The causes for female infertility can be classified in 5 equal groups:
The primary evaluation of the woman consists of the following:
- A sperm specimen from the man
- About 1 - 2 months – at a maximum – measuring the body temperature in the morning
- HSG (Hysterosalpingography)
- A serum progesterone analysis, once, on day 20 to 23 in the menstrual cycle
- A serum FSH and a serum LH analysis, once, on day 3 to 5 in the menstrual cycle
Comments on the counseling of the couple
Re 1) Measuring the basal body temperature in the morning is recommended as a way to teach women more about their menstrual cycle. For anovulatory women and women with a menstrual cycle of more than 35 days this makes no sense. The diagnostic certainty is very low.
Re 2) HSG can reveal obstructions, fibroma uteri, etc. Many clinics consider this examination fundamental prior to referral to hospital. It is important to note that 30% of the HSG results can be incorrect.
Re 3) The serum progesterone analysis can be made at the same time as 1) and will demonstrate whether there has been an ovulation. Values of more than 20 nmol/l is a certain evidence of ovulation.
Re 4) - see male infertility. Often a result from a sperm count states a lot of figures. In general, a sperm specimen is normal if it contains more than 15 mill. motile sperm cells per ml and more than 40% have a normal appearance. If antibodies are detected, the patient often has a problem.
Re 5) If women in more than one menstrual cycle have increased values of serum LH and serum FSH (more than 10 IU/l) their chances of conceiving are very reduced at any kind of infertility treatment.
Occasionally also diagnostic laparoscopy is needed to evaluate the peritoneal surface and anatomy of the genitals.
This includes laparoscopy for
- Confirming patency of the tubes
On the basis of these tests the patients can quickly be catalogued and referred.