Top Infertility Tests For Women And Men

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Infertility Tests usually consists of several step wise tests to detect and then treat causes of infertility. It usually takes less than 6 weeks to find out the causes of infertility.  About 80% of infertility is caused by one or more of three problems.
  • Sperm problems: Does he have enough and good sperms?
  • Ovulation problems: Is she ovulating regularly? Are her eggs OK and of good quality?
  • Fallopian tube problems: Are her fallopian tubes open?
Infertility testing and checkups can be done to prospectively counsel women about their future chances of fertility and having a baby.These include information on:
  • Woman’s age
  • Ovarian reserve testing (FSH, antral follicle count, anti-mullerian hormone, estardiol)
  • Common problems with fertility (pelvic surgery, sexually transmitted diseases (STD), endometriosis, autoimmune conditions, medications, menstrual issues.
Infertility and fertility testing should answer which of these may be responsible for the couple’s inability to get pregnant, and most of these tests can be completed within 5-6 weeks.
If no specific cause is found, and that happens in about 1 in 7 couples, then the diagnosis is unexplained infertility.

Infertility Tests Step 1: HIS Fertility

Finding out about his fertility is the second most important information to know when trying to get pregnant.Find the most important information about fertility here.
Male infertility can primarily be classified as:
  • obstructive and
  • non-obstructive infertility.
More infrequent are retrograde ejaculation, sexual dysfunction, and congenital abnormalities.
Obstructive disorders which are caused by a former vasectomy must be attempted re-anatomized prior to other treatment.
Non-obstructive disorders are often detected because of impaired sperm quality – from a slightly reduced sperm count and morphology to no sperm cells at all in the ejaculate.
Patients who lack spermatic cords or have less than 1 mill. sperm cells per ml in the ejaculate must be evaluated genetically prior to treatment where own sperm cells will be used.
  • Patients with male infertility are treated according to a step-by-step process
  • Treatment of severe male infertility is most effective with in-vitro fertilization IVF
  • Genetics and cancer risks at male infertility:
The below stated guidelines are due to the fact that many men with a severely reduced sperm count have micro-deletions on the Y-chromosome or chromosome aberrations.
Furthermore, these men have a considerable risk of developing testicle cancer, as compared to normospermatic men. It is today possible to evaluate for this diagnosis by ultrasound scan of the testes, as this will disclose a possible preliminary stage of carcinoma in situ.
Men with cystic fibrosis deletions might also have a congenital absent vas deferens (CAVD) as the only symptom, whereas their children can get the disease. Now, where it is possible via ICSI (Intra Cytoplasmatic Sperm Injection) to treat almost all men with reduced or lacking spermatogenesis, there are great worries about the increased genetic risk these parents expose their offspring to.
Therefore – this genetic evaluation of the man.
A semen analysis also known as a sperm count measures the quality, the amount, number, and other paramenters of semen a man produces. A man can only find out through a semen analysis if he is fertile or not  The semen analysis helps determine whether a man is fertile and is usually one of the first tests done to help determine whether a man has a problem fathering a baby.
More than 40% of couples who are unable to have children (infertile) will be infertile because of his sperm problems. The sperm count should be the number one fertility test done when you evaluate your fertility.
It is obtained through masturbation, it’s nonivasive and it guarantees the person getting tested an orgasm. What a great deal!
According to WHO World Health Association criteria these are the major parameters a sperm count checks for are:
  • Volume (over 2 cc is normal)
  • Sperm count (over 20 million per cc or 40 million total is normal).
  • Sperm morphology (percentage of sperm that have a normal shape)
  • Sperm motility (percentage of sperm that can move forward normally)
The sperm count checks to see if there are enough sperms. If the sample has less than 20 million sperm per ml, this is considered to be a low sperm count. Less than 10 million is very low.
The technical term for a low sperm count is oligospermia (oligo means few).
Some men will have no sperms at all and are said to be azoospermic. This can come as a rude shock because the semen in these patients look absolutely normal – it is only on microscopic examination that the problem is detected.

What is normal sperm motility?

Motility checks whether the sperms are moving well or not (sperm motility). The quality of the sperm (morphology) is often more significant than the count. Sperm motility is the ability to move.
Sperm are of 2 types – those which swim, and those which don’t. Remember that only those sperm which move forward fast are able to swim up to the egg and fertilise it – the others are of little use.
Motility is graded from a to d, according to the World Health Organisation (WHO) Manual criteria as follows.
  • Grade a (fast progressive) sperms are those which swim forward fast in a straight line – like guided missiles.
  • Grade b (slow progressive) sperms swim forward, but either in a curved or crooked line, or slowly (slow linear or non linear motility).
  • Grade c (nonprogressive) sperms move their tails, but do not move forward (local motility only).
  • Grade d (immotile ) sperms do not move at all.
Sperms of grade c and d are considered poor. If motility is poor (asthenospermia), this suggests that the testis is producing poor quality sperm and is not functioning properly – and this may mean that even the apparently motile sperm may not be able to fertilize the egg.
This is why we worry when the motility is only 20% (when it should be at least 50% ? ) Many men with a low sperm count ask is – ” But doctor, I just need a single sperm to fertilise my wife’s egg.
If my count is 10 million and motility is 20%, this means I have 2 million motile sperm in my ejaculate – why can’t I get her pregnant ? ” The problem is that the sperm in infertile men with a low sperm count are often not functionally competent – they cannot fertilise the egg.
The fact that only 20% of the sperm are motile means that 80% are immotile – and if so many sperm ( Sperm Video ) cannot even swim, one worries about the functional ability of the remaining sperm.
After all, if 80% of the television sets produced in a factory are defective, no one is going to buy one of the remaining 20% – even if they seem to look normal.

What is normal sperm morphology?

Whether the sperms are normally shaped or not – what is called their form or morphology. Ideally, a good sperm ( Sperm Video ) should have a regular oval head, with a connecting mid-piece and a long straight tail.
If too many sperms are abnormally shaped (this is called teratozoospermia, when the majority of sperm have abnormalities such as round heads; pin heads; very large heads; double heads; absent tails) this may mean the sperm are functionally abnormal and will not be able to fertilise the egg.
Many labs use Kruger “strict ” criteria (developed in South Africa ) for judging sperm normality. Only sperm which are “perfect” are considered to be normal. A normal sample should have at least 15% normal forms (which means even upto 85% abnormal forms is considered to be acceptable!)

Sperm clumping or agglutination.

Under the microscope, this is seen as the sperms sticking together to one another in bunches. This impairs sperm motility and prevents the sperms from swimming up to through the cervix towards the egg.

Putting it all together, one looks for the total number of “good” sperms in the sample – the product of the total count, the progressively motile sperm and the normally shaped sperm.
This gives the progressively motile normal sperm count which is a crude index of the fertility potential of the sperm. Thus, for example, if a man has a total count of 40 million sperm per ml; of which 40% are progressively motile; and 60% are normally shaped; then his progressively motile normal sperm count is : 40 X 0.40 X 0.60 = 9.6 million sperm per ml. If the volume of the ejaculate is 3 ml, then the total motile sperm count in the entire sample is 9.6 X 3 = 28.8 million sperm.

What does the presence of pus cells in the semen signify?

Whether pus cells are present or not. While a few white blood cells in the semen is normal, many pus cells suggests the presence of seminal infection. Unfortunately, many labs cannot differentiate between sperm precursor cells ( which are normally found in the semen) and pus cells. This often means that men are over treated with antibiotics for a “sperm infection” which does not really exist !
Some labs use a computer to do the semen analysis. This is called CASA, or computer assisted semen analysis. While it may appear to be more reliable (because the test has been done “objectively” by a computer), there are still many controversies about its real value, since many of the technical details have not been standardized, and vary from lab to lab.
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