Infertility is the inability of a couple to conceive for more than a year of having regular unprotected intercourse. Infertility is becoming a common problem these days due to lifestyle related problems. An average estimate suggests that 60-80 million couples suffer from infertility, out of which 15-20 million couples belong to India. The problem here is more serious because couples do not usually seek medical advice for their problem, which also affects their relationship and mental health.
‘It is estimated that 1 out of 3 times, infertility of a couple is due to a problem with woman’s fertility. Many couples could have more than one cause of infertility and may therefore require a number of tests to determine the underlying cause. Hence, it is very important for couples to consult a gynaecologist if you’re finding it hard to get pregnant,’ says Dr Abha Shroff, chief pathologist and director at Disha Pathology Labs, Mumbai.
When should women get themselves checked for infertility?
‘Before getting tested for infertility, women should try fertility awareness methods to figure out the best time to become pregnant. Some couples find that they have been missing the most fertile days of their cycle while trying . Women are most fertile during ovulation and 1 or 2 days before ovulation. Women trying to get pregnant should record their menstrual cycle and their days of ovulation. This record will help your doctor to decide whether you need to take infertility tests,’ says Dr Shroff.
Dr Shroff highlights some common baseline and advanced tests included in infertility profile that helps diagnosis of women’s infertility problems:
1. Complete blood count (CBC): A CBC gives a measure of red blood cells (RBCs), white blood cells (WBCs) and platelets in your blood. It helps in diagnosis of several conditions like infections, anemia and other blood disorders. CBC form a baseline test is you’re infertile and want to undergo in-vitro fertilization (IVF). This is because IVF procedure requires surgical procedure to retrieve eggs and it’s important for the doctor to know if you’re anemic.
2. Erythrocyte sedimentation rate (ESR): It is the rate at which your red blood cells settle down. The rate is increased in case there is an inflammation in the body. So, this test is ordered when an inflammatory condition is suspected. In infertility testing, ESR is required before going ahead with hysterosalpinogogram (HSG), a diagnostic procedure to check infertility.
3. Blood Sugar: Fasting and PP” Blood sugar levels can be affecting your chances of becoming pregnant. Therefore, checking blood sugar and insulin levels becomes important in infertility testing.
4. VDRL (syphilis testing): Syphilis does not affect fertility but untreated syphilis can affect both the mother and the fetus. Therefore, before getting pregnant this test is required and included in infertility testing.
5. Rubella IgG: This test identifies if you’re immune to Rubella virus. It is not required to diagnose infertility but every woman should be immune to the virus before trying to conceive. If a woman contracts the virus in the first 3 months of pregnancy, complications with the fetus can occur.
6. Vit B12, Vit D3 tests: Vitamin B12 or folate levels are important for identifying anemia while D3 vitamin levels are associated with infertility in women.
7. Thyroid testing: Free T3, Free T4, thyroid stimulating hormone (TSH) are thyroid hormones which if not found in the desirable range may indicate overactive or underactive thyroid gland. Thyroid dysfunction has a great impact on both ovulation and pregnancy. Here’s detailed information on thyroid profiling.
8. Hormonal testing: By checking the level of reproductive hormones, infertility caused due to interference in the process of ovulation or inadequate ovarian reserves can be identified.
- Prolactin: Prolactin is a hormone that is extremely essential for maintaining fertility in women. It inhibits reproductive hormones, namely follicle stimulating hormone (FSH) and gonadotropin-releasing hormone (GnRH). These hormones are requird to trigger ovulation in and allow the eggs to develop and mature. If you have high levels of prolactin then your ovulation might be affected causing infertility.
- AMH (Anti Mullerian Hormone): This hormone is produced by the cells in ovarian follicles. Therefore, the levels of these hormones indicate ovarian reserve or the egg supply in the ovaries A lower value could indicate infertility.
- FSH test: It is the main hormone responsible for stimulating production of eggs. A high FSH level indicates poor ovarian reserve and a low level is usually associated with polycystic ovarian syndrome (PCOS)
- LH (on day 2 or day 3 of period): LH or lutenizing hormone is one of the most important hormone for reproduction. High levels of LH can interfere with the process of ovulation and menstruation, contributing to infertility. It could also indicate PCOS.
- E2 or estradiol (on day 2 or day 3 of period): Estradiol (E2) or the primary estrogen is a major female reproductive hormone that is produced in the ovaries. The egg follicles in the ovaries secrete estradiol in order to trigger the reproductive cycle.
The entire infertility profiling would cost approximately Rs 15,000 – Rs 18,000 in most of the diagnostic centres, says Dr Shroff.
Hysterosalpingogram (HSG): Additionally, your doctor may require you to undergo a test called hysterosalpingogram (HSG). In this test a tube is inserted through the cervix to push a special dye. With the help of X-ray, the movement of dye helps to check if the fallopian tubes are open.