Ovulation problems
An ultrasound scan of the pelvis and blood and urine hormone assays can confirm ovulation and evaluate any related problems. The ultrasound scan investigates the morphology of the ovaries and monitors the growth of ovarian follicles –small bubbles of liquid containing the oocytes, the size of which gradually increases as the oocytes mature. In a normal menstrual cycle, only one follicle develops each month. When this follicle has reached a diameter of approximately 2 cm, it ruptures and releases the oocyte. This is known as ovulation. Follicular rupture is triggered by a hormone known as LH, which is found in large quantities in the preceding 24-hour urine. Simple tests can detect this hormonal peak. Ovulation is then confirmed by a progesterone blood assay, one week after ovulation, or by the disappearance (collapse) of the dominant follicle on ultrasound scanning.
Infertility of tubular origin
Hysterosalpingography (HSG) is the examination most frequently used to evaluate a problem associated with the fallopian tubes. This is a radiological examination in which a liquid (contrast medium) is injected into the uterus and fallopian tubes from the Cervix uteri. The passage of the liquid is monitored on a screen. Approximately 4 to 5 X-rays are taken during the examination. The irradiation dose is very low. The liquid fills the uterine cavity, outlining the contours, and then continues to the end of the fallopian tubes where it freely flows off if the tubes are healthy. If the liquid does not pass through the fallopian tubes, does not fill them completely or fails to run off at the ends of the tube, the latter are probably damaged in some way.
Diagnosis will then be based on an examination that directly displays the fallopian tubes : laparoscopy. This is a minor surgical procedure carried out under a general anaesthetic. An optical lens tube (laparoscope) is introduced through the navel via a small incision. The laparoscope is connected to a camera and a television monitor to give an excellent view of the internal female organs (uterus, ovaries and fallopian tubes). The injection of a blue dye into the fallopian tubes from the Cervix uteri confirms whether or not the tubes are permeable.
Infertility of cervical or uterine origin
The post-coital test is used to evaluate the quality of the cervical mucus and its interaction with the spermatozoa during the fertile period. A small quantity of mucus is collected from the Cervix uteri a few hours after intercourse. The quality of the mucus is assessed on the basis of several criteria (volume, consistency, clarity and pH). It is then placed on a slide and examined beneath a microscope for mobile spermatozoa.The uterine cavity is assessed by radiological examination comprising the injection of a contrast medium from the Cervix uteri (hysterosalpingography) or by direct visualisation of the interior of the cavity (hysteroscopy).
Age-related infertility
Hormone assays (FSH, estradiol, AMH) of the blood on the second or third day of the period and an evaluation of the number of ovarian follicles on ultrasound scanning are carried out to determine the ovarian reserve, i.e. the residual fertility potential. An elevated FSH, a low AMH and the presence of ≤ 5 follicles per ovary indicate that the chances of pregnancy are reduced.
Infertility of masculine origin
Analysis of the semen (semen analysis) is the reference examination. It is essential in any evaluation. A sample of semen is collected by masturbation and the following parameters are evaluated: volume (quantity), concentration (count), mobility (movements) and morphology (appearance beneath the microscope) of the spermatozoa. Signs of infection (white blood cells, bacteria) are also tested for as this may explain the decline in the quality of the semen. If an abnormal result is obtained, a second sample is indicated because the quality of the semen can fluctuate over time. A clinical examination conducted by a specialist (urologist or andrologist) is recommended in order to rule out any local cause of an abnormal semen analysis . In the case of azoospermia, surgical exploration of the excretory ducts or testicles is useful to check for the presence of spermatozoa in this region. They can thus be collected and preserved for medically assisted procreation.
Diagnostic hysteroscopy
This is carried out on an outpatient basis in the doctor’s surgery or sometimes in an operating theatre. In principle, no specific preparation is required. It can confirm the presence of any anomaly in the uterus or establish that the urine cavity is indeed normal and ready for embryo implantation.
Diagnostic laparoscopy
The abdomen is inflated with CO2 (carbon dioxide) and a one-centimetre incision into the umbilicus (which will leave very little scarring, if any) facilitates the insertion of a telescope (laparoscope) connected to a video camera.
Two further incisions of 5 mm are usually made in the sub-pubic region to allow the introduction of fine instruments used to handle the organs. The interior of the abdominal cavity can be inspected and the integrity of the fallopian tubes, ovaries and uterus checked.
Diagnostic laparoscopy is performed in an operating theatre under a general anaesthetic.
