Investigating the cause of infertility

When should a couple seek help for infertility?

  • Couples below the age of 35 who are unable to conceive within a period of 12 months
  • Couples above the age of 35 who are unable to conceive within a period of 6 months
  • Sooner, should any of the following be known:
    • if the female partner is older than 35
    • If the female partner has a known decreased ovarian reserve, irregular periods, abnormalities of the uterus, fallopian tubes or ovaries
    • If the male partner is known to be sub-fertile

However, since age plays such a significant part in infertility, couples are encouraged to seek help sooner rather than later. The earlier problems are detected and addressed, the greater the chance of success.

Investigating the cause of male related infertility

Your Fertility Specialist at Genesis Reproductive Centre will refer you to a Specialist Urologist for an assessment if deemed necessary. The following is what you can expect.

initial consultation

  • Your Fertility Specialist or Specialist Urologist will take down your medical history. The following information is of importance:
    • Your reproductive history
    • Details of your past and present sexual health
    • Childhood illnesses and developmental issues
    • Past medical and surgical history
    • Medication you used in the past and the present
    • Family history
    • Current state of health
  • A physical exam will be performed. A genital examination is neccesary to determine the presence of abnormalities in the penis, testes epididymis and Vas Deferens. A rectal exam will also be performed if neccesary to indicate any abnormalities of the prostate.
  • Blood and/or urine tests will be performed. This usually includes a hormone profile as well as tests to detect the presence of any underlying infections.
  • Your Specialist Urologist, if deemed necessary, will refer you for more advanced tests as described below.

semen analysis

This test is available at Genesis Reproductive Centre. You will be required to provide a sample of your semen for analysis by an andrologist.

The following will be evaluated:

  • Sperm count
  • Morphology (the size and shape of the sperm)
  • Motility (the movement of the sperm)
  • The presence of anti-sperm antibodies

testicular biopsy

A testicular biopsy is usually performed by a Specialist Urologist. 

It is indicated if no sperm were found in your semen sample.

A piece of tissue is removed from the testes under local anaesthetic and evaluated for the presence of sperm which can be used for reproductive treatment.

ultrasound

  • An ultrasound scan of the scrotum may identify any blockages or varicoceles around your testicles or sperm ducts.
  • A transrectal ultrasound may also be performed by placing a probe in the rectum. It is useful in identifying any abnormalities or blockages of the seminal vesicles and ejaculatory ducts.

genetic tests

This test may be offered if a low sperm count or no sperm were found in the semen sample.

It is useful to determine if infertility is caused by a genetic abnormality and also provides valuable information on the transfer of genetic problems to future offspring.

Investigating the cause of female related infertility

Initial consultation

  • Your Fertility Specialist will take down your medical history. The following information is of importance:
    • Details of your past and present sexual health
    • Past medical and surgical history
    • Details on your menstrual cycle
    • Family history
    • Current state of health, in particular your BMI
    • Details on your  lifestyle habits such as smoking, caffeine and alcohol consumption
  • A physical exam will be performed. Your breasts will be examined for lumps and an internal exam will be performed to look for infections and inflammation in your vagina and cervix.
  • A pap smear will be performed to identify the presence of abnormal cells on the surface of the cervix.
  • Blood and/or urine tests will be performed. This usually includes a hormone profile as well as tests to detect the presence of any underlying infections.

pelvic ultrasound

This examination is performed by your Fertility Specialist at your initial consultation.

It enables the visualisation of the uterus and ovaries whereby the presence of endometriosis, polyps, fibroids and ovarian cysts can be diagnosed.

Antral follicle count (AFC) will also be performed. This is where the amount and size of the follicles on the ovaries are assessed, which is invaluable information when determining the cause of infertility and the course of treatment to follow.

Hysterosalpingogram (hsg)

This very useful investigation involves taking an x-ray of the pelvic area after contrast dye is inserted through the uterine passage. This enables visualisation of the cervical canal, uterine cavity and fallopian tubes.

The following can be assessed:

  • Shape, outline and abnormalities of the uterus such as uterine septum, fibroids and polyps
  • Abnormalities of the cervix
  • Patency and functioning of the fallopian tubes

This procedure is performed at the radiology department by a Fertility Specialist or radiologist assisted by a radiographer.

hysteroscopy

This procedure is useful in evaluating the cervical and uterine cavity.  Fibre optic scopes are inserted via the cervix into the uterus. The picture is transferred from the fibre optic lenses to a colour monitor where it can be evaluated for abnormalities, such as uterine septums, polyps and fibroids. Surgery can be performed then and there to correct these abnormalities using hysteroscopy.  

This procedure is performed in theatre under general anaesthetic. The patient is usually discharged the same day. Some Fertility Specialists can also perform the procedure in their consultation rooms.

laparoscopy

This procedure involves inserting a camera and surgical instruments into the abdomen through openings in the abdominal wall.

A highly skilled gynaecologist are then able to visualize the female pelvis and abdomen three dimensionally, diagnose the problem and surgically correct the problem at the same time.

The major benefit of this procedure is that there are minimal post-operative discomfort for the patient and shorter recovery time needed.

The procedure is performed in theatre under general anaesthesia and the patient can go home the same day, depending on the extent of the surgery performed.

Recurrent miscarriage screen

This involves a series of tests, including blood and genetic tests.

It is usually offered to patients who suffered at least 3 miscarriages, in aid of identifying the underlying cause of the pregnancy loss.

contact us to take the first step

We are ready to answer your questions.

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Suite G20 Mediclinic Kloof 511 Jochemus Street Erasmuskloof

Call us

+27 12 3674378

E-mail

info@genesisart.co.za

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