F ertility Testing

1. Fertility Testing Sana Javed AmnahMahroo SidrahNaseem Fatima Darakhshan TehreemTanveer MishaMazhar

2. Fertility Testing • Required when infertility is suspected: the biological inability of a person to contribute to conception • The state of a woman who is unable to carry a pregnancy to full term

3. Female Infertility: Pathophysiology • Age • Weight • Genetic causes: Gonadaldysgenesis (Turner syndrome) • Hypothalamic-Pituitary disorders • Anatomical disorders

4. Female Infertility: Pathophysiology

5. Pathophysiology: Ovulatory problems • Premature menopause • Luteal dysfunction • Ovarian cancer

6. Tubular Infertility When fallopian tubes become damaged or blocked, they keep sperm from getting to the egg or close off the passage of the fertilized egg into the uterus. • Infection  • Abdominal Diseases  • Previous Surgeries  • Ectopic Pregnancy  • Congenital Defects

7. Pelvic causes • Pelvic causes include any disruption of the normal pelvic anatomy: • Scar tissue or "adhesions" • Endometriosis • Blocked, scarred, or distorted fallopian tubes • Benign tumors (fibroids) of the uterus

8. Cervical infertility involves inability of the sperm to pass through the mouth of the uterus due to damage of the cervix. • Causes: • Inadequate or inhospitable cervical mucous • Cervical narrowing or "stenosis" • Infections of the cervix with common sexually transmitted diseases \ • Immune attack of sperm or "sperm allergy“

9. Uterine causes • Uterine causes include: • Thin or abnormal uterine lining • Anatomic problems (polyps, uterine fibroids, abnormal shape of the uterus, septum or "dividing wall" within the uterus)

10. Unexplained Infertility • Difficulty in picking up the egg by fallopian tube • Failure of implantation of the embryo into the uterus • Failure of the sperm to fertilize the egg when in contact with each other Behavioral Factors:  • Diet and Exercise • Smoking • Alcohol • Drugs Environmental and Occupational Factors:  • Lead • Medical Treatments and Materials • Ethylene Oxide • Dibromochloropropane (DBCP)

11. Fertility Test For Women Cervical Mucus Test Cervical mucus becomes clear and stretchy Allow sperm to survive in and travel through it. The consistency of fertile mucous is akin to egg white. Ovarian function tests To check functioning and working of hormnes during your ovulation cycle. Tests include Day 3 FSH Day 3 Estradiol blood tests to determine the levels of inhibin B.

12. Post Coital test(PCT) To determine: • receptivity of cervical mucus • ability of sperm to penetrate the cervical mucus and to maintain activity • volume of mucus is measured • amount of mucus is determined ( scant, moderate, profuse ) • Color and clarity is noted • involves a bacterial screening.

13. Ultrasound tests • assess the thickness of the lining of the uterus (endometrium) • monitor follicle development • to check the condition of the uterus and ovaries. • maybe conducted two to three days later to confirm that an egg has been released.

14. Hormone Tests Hormone tests include the following: • Luteinizing Hormone • Follicle Stimulating Hormone • Estradiol • Progesterone • Prolactin • Free T3 • Total Testosterone • Free Testosterone • DHEAS • Androstenedione

15. Endometrial biopsy • Endometrial biopsy is a procedure in which a tissue sample is taken from the lining of the uterus and is checked under a microscope for any abnormal cells or signs of cancer • NORMAL RESULTS: • The biopsy is normal if the cells in the sample have no abnormalities. • ABNORMAL RESULTS: • Endometrial cancer or precancer (hyperplasia) • Uterine fibroids • Uterine polyps • Infection • Hormone imbalance • If the lining is being tested for infertility, the sample may determine if hormones are properly stimulating the lining so that the fertilized egg can implant.

16. Laparoscopy

17. Hysteroscopy • A narrow instrument called hysteroscope is inserted into the uterus enabling the doctor to examine it. • There are two types of hysteroscopy. Diagnostic hysteroscopy is used to detect any problems inside a woman's uterus. Operative hysteroscopy is used to help perform surgical procedures • What Can Hysteroscopy Detect?Diagnostic hysteroscopy can be used to detect a number of uterine abnormalities that may be contributing to infertility. These abnormalities include: • uterine fibroids • uterine adhesions • uterine cysts • septate uterus

18. Hysterosalpingogram • A hysterosalpingogram (HSG) is an X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them. • PROCEDURE: • A dye is put through a thin tube into the uterus. • The dye will flow into the fallopian tubes because the uterus and the fallopian tubes are hooked together. • Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. • The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage in the fallopian tube.

19. Male Infertility: Pathophysiology • Complete absence of sperm (azoospermia) • Low sperm count (oligospermia) • Abnormal sperm shape (teratozoospermia) • Problems with sperm movement (asthenozoospermia) • Sperm that is completely immobile (necrozoospermia); the sperm may be alive and not moving, or they may be dead • Problems with sperm delivery, due to sexual dysfunction, an obstruction, previous vasectomy, or retrograde ejaculation • Problems with erections or other sexual problems

20. Male Infertility Tests Diagnosing male infertility problems usually involves: General physical examination and medical history • Examination • Questioning about any inherited conditions • chronic health problems illnesses • injuries or surgeries that could affect fertility. Semen analysis • Semen is generally obtained • sent to a laboratory to analyse • signs of problems such as infections

21. Additional tests 1. Scrotal ultrasound 2. Transrectal ultrasound. 3. Hormone testing

22. Post-ejaculation urinalysis • Genetic tests • Testicular biopsy • Anti-sperm antibody tests