Primary diagnosis of infertility: examination for infertility in women, men and what tests need to be taken. How is infertility determined in women?

Tests for female infertility

Tests for female infertility

To identify the causes of infertility in women, reproductive specialists prescribe laboratory tests.

Some studies are mandatory for all groups of patients (clinical and biochemical tests of blood and urine, analysis of the blood coagulation system, hormonal studies, analysis for infections).

Additional studies may also be prescribed, which include genetic blood tests, histological studies of the endometrium, tumor markers, and additional hormonal studies.

Patients often ask whether there is any special test for infertility in women? One test does not make a diagnosis of infertility. The examination is always comprehensive.

In addition to tests for the most common causes of infertility, an examination using ultrasound and instrumental methods (echohysteroscopy, hysteroscopy, laparoscopy) is required. The purpose of the examination: to identify the cause of infertility to determine treatment tactics.

Hormone tests in women

When determining the causes of infertility in women, reproductive doctors prescribe hormone tests that reflect the reproductive function of the female body.

The list of hormone tests necessary to make a diagnosis is determined by a fertility specialist individually, based on the clinical situation.

1) Sex hormones

When the production of follicle-stimulating hormone (FSH) by the pituitary gland decreases, the entire functioning of the ovaries is disrupted: they do not produce eggs and ovarian hormones - estrogens and progesterone. When FSH levels are low, the menstrual cycle is disrupted.

Luteinizing hormone (LH) is produced by the pituitary gland and influences the production of progesterone in the ovaries. A high rate indicates the presence of endometriosis, polycystic disease or ovarian failure.

If there are deviations in prolactin levels, follicle growth and the ovulation process are disrupted.

The male sex hormone, testosterone, is also present in the female body. In excess it leads to disruption of ovulation and can lead to miscarriage.

Normal progesterone levels affect the growth and development of the endometrium in the uterus. This is necessary for successful implantation of the embryo into the uterine cavity and the development of pregnancy. An increase in the level of this hormone can signal ovarian diseases (for example, ovarian cysts); if it decreases, ovulation does not occur in women.

Elevated numbers of 17-OP indicate the presence of adrenogenital syndrome. Against this background, the hormone testosterone increases and ovulation does not occur.

AMH (anti-Mullerian hormone) reflects ovarian reserve ovaries. Low levels indicate ovarian depletion. The lower the AMH, the lower the likelihood of pregnancy.

Estradiol (estrogen) affects the menstrual cycle, egg maturation. It also affects the growth of the endometrium and prepares the uterine mucosa for embryo implantation.

Blood for sex hormones must be donated strictly on an empty stomach and on a certain day of the menstrual cycle.

On days 2-3 of the menstrual cycle - FSH, LH, prolactin, AMH.

On days 8-10 of the menstrual cycle - testosterone, 17-OP.

On days 19-21 of the cycle - estradiol, progesterone.

2) Thyroid hormones

Changes in normal thyroid hormone levels in women have a negative effect on ovulation and follicular growth.

On the eve of the test, training and stress should be avoided. It is advisable to take it in the morning, on an empty stomach. An hour before the test, it is advisable to be in a calm state.

3) Hormones of the adrenal cortex

An increase in the level of these hormones leads to disruption of follicular development, delayed ovulation and negatively affects the production of cervical mucus.

On the eve of the test, you need to exclude fatty foods and alcohol from your diet. It is advisable to take it in the morning, on an empty stomach. Do not smoke an hour before the test.

Very often, one of the causes of infertility is sexually transmitted infections. They lead to a chronic inflammatory process, the formation of adhesions, and obstruction of the fallopian tubes.

Untreated or untreated infectious diseases of the reproductive system become chronic, the clinical picture is erased, and the woman may not know that the disease has become latent. However, she may remain a carrier of this infection.

To identify diseases or carriers of infections, examination for sexually transmitted infections is mandatory and is included in the standard examination for infertility or before planning pregnancy.

Tests for infections are carried out using smears from the woman’s genital tract (smears for flora and PCR diagnostics) and venous blood (for the presence of antibodies and antigens in the blood).

VitroClinic specialists adhere to the tactic of prescribing the optimal number of additional tests to clarify the diagnosis. Therefore, tests such as HLA typing and postcoital testing that have lost their relevance are not prescribed.

Biochemical blood tests

These blood tests reflect the functioning of a person’s internal organs, and the slightest deviations can reveal the presence of pathology and provide timely treatment. The mandatory study includes: total protein, albumin, glucose, creatinine, cholesterol, ALT, AST, potassium, sodium, total bilirubin, urea.

If the wife does not become pregnant, despite the fact that the husband regularly has sexual contact with her without using contraceptives for a year, then the man must visit an andrologist to rule out the presence of infertility and undergo the necessary tests.

Preparing for diagnosis

The main test for infertility that a doctor will prescribe for a man is a spermogram. It consists of assessing the volume and viscosity of sperm, the number, motility and structure of sperm (cells involved in fertilization), as well as the number of leukocytes, red blood cells and antibodies in it.

In order for this study to be informative, you need to properly prepare for it:

1. First of all, abstain from sexual intercourse for 3-4 days. This period is necessary for sperm maturation.
2. During your abstinence, avoid visiting a bathhouse, sauna, sports club, do not take a hot bath, and try to get a good night's sleep.
3. Do not drink alcoholic beverages or take medications, stop smoking (or, if this does not work, reduce the number of cigarettes you smoke as much as possible).

These recommendations must be followed, because all of the above adversely affect sperm and spermogram results may be poor, even in the absence of diseases that can cause infertility.

It is important to correctly collect sperm for research:

1. First, urinate. Urine will “cleanse” the urethra.
2. Then wash your hands with soap and obtain sperm by masturbation. If you absolutely do not want to masturbate, ask your spouse to help. You should not use a condom (it contains substances that kill sperm) or oral sex (oral contents will contaminate the sperm).
3. It is very important to collect the first portion of sperm, which contains the most mature and motile sperm. Sperm (or ejaculate, as it is also called) is collected for analysis in a clean, dry container, which can be purchased at any pharmacy.
4. Once received, the sperm must be examined within an hour, so it is best to take it to a laboratory. If this is not possible, then it is necessary to deliver it there as quickly as possible. The container must be kept warm.

Where to perform sperm testing? It is best to do this in the laboratories of family planning centers or specialized clinics that treat infertility. They employ specialists with extensive experience in conducting such research.

Interpretation of test results for infertility in men

After receiving the spermogram results, consult your doctor. He will evaluate whether there are any changes in it. If the results are poor, the doctor will suggest that you donate sperm for analysis again, after 1–2 months. This is necessary to ensure that these sperm changes are persistent and non-random in nature before proceeding with further examination and treatment, which can be time-consuming and expensive.

What changes can there be in the spermogram?

Aspermia

If sperm cannot be obtained, this condition will be called aspermia. Aspermia can occur during retrograde ejaculation, when sperm enters the bladder, so if it is present, urine must be collected for examination immediately after ejaculation.

If the semen volume is less than 2 ml, this is oligospermia. In this case, the reason for the decrease in sperm volume may be problems with the seminal vesicles and prostate gland, since their secretion makes up most of the biological fluid.

Agglutination

The study may reveal agglutination (“gluing”) of sperm. The degree of its severity is assessed as “+” (from one to four). In this case, “+” corresponds to mild, and “++++” to severe agglutination. The more pluses, the worse. The cause of this phenomenon may be inflammation of the accessory sex glands (prostate and seminal vesicles).

It also causes an increased amount of mucus in the sperm, which makes the sperm more viscous and impedes the movement of sperm.

An increased (more than 1 million in 1 ml) number of leukocytes can also suspect the presence of inflammation.

In this case, the man will be examined to identify the source of the appearance of leukocytes in the sperm.

Azoospermia

When examining semen, the number of sperm in it and their motility must be assessed.

If the test shows that there are no sperm in the ejaculate, they speak of azoospermia. It can occur if, for some reason, sperm do not form in the testicles (such infertility is called secretory) or they cannot get from them into the urethra, and from there into the vagina. This is the so-called excretory (or obstructive) infertility.

A condition in which 1 ml of semen contains less than 15 million sperm (or less than 40 million in the entire ejaculate) is called oligozoospermia.

There are three degrees of oligozoospermia:

1. They speak of the first degree if the number of sperm in the ejaculate is less than 39 million, but more than 20 million (or in 1 ml less than 14 million, but more than 10 million).
2. If the ejaculate contains from 19 to 10 million sperm (1 ml contains from 9 to 5 million), then this is the second degree of oligospermia.
3. The third degree of oligospermia includes conditions in which the ejaculate contains less than 10 million sperm (or less than 5 million per ml).

Sperm may move quickly (category A), slowly and sluggishly (category B), hesitate in place (category C), or not move at all (category D). For fertilization, it is important that more than 32% of all sperm present in the sperm belong to category A and B. If there are fewer such sperm, then this will be called asthenozoospermia.

Like oligospermia, asthenozoospermia can also be of three degrees. With the first of them, the number of motile sperm (categories A and B) is 32–20%, with the second - 19–10%, with the third - less than 10%.

Identification of the degrees of oligospermia and asthenospermia is necessary to assess the effectiveness of the treatment, which will be prescribed after completion of the examination and identification of the reasons that led to changes in these sperm parameters.

If the analysis shows that there are no motile sperm in the semen, then they speak of necrozoospermia.

Semen examination also evaluates the number of normal spermatozoa. A normal sperm consists of a head, a neck, an intermediate part and a tail. There may be sperm with the absence of a head or its doubling, its excessively large size, as well as sperm with a double tail or its absence.

Such sperm are incapable of fertilization. An increase in their number of more than 70% is called teratozoospermia.

What else does the andrologist check to identify the causes of infertility?

The reasons for the violation of sperm parameters can be different, and in order to find them out, the doctor must exclude the presence of sexually transmitted infections, as well as examine the organs that are involved in the process of fertilization.

Sperm are produced in the testicles. This process is regulated by hormones (testosterone and follicle-stimulating hormone), so a blood test will be prescribed for these hormones (as well as luteinizing hormone, which regulates the production of testosterone and prolactin to exclude a disease that may interfere with the production of these hormones).

It is important to donate blood to study these hormones in the morning (before 11.00), since in the evening their concentration in the blood drops.

The doctor will definitely examine the testicles in order to assess their size and consistency and rule out the presence of varicose veins of the spermatic cord (varicocele).

With varicocele, the testicles suffer from a lack of oxygen and the accumulation of substances toxic to sperm. Varicose veins of the spermatic cord come in three stages:

1. In the first stage, varicose veins can only be detected by ultrasound.
2. In the second, when performing special tests that lead to an increase in pressure in these veins.
3. In the third stage, dilated veins are detected during a routine examination.

The doctor then examines the man's prostate gland and seminal vesicles. If chronic inflammation in the prostate gland is detected, a drug containing regulatory peptides obtained from the prostate gland of mature bulls, the amino acids glycine and arginine, and zinc can be prescribed.

This drug has an anti-inflammatory effect, improves sperm motility and increases the number of their normal forms, and also reduces the number of antisperm antibodies, reduces DNA fragmentation (the main carrier of genetic information) of sperm. All this can increase the ability of sperm to fertilize. More detailed information about this drug can be found on the website.

The diagnosis of infertility is made after 12 months of unsuccessful attempts to become pregnant while maintaining an active sex life and lack of contraception. According to statistics, 20% of couples face this problem. But this diagnosis is not a death sentence. In most cases, the situation is fixable. It is necessary to identify the cause of infertility as soon as possible and prescribe treatment, which will result in a long-awaited pregnancy and the birth of a child.

Infertility (lat. sterilitas) is the inability of women and men to fertilize.

Infertility can be:

• absolute – the presence of a pathology that excludes the possibility of conception (in women – absence of the uterus, ovaries; in men – absence of sperm, testicles);
• relative - the presence of a cause that can be eliminated.

Also distinguished:

• primary infertility – failure to conceive in a sexually active couple;
• secondary infertility – failure to conceive after pregnancy.

The main causes of infertility include:

• hormonal imbalance;
• infectious diseases;
• abnormal structure of the genital organs;
• genital injuries;
• immunological problems;
• psychological problems.

Methods for diagnosing infertility

Infertility is most often blamed on the woman. But this is a deep misconception. According to studies, 40% of infertility cases are diagnosed in women, 40% in men. The remaining 20% ​​includes combined and unknown causes. Therefore, it is important to diagnose infertility in both women and men. Moreover, it is worth starting the examination with the man, because there are fewer factors influencing male infertility and this diagnosis is simpler.

Diagnosis of infertility in men

Examination of a man for infertility takes place in several stages. First, the main studies are ordered. If after them the doctor still has some questions, then additional ones are prescribed.

The main methods for diagnosing male infertility include the following steps.

1. Consultation with an andrologist or reproductive specialist.

Survey. Past illnesses, pregnancies of other partners, characteristics of sexual life and the degree of influence of negative factors (harmful industries, smoking, alcohol) are clarified.

Inspection. The degree of expression of secondary sexual characteristics is determined, the scrotum is palpated.

1. Laboratory diagnosis of infertility.

Spermogram is a study of ejaculate. Preparation for the analysis is very important and begins a week before the test. Following a diet, avoiding alcohol consumption, visiting the sauna and bathhouse, stress, and no sexual intercourse for two days. If a man has a cold, the test should be postponed until complete recovery. The research procedure takes place in three stages: masturbation (in a specially designated room in a medical institution or at home), sample collection, and analysis. The ejaculate must reach the laboratory within an hour and must be at room temperature during transportation. Based on the results of the spermogram, the volume of ejaculate, the number of sperm, their motility, morphology and several other indicators are assessed. If deviations from the norm are detected, the analysis is repeated 2 more times to exclude errors or the influence of other factors.

Analysis of hormone levels. These are mainly follicle-stimulating hormone (FSH), testosterone, luteinizing hormone (LH) and prolactin. If these hormones are abnormal, we can talk about endocrine disorders.

1. Ultrasound examination (ultrasound).

Ultrasound and Dopplerometry of the scrotal organs. It is used to assess the structure and pathology of the testicles and their appendages.

TRUS (transrectal ultrasound) is performed to assess the condition of the prostate gland and seminal vesicles.

Additional diagnostics of infertility in men includes the following studies:

• genetic tests are prescribed for disorders of sperm maturation and production or their absence;
• analysis for sexually transmitted diseases (STDs) is carried out in case of inflammation combined with an abnormal spermogram;
• prostate secretion excludes or confirms inflammation of the prostate;
• determination of tumor markers is prescribed in case of suspected malignancy;
• an immunological study (MAR test) should reveal the presence or absence of antisperm antibodies;
• testicular biopsy is indicated in the absence of sperm or a serious decrease in their number;
• a study of post-orgasmic urine is carried out in the absence of ejaculation or its small volume to exclude or confirm the reflux of sperm into the bladder.

Each of the additional methods for diagnosing the causes of infertility has serious indications for research and should be carried out by experienced specialists.

Diagnosis of infertility in women

Female infertility requires more serious research than male infertility. After all, the female body must not only form a high-quality egg, but also create special conditions for fertilization, gestation and birth of a child.

As with the examination of male infertility, the diagnosis of female infertility is carried out in stages.

1. Consultation with a gynecologist or reproductive specialist.

Survey. The list of past diseases, operations (especially on the pelvic organs), genetic abnormalities in the family, the presence of pregnancies, characteristics of sexual life and the menstrual cycle, and the influence of harmful factors is specified.

Inspection. First, the ratio of height and weight and the development of secondary sexual characteristics are assessed. Then a gynecological examination of the vagina and cervix and a two-handed examination of the uterus and ovaries are performed.

1. Laboratory diagnostics.

Smear. Analysis of discharge from the cervical canal will indicate the presence of an inflammatory process or STD.

Blood test for hormones (FSH, LH, estrogens, progesterone and androgen), infections and increased clotting.

1. Ultrasound diagnosis of the condition of the uterus and ovaries. Ultrasound is the most informative and reliable way to determine ovulation. In addition, you can evaluate the condition of the uterus and ovaries, monitor the growth of the endometrium and determine the causes of menstrual irregularities.
2. Rectal temperature measurement. This additional research method is carried out over a period of 3 months and assesses the presence (37°C) or absence (<37°С) овуляции. Наблюдение и измерение женщина проводит самостоятельно.
3. Hysterosalpingography (HSG). This is an x-ray examination aimed at diagnosing tubal infertility and assessing the condition of the uterus. This research method is carried out on days 5-7 of the cycle by injecting a contrast agent into the uterus and assessing its movement through the fallopian tubes. This method is not always informative in assessing the patency of the fallopian tubes, because the patient experiences discomfort, which may affect the result. This method is more suitable for identifying uterine pathologies. And the most reliable way to assess the patency of the fallopian tubes is laparoscopy.
4. Laparoscopy. This type of examination is performed under general anesthesia using a special apparatus through small holes in the abdominal cavity. The undoubted advantage of this study is not only its high information content, but also the possibility of correcting identified disorders (restoration of fallopian tube function, removal of fibroids and ovarian formations).
5. Hysteroscopy. This method of endoscopic examination of the uterus not only evaluates its condition, but also allows for treatment of almost any uterine pathology.
6. Tomography of the skull and sella turcica is prescribed if endocrine infertility is suspected.
7. Spiral computed tomography of the pelvic organs is prescribed to clarify pathologies of the internal genital organs.

Diagnostics of partner compatibility

There are cases when conception does not occur due to incompatibility of partners. There are several methods for diagnosing such cases of infertility.

• Karyotyping is a study of the genetic compatibility of partners. The material for analysis is blood from a vein.
• HLA typing – assessment of immunological compatibility. The more antigens that react aggressively to foreign cells, the less chance of pregnancy.
• Kurzrock-Miller test. This diagnostic method examines the interaction of male and female germ cells. The specialist places cervical fluid and sperm into one tube and observes the behavior of the cells.
• Shuvarsky's test. This method is similar to the previous one, but the combination of cervical fluid and sperm occurs naturally. A woman takes this test no more than 6 hours after sexual intercourse.

There are many reasons why there are problems with conception. Conducting timely diagnosis and prescribing treatment for infertility in most cases can eliminate them. The main thing is to conduct a comprehensive study of both men and women. As a result, even already desperate couples have a high probability of becoming happy parents of a long-awaited child.

To find out the reasons for decreased fertility, tests are taken. The cost of the examination depends on the number and type of diagnostic measures prescribed to you. The price for testing for infertility in women varies depending on the type of test. There is no universal cost for all tests.

Analysis for infertility in women

Since it is not possible to determine infertility in women based on symptoms or medical history, laboratory tests are required. They include: blood and urine tests, determination of blood group and its Rh factor, analysis for syphilis and hepatitis, as well as some types of viral infections.

Screening for sexually transmitted infections

The examination is carried out to identify pathogens of sexually transmitted infections, such as gardnerella, ureaplasma, chlamydia and mycoplasma. It is very important to detect and treat them in time, since they are often the cause of infertility or fetal death.

Immune tests

To identify antisperm bodies that interfere with conception, the MAP test and PCT (postcoital) test are used. The essence of the latter is to determine the effect of mucus inside the cervix on sperm activity a couple of hours after intercourse.

Basal temperature measurement

This test should be carried out for at least 3-4 cycles. It is the most inexpensive and has sufficient accuracy. With its help, you can determine whether a woman is ovulating or not.

A preliminary examination allows our specialists to identify the causes of infertility and develop an optimal plan that will achieve the best treatment results and give birth to a healthy child.

A test for infertility in women makes it possible to understand where the source of the problem lies. Perhaps the partner is to blame for the lack of conception; According to statistics, about 40% of married couples do not have children as a result of infertility in the man. Therefore, both partners must be tested.

Diagnosis of infertility in women includes various procedures, from the simplest standard tests to complex invasive procedures. In some cases, during the intervention, it is possible not only to detect the cause of the disorders that have arisen, but also to eliminate it, for example, with hysteroscopy or laparoscopy.

In most cases, the infertility problem experienced by a couple is related to 4 main objects that play a decisive role in conceiving a child: sperm, ovaries, uterus and fallopian tubes. The probability of detecting disturbances in the functioning of these organs in men and women is approximately the same - 40%. In 10% of cases, both partners have problems. The remaining 10% are cases where no obvious abnormalities in the functioning of the organs were detected and the cause was not clear. Such situations are called idiopathic or infertility of unknown origin.

Content

According to statistics, about 15% of married couples face various types of infertility. Female infertility is understood as a persistent inability to perform reproductive function. Timely diagnosis and adequate treatment make it possible to achieve the desired pregnancy in 40-60% of cases.

Reason to see a doctor

Infertility is defined as having regular sexual intercourse without contraception for one to two years. Primary infertility in women means no history of pregnancy. Secondary infertility is established if a woman has had a history of pregnancy.

Female infertility occurs in 45% of childless couples. However, this diagnosis can only be confirmed if infertility in a man is excluded.

Infertility in women involves not only gynecological diseases. Identifying the causes of infertility is a long process that includes various areas of diagnostic search. The cause of infertility in a woman can be disorders in the psychoemotional sphere and the endocrine system.

Necessary tests for women

Examination for infertility in women includes laboratory tests and instrumental research methods. The list of tests and procedures is determined by the doctor, who takes into account the woman’s age and medical history:

• past infections, inflammatory processes and surgical interventions;
• hereditary pathologies;
• presence of pregnancies in the past.

The first stage of the examination is a gynecological examination and study, analysis of the patient’s medical history. It is mandatory to perform a general smear and ultrasound examination in women. If cervical pathology is suspected, a simple and extended colposcopy is performed.

Examination for infertility in women also includes:

• determination of the concentration of sex steroids and thyroid hormones;
• performing immunological screening;
• testing for sexually transmitted infections;
• confirmation of ovulation;
• endometrial examination.

In some cases, consultation may be required narrow specialists, for example, an endocrinologist.

Often, the diagnosis of infertility includes a significant list of various laboratory and instrumental studies, which is associated with certain costs and discomfort. Some invasive diagnostic methods in women are factors in the development of infertility:

• diagnostic curettage of the cervix and uterine cavity (RDW);
• hysterosalpingography;
• hysteroresectoscopy;
• hysteroscopy.

• chronic endometritis;
• salpingo-oophoritis;
• dysfunction of the receptive apparatus of the uterus.

The traumatic nature of invasive diagnostic methods increases the risk of infectious complications, which aggravates infertility in women. Gynecologists emphasize that tests to determine the cause of infertility should be as non-invasive as possible. The feasibility and compatibility of the research carried out is essential.

In recent years, there has been a tendency to increase the number of cases of infertility caused by male factor. The examination of men and women is carried out in parallel.

What hormones need to be tested for infertility?

Assessing a woman's hormonal levels is of particular importance in diagnosing infertility. Many processes occurring in a woman’s body are regulated and controlled by the required level of sex hormones. A decrease or increase in the concentration of sex hormones affects:

• mechanism;
• advancement of the egg into the uterine cavity;
• conception, gestation;
• childbirth and lactation;
• composition of cervical mucus.

Necessary physicochemical properties of cervical canal secretion, which is located in the cervix, provide a unique preparation of sperm for subsequent fertilization of the egg.

Hormone tests involve determining the concentration in the blood of:

• TSH (thyroid stimulating hormone), T3 (triiodothyronine) and T4 (thyroxine), which are thyroid hormones;
• FSH (follicle stimulating hormone);
• LH (luteinizing hormone);
• prolactin;
• estradiol;
• testosterone;
• progesterone.

Follicle-stimulating hormone is produced by the pituitary gland. FSH causes the growth of follicles, stimulates the function of the corpus luteum by regulating the production of estrogens, which are sex hormones. It is advisable for women to perform the analysis at different phases during a particular cycle.

LH

Luteinizing hormone is produced in the anterior pituitary gland. LH stimulates estrogen production in the ovaries. When assessing the analysis, the doctor takes into account the correct ratio of the hormones LH and FSH.

Progesterone

The hormone is secreted in the second phase of the cycle due to the formation of the corpus luteum. Progesterone is considered the pregnancy hormone in women. The required concentration of progesterone ensures the preparation of the uterine mucosa for implantation of the fertilized egg. After pregnancy occurs, the hormone helps to prolong it until the formation of the placenta, which takes over the function of the corpus luteum.

Prolactin

The hormone is secreted by the anterior pituitary gland. Prolactin regulates the production of progesterone and FSH. The hormone provides the ovulation mechanism, which makes conception and pregnancy possible. After childbirth, prolactin promotes lactation.

Testosterone

This hormone is produced by the adrenal glands and ovaries in insignificant quantities. Testosterone is a male sex hormone. Excessive testosterone production causes disruption of the ovulation mechanism, miscarriage and early pregnancy loss.

DEA sulfate

It is an androgenic hormone produced by the adrenal glands. The concentration of the hormone allows us to judge the condition and functioning of the adrenal glands. Metabolic reactions lead to the formation of male sex hormones, in particular testosterone and dihydrotestosterone. Hormone production is stable under normal conditions. The hormone is excreted from the body in the urine, which prevents sharp fluctuations in the level of DHEA sulfate.

Estradiol

The sex hormone is produced by follicles that mature in the ovaries, the corpus luteum. The process of hormone production occurs under the influence of LH, prolactin and FSH. The concentration of estradiol affects the cycle and maturation of eggs in the ovaries.

Thyroid hormones

TSH is produced by the thyroid gland. The functioning of the thyroid gland is also ensured by the hormones T3 and T4. The concentration of hormones that are produced by the thyroid gland affects the adequate maturation of follicles in the ovaries and the mechanism of ovulation.

Immunological screening

With some disturbances in the functioning of a woman’s immune system, the production of antibodies is observed, which is a reaction to a protein present in sperm. Normally, women do not produce antisperm antibodies due to protective mechanisms.

The doctor prescribes a test to detect antisperm antibodies if there are no other factors of infertility. Detection of antibodies may indicate infertility that has an immune cause.

Presence of antisperm antibodies in women it does not always lead to infertility. However, the likelihood of pregnancy is reduced by half.

To identify antisperm antibodies, a postcoital test is sometimes used, which involves examining the secretions of the cervical canal under a microscope a certain number of hours after sexual intercourse. The test sample must contain spermatozoa that move in a straight line. The number of male germ cells correlates with the norm. Immobility of sperm may indicate poor sperm quality and the presence of antisperm antibodies in a woman.

Endometrial examination

Chronic inflammatory processes in the uterus, hyperplasia and hypoplasia, fibroids, polyps and adenomyosis can cause infertility in women. The fertilized egg cannot implant and develop adequately in the altered inner layer of the uterus. Diagnosis of infertility necessarily includes examination of the endometrium or uterine mucosa.

Gynecologists call the simplest method of studying the condition of the endometrium an ultrasound examination of the internal genital organs, which is carried out both abdominally and transvaginally. Ultrasound allows you to measure the thickness of the endometrium, identify benign formations of the uterus, for example, polyps and fibroids, pathologies of the ovaries and tubes, and also suspect endometriosis. A discrepancy in the thickness of the inner layer of the uterus indicates hyperplasia and hypoplasia in women, which are often caused by an imbalance in hormones.

For endometrial hyperplasia the thickness of the inner layer of the uterus exceeds the norm. This pathology causes the formation of polyps and the need for surgical intervention.

The endometrium of the uterus can be examined through a biopsy. During this procedure, samples of the inner layer of the uterus are taken. The obtained samples are examined in the laboratory as part of histological analysis.

The analysis allows you to obtain information about the condition of the endometrium and increase the chances of embryo implantation. A biopsy reveals:

• the cause of infertility and miscarriage, bleeding;
• hormonal disorders;
• endometrial hyperplasia;
• uterine cancer.

Types of analysis:

• pipel biopsy, performed using a thin tube with a piston to create negative pressure and suction pieces of the endometrium of the uterus;
• aspiration biopsy carried out using a syringe or vacuum apparatus;
• curettage of the uterus a curette as part of a minor surgical operation;
• hysteroscopy, performed using a hysteroscope with a video camera and a surgical instrument.

Feasibility and choice of anesthesia depends on the type of analysis. A biopsy is not performed if infections and inflammatory processes or blood clotting disorders are detected.

The process of preparing and studying the material takes 7-10 days. In conclusion, the structural features of the inner layer of the uterus are described. The diagnosis is made to a woman after receiving the results of other tests and studies.

Consultation of narrow specialists

In case of infertility, a woman turns to a gynecologist, who prescribes the necessary tests and studies. Often, in the absence of pregnancy, 12 months after the start of planning, a married couple is recommended to contact a fertility specialist. This doctor specializes in conception and infertility.

A gynecologist or reproductive specialist can refer a woman or couple to specialists. It is advisable for a couple to visit a geneticist in the following cases:

• the age of the spouses is over 35 years;
• genetic diseases in the family;
• consanguinity between spouses.

Infertility in women is often caused by hormonal imbalances. It is necessary to visit an endocrinologist for the following pathologies and conditions:

• disruptions of the menstrual cycle;
• overweight;
• acne;
• hirsutism.

For diseases of the genitourinary system, consultation with a urologist may be required. In some cases, infertility is psychosomatic in nature. Psychological infertility is spoken of in the absence of disturbances in the functioning of internal organs. In case of infertility of unknown origin, a woman needs to visit a psychologist or psychotherapist.

Ovulation confirmation

Adequate functioning of the ovaries ensures reproductive function in women. The ovaries contain eggs that are capable of fertilization. The processes occurring in the ovaries are controlled by the hypothalamus and pituitary gland.

The hormone FSH, produced in the pituitary gland, promotes the secretion of estrogens and the maturation of follicles in the first phase of the cycle. During each cycle, several follicles laid in the ovaries in the prenatal period begin to mature. Only one follicle goes through all stages of development, which after its maturation is called the Graafian vesicle.

When the egg inside the follicle becomes mature, its wall is destroyed under the influence of the hormone LH. The egg is released from the follicle for subsequent fertilization in the fallopian tube. In place of the follicle, a corpus luteum is formed that synthesizes the hormone progesterone. If fertilization occurs, high levels of the hormone progesterone ensure prolongation of pregnancy until the placenta forms. In the absence of pregnancy, the corpus luteum is destroyed before menstruation.

Ovulation in women divides the cycle into two phases, being a necessary condition for conception. An imbalance of hormones leads to a distortion of the ovulation mechanism due to disruption of the functioning of the ovaries.

Distortion of the ovulation mechanism and its absence is the most common cause of infertility.

Ovulation can be confirmed by both laboratory and instrumental diagnostic methods. Ovulation is supported by changes in the level of sex hormones during the cycle, which is determined by the results of a blood test.

The fact of ovulation can be determined through rapid tests that determine fertile days using saliva and urine. The test strips are impregnated with special chemicals that react to the release of the LH hormone in the urine. A positive result indicates ovulation, which should occur within two days.

There are optical systems that detect ovulation using saliva. These devices resemble a microscope and are designed for reusable use.

Ovulation can be confirmed using folliculometry. This procedure is a series of ultrasound examinations performed to evaluate the growth of the follicle and confirm the fact of ovulation. Folliculometry is an informative method of examining women, allowing to identify anovulation and concomitant pathologies of the internal genital organs.

An increase in the level of the LH hormone leads to an increase in basal temperature, which is measured in the rectum, vagina or oral cavity with a mercury thermometer. The objectivity and reliability of the results is achieved by observing the following conditions:

• measurement in one area;
• determination of temperature after a continuous night's sleep at a strictly set time.

ARVI, alcohol consumption, physical activity influence the measurement results.

The release of the LH hormone is manifested by an increase in basal temperature by 0.4 degrees. Anovulation is indicated by the absence of a rise in temperature in the middle of the cycle.

Changes in hormone levels during ovulation are accompanied by the appearance of subjective symptoms and sensations:

• enlargement and engorgement of the mammary glands;
• cramping pain in the lower abdomen;
• feeling of fullness in the rectum.

Confirmation of ovulation is carried out using laboratory tests, tests and instrumental methods in women.

Tests for sexually transmitted infections

Infertility in women can be a consequence of a chronic inflammatory process occurring in the area of ​​the appendages, uterine cavity, and cervix:

• adnexitis;
• endometritis;
• endocervicitis.

Chronic inflammation is caused by sexually transmitted infections of a specific and nonspecific nature. Some sexually transmitted infections have mild symptoms or occur latently.

Experts call the following infections leading to infertility:

• gonorrhea;
• chlamydia;
• mycoplasma;
• cytomegalovirus;
• herpes simplex virus;
• trichomoniasis;
• some types of HPV;
• ureaplasma.

Somewhat less frequently, inflammation of the genital organs in women can be caused by:

• enteroviruses;
• streptococci;
• coli;
• Candida fungi.

In order to diagnose infections that can be sexually transmitted, microscopic examination of smears from the following areas is carried out:

• vagina;
• urethra;
• cervical canal.

To identify the RNA and DNA of pathogens, urine, blood, and mucus of the infectious agent are analyzed using the polymerase chain reaction method. This analysis is called PCR diagnostics.

Culture for microflora and sensitivity to antibiotics increases the effectiveness of therapy.

How to prepare for the test

Conducting an examination of infertility in women requires preliminary preparation and certain restrictions, which depend on the specific study. When taking general and biochemical blood tests, women must follow several basic rules:

• performing tests up to 11 o'clock strictly on an empty stomach;
• the day before, it is undesirable to eat fatty heavy foods or drink alcoholic beverages;
• the interval between eating and taking the test should be from 8 to 11 hours;
• You are allowed to drink only still water;
• medications can only be taken as prescribed by a doctor;
• smoking within an hour before the test is not recommended;
• It should be taken into account that stress, physical and emotional stress, physiotherapy and instrumental diagnostic methods can distort test results;
• Dynamic analyzes should be performed in the same laboratory.

Before taking a urine test, women must wash themselves thoroughly. The average portion of urine is collected in a sterile container, excluding the first drops. A cotton ball will be placed in the vagina, which prevents discharge from entering the urine portion. After collecting the material, it should be delivered to the laboratory. Do not store the urine sample as bacterial growth may lead to poor results.

Tests for sex hormones in women are taken on certain days of the cycle:

• FSH and LH - on days 3-5;
• testosterone, DHA sulfate- on days 7-9;
• estradiol - on days 5-7 (21-23);
• progesterone - on days 21-23.

The direction indicated cycle phase. Before taking a blood test for the hormone prolactin, you cannot palpate the mammary glands; you should exclude stressful situations and sexual intercourse.

Testing for sexually transmitted infections requires completion of treatment with antibacterial drugs at least a month before diagnosis. During menstruation, taking smears from women is prohibited.

Performing smears requires compliance with the following rules:

• abstaining from sexual intercourse and douching 2-3 days before the test;
• exclusion of medications in the form of suppositories, sprays, tablets.

Before performing a smear It is not advisable to wash yourself. It is advisable to urinate 2 hours before the test.

Carrying out an endometrial biopsy requires certain preparation. To exclude infections and prevent complications, the following tests are recommended:

• general blood and urine analysis;
• blood for biochemistry, syphilis, HIV and hepatitis;
• coagulogram, which means determining blood clotting indicators;
• flora smear;
• hCG test in blood or urine.

Two days before the test, women need to avoid sexual intercourse, taking any medications that were not prescribed by a doctor, and douching. If the biopsy involves the use of intravenous anesthesia, the woman's last meal should be twelve hours before the procedure.

Where to get tested for infertility

If a woman does not become pregnant after one or two years of stable sexual activity without using contraception, she should consult a gynecologist and undergo the necessary tests. Many antenatal clinics have rooms for family planning and infertility, where the local gynecologist refers the woman for further examination.

Various tests, for example, to determine the concentration of sex hormones and infections, can be performed in laboratories. Some laboratories have special comprehensive programs to identify factors of infertility.

Often, a woman has to go to clinics specializing in infertility. These medical centers usually diagnose female and male infertility, are equipped with innovative equipment, have their own laboratory and highly qualified staff. Thus, a woman does not need to go to various institutions to undergo examination for infertility, which significantly reduces the duration of diagnosis.