • Laparoscopy with chromopertubation: It is done under general anaesthesia. A liquid dye is pushed into uterine cavity & its flow is directly seen by doing laparoscopy.

The advantage laparoscopy of is that any corrective surgery can be done during same procedure.

When we should consider tubal patency test ?

  • History of tubal ectopic pregnancy
  • History of pelvic infections or pelvic inflammatory disease.
  • History of pelvic or lower abdominal surgery.
  • Endometriosis

What are the chances of pregnancy after tubal patency test ?

Pregnancy chances depend upon various complex factors like

  • Age of woman
  • Ovarian reserve
  • Duration of infertility
  • Whether block is in proximal (uterine end) or distal (ovarian end) part of tube
  • The quality of sperm
  • Experience of surgeon if any corrective surgery is planned.

Endometrial Receptive Array

What is ERA ?

-ERA is an abbreviation for Endometrial ReceptivityArray or Analysis.

-This is specialised  genetic test carried out on a tiny portion of the woman’s uterine  lining to determine  the most appropriate day to transfer embryo during an IVF cycle.

Who can benefit from ERA?

Endometrial Receptivity Array test is done in couple with repeated implantation failure.

How is ERA test done?

  • Endometrial biopsy for ERA test can be done in natural ovulation cycle or after giving hormonal treatment.
  • After endometrial biopsy the genetic material is extracted from the endometrial tissue.
  • The extracted genetic material (RNA ) is tested for 236 genes which are normally expressed during implantation window.
  • The result of ERA is reported as pre receptive or non-receptive
  • ERA test may be repeated in some cases when report is pre or post receptive.
  • This guides us to decide the most suitable day for embryo transfer.

Is there any limitation of ERA test?

  • A normal ERA test (receptive) does not guarantee delivery of a healthy baby.
  • Pregnancy may fail to start & continue if there is embryo abnormality.
  • ERA checks the receptivity of endometrium during physiological implantation window.
  • Similarly ERA cannot tell us about condition of uterus to carry pregnancy till healthy delivery.

Decreased Ovarian Reserve

Ovarian reserve is the number as well as quality of the remaining eggs in both ovaries at a given age.

Egg quality directly affects embryo development & the ‘take home baby ‘rate.

Ovarian Reserve Test ( ORT ) helps to determine the chances of natural conception as well as with treatment.

It is very important to identify women with low ovarian reserve so that they can take important decisions regarding their own fertility in a timely manner.

 

Following are the risk factors for Decreased ovarian reserve :

  • Family history of early menopause
  • Ovarian surgery especially for endometrioma.
  • Surgical removal of part of ovary (for cystectomy) or removal of one whole ovary (Oophorectomy )
  • Cancer survivors after pelvic surgery , chemotherapy or radiotherapy
  • Smoking
  • Ovarian inflammation -endometriosis & pelvic infection etc.
  • Unexplained infertility
  • Poor response in previous IVF cycle
  • Known case of certain genetic conditions like Turner syndrome & mutation carriers like Fragile X /FMR1 /BRCA -1

 

Ovarian reserve should be tested in following conditions also :

  • Planning fertility preservation
  • Candidate for IVF
  • Planning to delay pregnancy for personal reasons

 

Ovarian reserve can be determined with Ovarian Reserve Test ( ORT ):

  • USG for Antral Follicle Count (AFC scan) – Good for number of eggs.
  • Blood test for determination of Anti Mullerian Hormone ( AMH ) – Good for number of eggs & quality to some extent.
  • Blood test to assess function of ‘Hypothalamic -Pituitary -Ovarian axis’ – Follicle Stimulating Hormone (FSH,) Luteinising Hormone (LH) & Estradiol.

 

Caution while interpreting result of ORT :

  • None of above test can predict the chance of pregnancy with 100 % accuracy.
  • Most important factor determining chance of conception is quality of oocyte which cannot be assessed precisely with any available test.
  • A woman with good ovarian reserve may face difficulty in having a healthy baby due to issues in sperm quality or implantation issues.
  • Woman with low AMH & AFC also can conceive with individualised treatment protocol.
  • Women with low ovarian reserve should consult a fertility specialist to discuss their treatment choices.

Ultrasonography

Ultrasound imaging makes use of ultrasound waves to visualise internal organ of body.

 

Baseline Pelvic USG

1st visit USG is done in detail to assess following conditions which may affect fertility :

  • Ovarian reserve
  • PCOD
  • Endometrioma in ovary
  • Stage 3-4 endometriosis
  • Any ovarian cysts
  • Fibroid
  • Adenomyosis
  • Polyp
  • Endometrial thickness
  • Any abnormality in shape or size of uterus
  • Hydrosalpinx
  • Health of your pregnancy.

 

Antral Follicle Count Scan (AFC scan)

Ovarian reserve is checked by doing Antral Follicle Count ( AFC) during initial visit itself.

Antral Follicles are tiny 2-10 mm follicle, each containing 1 egg.

Follicular Monitoring Scan

Growth of the follicle, uterus lining thickness & ovulation timing are checked by doing follicular monitoring USG.

Oocyte retrieval & Embryo transfer

Retrieval of oocytes ( eggs ) from ovaries & transfer of embryos into the uterus are done under ultrasound guidance.

USG guided ovarian cyst aspiration

Cyst aspiration can be done as day care procedure to drain ovarian cysts.

We offer following USG services using 2D & 3 D technique.

Use of ultrasound in men

For men ultrasound is done in few select cases to assess following conditions:

  • Varicocele
  • Penile blood flow assessment ie, penile doppler cases of erectile dysfunction
  • Accessory male glands in few cases if there is low sperm count or suspected infection
  • Volume of testis in men with very low or nil sperm count.
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