Evaluation of Couples
Evaluation of Couples
At Orrchid Fertility Centre the fundamental to the entire treatment regimen is Evaluation of couples, the first step towards fulfilling the dream of parenthood. Infertility evaluation is to conduct necessary investigations, which will determine the cause and severity of infertility so as to develop an effective treatment plan.
Infertility may be due to the problem in male or female or in both the partners. There are several causes of infertility both in males and females, thus infertility evaluation need to be done for both the partners.
We at Orrchid Fertility understand the importance of treating the couple as a unit, not only the physical causes of infertility are investigated but also the mental and psychological factors causing and occurring because of infertility are evaluated and treated.
Male partner evaluation
The initial test performed in male is a semen analysis. A semen analysis allows us to examine the count, motility and morphology of the sperm.
WHO criteria of semen evaluation:
The causes of altered Semen parameters could be related to the following problems at Sperm production (Testis), Erection & Ejaculation, Transport of semen & Central (Hypothalamus & Pituitary). Hence at Orrchid we evaluate the male partner thoroughly with respect to all above parameters.
Semen deficiencies are often labeled as follows:
Testicular biopsy is performed as an in-office surgical procedure in which several small pieces of testicular tissue are removed and examined for sperms which can be used in fertility procedures.
Testicular Sperm Aspiration (TESA)
A TESA procedure involves a needle biopsy of the testicle in which a sample of tissue is taken directly from the testis and used to extract sperm for ICSI.
Percutaneous Sperm Aspiration (PESA)
PESA is a procedure involving a needle inserted into the epididymis in an effort to locate and aspirate a pocket of sperms.
The extra sperms and testicular tissues obtained by TESA / PESA can be cryopreserved for future use.
| Parameters | Normal Findings |
| Sperm count (the number of sperm in a milliliter of semen) | Sperm count should be above 20 million in a milliliter of sperm. Complete semen sample should have at least 40 million sperm. |
| Semen motility (how well the sperm moves) | At least 50% of sperm should "swim" in more or less straight line. Sperm that "moves" well is more likely to reach the egg. |
| Morphology | At least 15% of your sperm should have a normal shape and structure, with an oval-shaped head. Abnormally shaped sperm is less likely to be able to fertilize an egg. |
| Ejaculate volume | > 2.0.ml |
| Ph | 7.2-7.8 |
| Sperm concentration | > 20 million /ml |
| Motility | > 50 % progressively motile |
| Morphology | < 85 % abnormal forms |
| Vitality | > 75 % or more live |
| Inflammatory cells | < 1 million cells /ml |
| Antibodies (immunobead test ) | < 20 % sperm binding to bead |
Semen deficiencies are often labeled as follows:
- Oligospermia or Oligozoospermia - decreased number of spermatozoa in semen
- Aspermia - complete lack of semen
- Hypospermia - reduced seminal volume
- Azoospermia - absence of sperm cells in semen
- Teratospermia - increase in sperms with abnormal morphology
- Asthenozoospermia - reduced sperm motility
Testicular biopsy is performed as an in-office surgical procedure in which several small pieces of testicular tissue are removed and examined for sperms which can be used in fertility procedures.
Testicular Sperm Aspiration (TESA)
A TESA procedure involves a needle biopsy of the testicle in which a sample of tissue is taken directly from the testis and used to extract sperm for ICSI.
Percutaneous Sperm Aspiration (PESA)
PESA is a procedure involving a needle inserted into the epididymis in an effort to locate and aspirate a pocket of sperms.
The extra sperms and testicular tissues obtained by TESA / PESA can be cryopreserved for future use.
At Orrchid Fertility Centre after detailed evaluation of the Male & assessing the severity, we advocate appropriate ART(Assisted Reproductive Techniques) which could be in the form of IUI, IVF, ICSI. The centre offers the best in class treatment for severe male factor.
Female partner evaluation
At Orrchid Fertility Centre Female evaluation generally comprises of detailed history with respect to age, years since marriage, coital history, any past medical / surgical history & detailed menstrual history. Detailed physical examination is done which includes bimanual per vaginal examination & detailed trans vaginal ultrasonography.
Some of the basic tests that are performed which will throw light on the course of infertility are as follows:
Hormonal Assays: The Hormones commonly evaluated are:
FSH (Follicle Stimulating Hormone)
Ideally FSH & LH tests should be done on Day-2/3 of menstrual cycle.
The levels of FSH / LH indicate the below said:
TSH (Thyroid stimulating hormone)
Prolactin
AMH (Anti mullerian hormone)
Some of the basic tests that are performed which will throw light on the course of infertility are as follows:
Hormonal Assays: The Hormones commonly evaluated are:
| - FSH (Follicle Stimulating Hormone) | - Progesterone |
| - Estrogen | - Androgens |
| - LH | - Inhibin |
| - Thyroid | - AMH |
| - Prolactin |
At Orrchid Fertility Centre we do not advocate to do all the above mentioned tests for every patient, depending on the history and clinical evaluation appropriate tests are suggested.
FSH (Follicle Stimulating Hormone)
| Phase of Menstrual cycle | Normal Values |
| Follicular phase | 1.37-9.9 international units per liter (IU/L) |
| Mid-cycle peak | 6.17-17.2 IU/L |
| Luteal phase | 1.09-9.2 IU/L |
| Women past menopause | 19.3-100.6 IU/L |
Ideally FSH & LH tests should be done on Day-2/3 of menstrual cycle.
The levels of FSH / LH indicate the below said:
- Decreased level seen in Hypothalamus dysfunction
- Border line elevated in impending menopause
- Significantly elevated in menopause
- If LH is raised and FSH is normal or decreased it suggests PCOS (Poly Cystic Ovarian Disease)
TSH (Thyroid stimulating hormone)
- Normal values 0.2-6 miu/ml
- Altered levels (Hypo/Hyper Thyroidism) causes menstrual disturbances.
Prolactin
- Normal values 3-30 ngm/ml
AMH (Anti mullerian hormone)
- Normal values > 2.2 units is ideal.
- AMH is a better marker in predicting ovarian response to controlled ovarian stimulation than Age of the patient, FSH, Estradiol and Inhibin B.
- In clinical practice, AMH measurement may be useful in the prediction of poor response and cycle cancellation and also of hyper-response and ovarian hyperstimulation syndrome.
- AMH may permit the identification of both the extremes of ovarian stimulation, a possible role for its measurement may be in the individualization of treatment strategies in order to reduce the clinical risk of ART along with optimized treatment burden.
For patient convenience all the above mentioned Hormonal tests are carried in the centre for better interpretation.
Other evaluation tests
Tests to evaluate the uterus and fallopian tubes / uterine abnormalities that can contribute to infertility is done as follows,
Pelvic Sonography
A good pelvic sonography tells us about the condition of the uterus, ovaries and to some extent the fallopian tubes. Many pathologies like fibroids, adenomyosis, uterine septum, polyps, synechiae, ovarian cysts, endometriomas, dermoids etc can be easily diagnosed. Sometimes hydro salpinges can be seen on sonography. Transvaginal USG is one of the most important tools for infertility specialist for ovulation monitoring and Oocyte (Egg) retrieval at the time of IVF / ICSI.
Tubal patency tests
Genetic tests
Genetic testing (like Karyotyping,Y chromosomal microdeletion & delta 508 mutation studies etc.) for severe male factor may be recommended if there is a suspicion that genetic or chromosomal abnormalities are contributing to infertility.
Once complete infertility evaluation is done, from here on the couples need to go through a thorough work up regarding all aspects of Infertility treatment.
Pelvic Sonography
A good pelvic sonography tells us about the condition of the uterus, ovaries and to some extent the fallopian tubes. Many pathologies like fibroids, adenomyosis, uterine septum, polyps, synechiae, ovarian cysts, endometriomas, dermoids etc can be easily diagnosed. Sometimes hydro salpinges can be seen on sonography. Transvaginal USG is one of the most important tools for infertility specialist for ovulation monitoring and Oocyte (Egg) retrieval at the time of IVF / ICSI.
At Orrchid, Sonography is done by Dr. Sanjeev Khot in person for better clinical co-relation and decision making which has a bearing on better clinical outcome.
Tubal patency tests
- HSG (Hysterosalpingography) is a special X-ray photograph showing the outline of the uterine cavity and the two fallopian tubes. The common problems that can be detected are blocked tubes, hydrosalpinges, endometrial problems like septum, polyp, congenital anomalies of uterus etc. HSG is an inexpensive and convenient screening test.
- Laparoscopy is an invasive procedure. This serves the dual purpose of checking patency of the fallopian tubes as well as providing an opportunity for the pelvis to be examined carefully to diagnosis or exclude the presence of endometriosis, adhesions or any other problem that may be causing or contributing to infertility. Laparoscopy is routinely done at the centre for enhanced clinical outcomes.
- Hysteroscopy is used to view the inside of the uterine cavity. Hysteroscopy is indicated in repeated IVF failures, history of pelvic tuberculosis and when a septum is suspected. Uterine polyps and submucosal fibroids can be removed by hysteroscopy. Tubal cannulation for cornual blocks can be tackled hysteroscopically.
Genetic tests
Genetic testing (like Karyotyping,Y chromosomal microdeletion & delta 508 mutation studies etc.) for severe male factor may be recommended if there is a suspicion that genetic or chromosomal abnormalities are contributing to infertility.
Once complete infertility evaluation is done, from here on the couples need to go through a thorough work up regarding all aspects of Infertility treatment.