1) Course of Examinations: Scheduled for Husband and Wife
On day 2 or 3 of menstruation, blood tests are arranged for the female patient to check levels of hormones related to ovulation and ovarian function, such as Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Prolactin, Thyroid Stimulating Hormone (TSH), Testosterone, Anti-Mullerian Hormone (AMH), etc. and depending on the patient’s condition, the physician in charge may request for other blood tests for evaluation.
On day 8 or 9 of the menstrual cycle, after the menstrual bleeding stop and prior to ovulation, a hysterosalpingography (HSG) is arranged to check for patency of the fallopian tubes and for any possible uterine malformations.
Women with regular menstruation periods expected to ovulate on day 14 of the cycle are arranged to have a pelvic ultrasound to check for any possible uterine or ovarian tumors. If ovulation is ascertained by the ultrasound, couples are arranged to have intercourse.
Three to 5 days after intercourse, the semen examination is arranged. Our center provides a complete set of semen examination including semen analysis, MAR test to test for anti-sperm antibodies and examination of sperm morphology after Kruger’s staining.
Depending on personal circumstances, the physician in charge may suggest to have a hysteroscopy or laparoscopy for the female patient.
2) Ultrasound Examination
Ultrasound examination can be done abdominally after the bladder is full. From the abdomen, the field of examination is larger but would be more difficult to delineate finer or more inconspicuous lesions.
Another method is vaginal ultrasound examination. There is no need to wait until the bladder is full but the field of examination is more limited to the pelvic organs; however, detailed structure and size measurements of lesions are more accurate.
During the process of ovulation induction, it is essential that ovarian follicle size or endometrial thickness are measured, in which case, vaginal ultrasound examination is necessary.
This procedure is taking an x-ray film after the injection of a contrast medium into the uterine cavity through the vagina and cervix in order to observe the flow of the contrast medium within the pelvic cavity through the fallopian tubes. Through this procedure, we can understand if the fallopian tubes are obstructed, if the uterus has any deformity or abnormality, if the pelvic cavity has any adhesions, polyps or any shape changes for any reason. Some medical institutions may replace the use of contrast medium to injecting water or air to check for patency of the fallopian tubes due to limitations of available equipment but accuracy is not as good
Hysterosalpingography is considered an invasive procedure and is usually arranged on day 8-10 of the menstrual period after the end of the menstrual period and prior to ovulation, considered the best time for this procedure.
There may be slight pain during the procedure and a few patients may have slight bleeding or allergy to the contrast medium. A minority of patients might even develop pelvic inflammatory disease. However, this can be prevented as much as possible with proper and careful application and adequate supplementation with antibiotics and analgesics as needed.
4) Semen Examination
Direct or indirect male factors accounts for about 40% of infertility in couples so the usual thinking that the female partner should be checked first since the male partner’s examination is more convenient and generally without discomfort is a misconception.
Semen analysis is done after sexual abstinence for 3-5 days and semen sample collected by masturbation and direct ejaculation into the collection cup provided by our center. Sample specimen collected in condoms and other containers are not advisable. Some people may have difficulty collecting specimen in the hospital setting, in which case, specimen collection can be done at home if it can be sent to the hospital within one hour and maintained near body temperature.
Semen analysis and interpretation
Our laboratory staff will examine semen sample collected including liquefaction time, sperm shape, appearance, pH value, volume, sperm count, motility and other parameters for a complete semen analysis. Aside from the conventional semen analysis, our center provides further examinations including a mixed antiglobulin reaction (MAR test) to test for anti-sperm antibodies and examination of sperm morphology under a high magnification microscope after Kruger’s staining for a more accurate determination of fertility.