How Is Infertility Evaluated?

According to Dr. dr. Binarwan Halim, Sp.OG(k), M.Ked(OG), FICS, obstetrician-gynecologist, Director of Halim Fertility Center (HCF), IVF Center of O& G Dept. of Faculty of Medicine of USU, Medan. Infertility tests for women are more complex. There are five disorders required to be checked as one of which may be causing the infertility. Whereas for men, the most important analysis needed is sperm test.

Several ways to find out about women' s fertility may include

1. Evaluation of the menstrual cycle, whether or not the cycle is normal. Period must occur regularly every 28-30 days. If period happens irregularly, it can be suspected that the woman is infertile since she does not ovulate properly. A test shall be conducted using USG to observe the ovum as it swells and ovulates, ready to be fertilized by sperm. For normal period cycle, a blood test shall be taken on the 21st day to examine the progesterone hormone. This test will reveal if there is ovulation.
2. Fertility test, to find out if there is ovulation using urine (Ovu Test) or by examining the vaginal discharge.
3. Fallopian tube test, to determine if the tube is blocked, conducted through a HSG test. The test is performed using USG to find out if there is a tumor, myoma, or cysts.
4. Cervical discharge test, conducted through Post-Coital Test (PCT) to measure the sperm penetration in the cervical area.
5. Fertility hormones test, performed to women with irregular periods.

"Whereas men' s fertility can be revealed through routine semen analysis. There are three components to consider, namely:

1. Sperm number, must not be less than 15 million per cc.
2. Sperm motility (sperm' s ability to " swim" ), must not be less than 42%.
3. Sperm morphology, the ones with oval-shaped head and long tail, must not be less than 4%," said dr. Binarwan.

"From these infertility tests, usually the complete detail of the cause cannot yet be identified. There is a 30% probability of other causes which are categorized as unknown infertility causes, usually called as idiopathic. The cause for these disorders cannot be revealed completely as it is so intricate. For example, the sperm' s ability to penetrate the egg we cannot know whether they will develop further, we cannot know if they will be able to attach themselves on the lining of the uterus (endometrium) once they are developed. We cannot check if they have the ability to develop further into a fetus. We cannot determine if there is a genetic disorder either. No test can be done for that," said dr. Binarwan.

"To check for disorders leading to infertility, a special laboratory analysis is required. For example, Anti-Mullerian Hormone (AMH), FSH, and estradiol can be conducted to analyze the ovary or the sufficiency of the ovarian reserve. Prolactin, testoterone, and FSH & LH tests can be performed to reveal the presence of hormonal disorder. Tumor marker such as CA 125 can be performed to check for cysts," said dr. Binarwan.

"Whereas hysterosonography using X-ray can be conducted to examine the uterine cavity. Sperm analysis can be performed to examine the sperm. FSH, testosterone, and prolactin tests can be performed for patients with low number of sperm, below 5 million," Binarwan concluded.