Fertility Assessment for Couples

Conditions and Diseases That Can Affect Fertility 

Fertility can be influenced by a variety of physiological, hormonal, genetic, anatomical, and environmental factors. It is important to understand that infertility is a shared condition—approximately 40% of cases are due to male factors, 40% to female factors, and 20% involve both or are unexplained. 

Female Factors: 

• Ovulatory Disorders: Polycystic Ovary Syndrome (PCOS), hypothalamic dysfunction, premature ovarian insufficiency. 
• Tubal Blockage or Damage: Often due to pelvic inflammatory disease (PID), endometriosis, or past surgeries. 
• Endometriosis: Endometrial tissue growing outside the uterus can impact ovulation, implantation, and tubal function. 
• Uterine Abnormalities: Fibroids, polyps, septum, or congenital malformations can hinder implantation or cause miscarriage. 
• Thyroid Disorders: Hypothyroidism or hyperthyroidism can disrupt hormonal regulation of the menstrual cycle. 
• Advanced Maternal Age: A natural decline in ovarian reserve and egg quality begins after age 35. 

Male Factors: 

• Sperm Abnormalities: Low sperm count (oligospermia), poor motility (asthenospermia), or abnormal morphology (teratospermia). 
• Varicocele: Enlarged veins in the scrotum can impair sperm production and function. 
• Hormonal Imbalances: Low testosterone, pituitary dysfunction, or thyroid issues. 
• Obstruction of Sperm Transport: Due to injury, infection, or congenital absence of vas deferens. 
• Genetic Disorders: Klinefelter syndrome, Y-chromosome microdeletions. 
• Lifestyle Factors: Smoking, alcohol, obesity, stress, and exposure to toxins or heat.

Diagnostic Tests for Fertility Assessment  

Accurate and timely diagnosis is central to effective fertility assessment and involves a series of targeted diagnostic tests for both partners to evaluate key reproductive functions and identify any factors that may be affecting the couple’s ability to conceive. 

For Female Partners 

A thorough female fertility evaluation focuses on three main components: ovulation, anatomical integrity, and hormonal balance. 

• Ovulation Assessment 
  • Basal Body Temperature Charting: Monitors cycle patterns and ovulation. 
  • Ovulation Predictor Kits (OPKs): Detect the LH surge prior to ovulation. 
  • Mid-Luteal Phase Progesterone Test: Blood test to confirm recent ovulation. 
  • Serial Ultrasounds: Track follicular development and ovulation.
• Hormonal Testing (Blood Tests) 
  • FSH and LH (Day 2–4 of cycle): Evaluate ovarian reserve and pituitary function. 
  • Estradiol (E2): Assesses estrogen levels. 
  • Anti-Müllerian Hormone (AMH): A key marker for ovarian reserve. 
  • Thyroid Function Tests (TSH, T3, T4): Assess thyroid’s role in fertility. 
  • Prolactin: High levels can inhibit ovulation. 
  • Androgens (Testosterone, DHEAS): Elevated in PCOS or adrenal disorders. 
• Imaging and Structural Tests 
  • Transvaginal Ultrasound: Evaluates uterus, endometrium, ovaries, and follicle count. 
  • Hysterosalpingography (HSG): X-ray with contrast dye to assess uterine cavity and fallopian tube patency. 
  • Sonohysterography: Saline infusion ultrasound for detailed uterine assessment. 
  • MRI or Laparoscopy: For suspected endometriosis or structural abnormalities. 

For Male Partners 

Male fertility evaluation primarily revolves around sperm production, transport, and hormonal function. 

• Semen Analysis 
  • Conducted after 2–7 days of abstinence. 
  • Measures: 
    • Volume 
    • Concentration (sperm count) 
    • Motility (progressive movement) 
    • Morphology (shape and structure) 
    • pH and vitality 
• At least two analyses are recommended to confirm consistency. 
• Hormonal Evaluation 
  • FSH and LH: Assess pituitary function and spermatogenesis. 
  • Testosterone: Evaluates androgen levels. 
  • Prolactin: Elevated levels may indicate pituitary dysfunction. 
  • Estradiol and Inhibin B: May be tested in selected cases. 
• Imaging and Specialized Tests 
  • Scrotal Ultrasound: For varicocele, testicular masses, or epididymal obstruction. 
  • Transrectal Ultrasound (TRUS): To visualize ejaculatory ducts and seminal vesicles. 
  • Genetic Testing: For azoospermia, recurrent IVF failure, or family history of infertility. 
  • Sperm DNA Fragmentation Test: Evaluates sperm quality beyond standard semen parameters. 

Additional Considerations in Fertility Evaluation 

 Beyond standard reproductive testing, additional lifestyle, medical, and systemic factors are carefully assessed to provide a comprehensive understanding of each partner’s fertility potential and to support the development of a personalized care plan. 

Lifestyle and Health Assessment 

• Body Mass Index (BMI) 
• Nutritional Status 
• Sleep and Stress Levels 
• Medication Review 
• History of Sexually Transmitted Infections (STIs) 

Couple-Based Evaluation 

• Assessment should be synchronized for both partners to identify combined or compounding factors. 
• A reproductive endocrinologist or fertility specialist will coordinate testing and develop a tailored management plan. 

Timeline and Next Steps 

 Once the fertility assessment is complete and the underlying factors affecting conception have been identified, couples receive individualized guidance based on their reproductive goals, medical history, and test results. Management options may include one or more of the following: 

Timed Intercourse 

Couples may be advised to engage in intercourse during the woman’s most fertile window, typically around ovulation, which can be confirmed through hormonal tracking or ultrasound monitoring. This low-intervention approach is often recommended in cases where no significant fertility barriers are identified, and cycle regularity is established. 

Ovulation Induction 

If ovulatory dysfunction is identified, medications such as clomiphene citrate, letrozole, or gonadotropins may be used to stimulate ovulation. 

Intrauterine Insemination (IUI) 

IUI involves placing processed sperm directly into the uterus around the time of ovulation to improve the chances of fertilization. It is often recommended for couples with mild male factor infertility, unexplained infertility, or cervical factor issues, and may be used alongside ovulation induction. 

In Vitro Fertilization (IVF) 

IVF is an advanced reproductive technology in which eggs are retrieved from the ovaries, fertilized in a laboratory, and then transferred into the uterus. IVF is recommended in cases of tubal blockage, severe male factor infertility, endometriosis, advanced maternal age, or previous failed fertility treatments. It may also be an option for fertility preservation or use of donor gametes. 

Please note that IVF is not currently offered as a clinical service to international patients. 

Surgical Intervention (If Indicated) 

Surgery may be recommended when structural abnormalities are identified, such as fibroids, polyps, adhesions, tubal occlusion, or endometriosis. Surgical correction may enhance natural fertility or improve the success rates of assisted reproductive techniques. 

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