Infertility is defined as inability of a couple to conceive after 12 months of unprotected sexual intercourse or can not carry the pregnancy to full term. It effects over 5 millions couple alone in the U. S. and many times more in the world, because of unawareness of treatments, only 10% seeks help from professional specialist. In fact, More than 40% of infertility of a couple is caused by male inability to fertilize. Diagnosis is a analytics approach, after initial consultation and medical history and personal information have been taken from a patient or couple. The main objective conventional diagnosis is to find the causes of infertility, but unfortunately, it has less than 1% successful rate. We will try to give you the definitions of type of diagnosis in alphabet order.
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Before reading the definition of types of diagnosis, you may want to know briefly what important information will be record on your personal file
I. General medical history
1. Any miscarriage, previous pregnancies and abortion.
2. Any ectopic pregnancy
3. Any previous surgery
4. Have you now on HRT.
5. Use of conceptive method, type of use
6. Any reproductive chronic pain including STD. urinary tract infection ad chronic diseases.
7. Medication you are taking now
8. Any medication of your mother during pregnancy to rule out infertility caused by birth defect
9. Your lifestyle.
II. Physical Exam
1. Male exam
a) Testicle related including injure, childhood testicle illness and abnormal in birth
b) Age of puberty
c) Number of previous sexual partners
d) Question related to ejaculation and impotence
e) Do you have child with other women
f) Have you ever contacted and treated with sexual transmitted diseases
g) Hot bath and sunnas
h) Smoking and drugs abuse
i) Expose to radiation
j) workplace hazard
k) Medication may influence your sexual organs.
l) Other general exam depending to your specialist (herbalist or others)
2. Female exam
a) reproductive organs infection
b) Any previous reproductive organ surgery
c) Pelvic exam
d) Question related to genetic defect.
e) vagina exam
f) Uterus and cervix
g) Fallopian tube
h) Ovaries
i) Bladder
k) Rectum
l) Other general exam depending to your specialist (herbalist or others)
III. Diagnosis or test From Conventional Perspective from letter A to Z
A. For Male patient
1. Acrosome reaction test
After the sample is taken your fertility specialist exam the acrosome reaction of your sperms to see how your sperm penetrate the female egg, how the enzymes (acrosome then acrosin released from the sperm head ) in sperm work through tough coating of the eggs and fgertilized it. The purpose of this test is to diagnosis the sperm acrosome then acrosin to see hoe these enzyme help to break tough surface of the egg. If not it may be the cause of infertility and specific treatment is required. It happens only 5% of infertility male population.
2. Antisperm antibody
3. Biochemical analysis
The study of the chemical substances and vital processes occurring in male testicle such as the concentration of white blood cells, the level of fructose in the semen, and the volume, pH, and liquefaction time of the ejaculate.
4. Computer-Assist semen analysis
The sample of sperm is scanned in to the computer pre store program to show how the sperm quality, quantity, shape and movement. Since any small change of the computer may produce a significant change in sperm calculation, therefore any abnormal sperm count should be confirmed by manual count.
5. Hemizona assay
Hemizona assay is the analysis to compare sample sperm of the male to the sperm of the fertiliized male by splitting the marure and normal egg into 2 half. 1/2 is tested by sample sperm and the other half is tested by fertilitized male sperm.
6. Hormone evaluation
Hormonal evaluation is a study to measure the levels of certain hormones produced by your body such as levels of FSH and testosterone which are inlvoved directly in sperm production. The test will only be used is the semen of sperm anaalusis come back with low density of sperm or your specialist suspects that hormone imbalance is the cause of infertility.
7. Human zona pellucida binding test
The testes help to exam how the sperm bind to outer layer of the egg. including hemizona assay.
8. Hypoosmotic swelling test (HOST)
hypoosmotic swelling test (HOST) is the test used to identify sperm membrane for structure integrity by examining how the sperm tails react to special sugar and salt. Only healthy sperm can react in that circumstance.
9. Pene trak
Pene trak is the test for 90 minutes to check the movement of sperm through a normal and friendly mucus in the test tube.
10. Peroxidase staining
It is a test to check for infection by differentiating white blood cell from the immature sperm.
11.Post-coital/cervical mucus test
It is a test to see how friendly the mucus of the cervix toward the sperm invasion during ovulation. The result can be determined after
a) Male partner sperm with female partner cervical mucus
b) Male partner sperm with healthy mucus
c) Known healthy sperm with female partner mucus
d) Known healthy sperm with known healthy muscle
12. Sperm penetration assay (hamster test)
Sperm penetration test only is needed if the normal semen test can not determine the sperm penetration ability then hamster eggs with the ouster membrane has been stripped off are used in place of female eggs because of it's structural similarity to human eggs. After the sperm and hamster eggs have incubated for three hours, the eggs are checked for sperm penetration. Any percentage over 10 % is considered normal and potential for fertilization. Since is uses eggs than human being, good sperm penetration rate in hamster test does not guarantee 100% of positive result in human.
13.Sperm-Ubiquitin tag immunoassay (SUTI)
Sperm-Ubiquitin tag immunoassay ignores other sperm attributes and focusing solely on sperm's ubiquitin because ubiquitin is considered as a universal marker of any sperm abnormalities including sperm damage and sperm defective, thereby reducing some unecessary treatments.
14. Semen analysis
A semen analysis is usually the first test for all infertility male , it helps to measure the amount of semen a man produces and determines the quantity and quality of sperm such as size, shape. movement and PH level in the sample.
a) Normal form sperm
Ovary head, single tail with intact midsection and an uncoiled.
b) Abnormal heads
Head of sperm if too big or too small and other than ovary head.
c) Abnormal tails
Coil, broken, bent tail and other than single tail.
d) Immature gen cells
Since white blood cells and white gen cells have a very similar apprance and structure, it is up to the specialist to make sure that the present is immature gen cells and not white blood cells.
e) Vital staining
It is the analysis to see the percentage of dead sperm compare to lice one.
f) Urinalysis
It is to make sure the infertility is not caused by retrograde rejaculation and the urinary tract is not infected.
15. Scrotal sonography
Scotal sonography is used to evaluate the testicle disorder and surrouding organs including prostate gland, epididymis, an absent or undescended testicle and any testicle abnormality.
16.Testicle biopsy
A small is taken and tested for the ability of sperm producing cell to produce normal cells. This test is necessary if the infertility male is found to have no sperm in semen, normal sex levels of hormone and abnormal sperm with unknown cause. The risk of the test may cause testicle damage.
17. Vasography
Vasography is a Radiographic study of the vas deferens. It helps to determine if the vas deferens is blocked or not and the reason of such blockage. In this study, if there is large amount of sperm containing fluid presented when the vas deferens is open, it indicate there is a block appeared in the vesicle end of the vas deferens. If there is no fluid presented, the procedure continue until the cause of blockage is found, if there is one.
B. For Female patient
1. Antisperm antibody test
The antisperm antibody test is one of procedure which helps to see the antigens in the body to see the immune system function toward sperm invasion through blood test. If the immune system recognized or not the sperm as the foreign object and produces white blood cells to kill them.
2. Blood test
Routine blood test is not necessary for infertility women, but sometimes blood test is ordered to check for anaemia, blood type and antibody. Or sometimes to check estradiol, LH, FSH and progesterone.
3. Cervical test
Cervical test is the study of the cervical mucus thoughtout menstrual ccycles and to see the mucus is friendly to sperm invasion or not, there are 2 types of cervical test
a) Spinnbarkeit
With the Spinnbarkit is a self help kit, it can be done by the women at comfort at her own home to exam the mucus characteristics, because the mucus consistently change throughout menstrual cycle.
b) Postcoital test
This test is done just before ovulation to see the cervical mucus is friendy to sperm invasion.
4. Endometrial biopsy
Endometrial biopsy removes some tissue from the infertile women uterine lining to chech for any endometrial adhesion and implants.
5. Hysteroscopy
It is a study of infertile women uterine abnormality by placing a small, thin with small telescope through the cervical canal to check the inside of uterus.
6. Ovulation test
Since failure of ovulation is account for over 25% of female infertility, your doctor may order ovulation test right after first visit. It helps to determine" Are the eggs produced each month?".
7. Progesterone test
Since progesterone is produced with high amount right after the eggs has emerged to stimulate ovulation because low levels of progesterone interferes with the ovulation of women menstrual cycle, causing infertility. Blood test is done at the 4 -9 days after predicted ovulation for women with 28 days cycle.
8. Radioimmunoassays (RIAs)
Radioimmunoassay (RIAs) is a very sensitive technique used to measure concentrations of antigens including levels of testosterone, LH, FSH, prolactin. It helps your doctor to determine that the infertility is not or caused by hormone imbalance of certain hormones during menstrual cycle.
9.Tubub patency test
It is the test to check the health of Fallopian tube and make sure there is no blockage in the tube with X ray examination. Normally, dye is injected through the cervix, it then fill the uterus and flows into the Fallopian tube, if there is blockage, the pressure may build up causing pain.
10 Ultrasound
The use of high frequency in ultrasound exam to check for any abnormality in the region including the ovulation scan which is see when egg mature and when a women ovulates and the thickness of the uterine lining, etc.
11.Urinaryluteinizing hormone ( LH) test
This is an urinary test which is used to check the levels of LH to igentify the surge of LH just before ovulation. It usually use to determine the best time for a couple to have sex and the female partner getting pregnant.
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