Infertility is not an isolated disease but an end result of minor to major to major diseases of reproductive system in a female or male partner.
Usually healthy couples will conceive within one year of marriage. If this fails then investigations are advisable. Wifes age is above 35 no time should be wasted and investigations should be started.
Before we understand all investigations, let us take a look at how natural conception occurs.
In a woman of reproductive age the ovary produces follicles that grow under influence of pituitary gonodotropics (FSH & LH), as the follicle grows it produces estrogen causes growth of uterine lining , at mid-cycle(day 14 of menses in 28 days real cycle) the follicle ruptures. Oocyte is picked up by the fallopian tube.
Around this time if intercourse occurs, sperms are deposited at the cervix. They swim up to reach the oocyte.
The fertilized oocyte divides to form an embryo and gets lodged in the uterus – which is called pregnancy.
So for natural conception a woman should ovulate, her reproductive organs should be healthy and the husband should be potent and have adequate sperms in his semen.
Since there are many causes of infertility, investigations are started after a through history.
History: Includes questions like wife’s age, duration of marriage coital frequency. Wife’s menstrual history- like regularity of menstrual cycle, duration of flow, dysmenorrhoea.
Past history in the couple suggestive of sexually transmitted diseases.
Wifes general and pelvic examination is done, and the gynecologist can draw a conclusion from all positive findings on history whether she has
Due to infections like Chlamydia, tuberculosis, Hydrosalpinx, pelvic adhesions- all are evaluated by laparoscopy.
Uterine cause of infertility is evaluated by hysteroscopy.
If there is no tubal or uterine pathology suspected patency of fallopian tubes can be checked by hysterosalpingography; which is a radiological test.