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Normal Fertilization
Fertility Tests
To determine if the male partner has problems is easy. The basic test is to test the semen. If this is abnormal, more tests will be advised. However some additional tests will be done if fertility treatment is being considered.
To determine if the female partner has problems concerning ovulation, egg transport, fertilization or implantation, various tests may be administered based on the physician's examination and analysis. They include:
Serum hormone testing
Includes the levels of luteinizing hormone, follicle stimulating hormone (FSH), prolactin, progesterone and thyroid stimulating hormone (TSH).
Performed to assess the uterus and the ovaries. Other pelvic abnormalities can be diagnosed and further procedures can be planned based on the findings. Antral follicle count (AFC) which reflects ovarian reserve, can be assessed during a pelvic ultrasound scan.
Endometrial biopsy
Used to detect genital tuberculosis. This is obtained as a tiny tissue sample from the endometrium at the time of periods.
often done in conjunction with a laparoscopy to examine visually the interior of the uterine cavity for scar tissue, adhesions, polyps, tumors, and other abnormalities. When appropriate, these can also be treated at the same setting.
Diagnostic laparoscopy
a minimally invasive surgical procedure. It permits direct visual assessment of the uterus, fallopian tubes, ovaries, and lower pelvis. Through this procedure, endometriosis, tubal disorders and pelvic adhesions can be diagnosed and treated.

Typically, you and your partner will have a consultation with your fertility specialist after which you will be advised about the tests that you both will need to undergo. These may be done in more than one stage as some of the tests need to be done at specific times of the menstrual cycle (some within the first three days of the period and some after ovulation). Similarly the male partner will also be advised on the number of days of abstinence before the semen test is done. The second consultation will be after all the tests are complete. Further treatment options will also be discussed at this consultation.
Male factors
    Male factor problems may be as a result of:
Inadequate or abnormal sperm production and /or delivery
Anatomical problems
Previous testicular injuries
Hormonal abnormalities
Semen analysis
We encourage male partners to have their semen analyzed at our Laboratory so their samples can be tested against rigorous standards. In addition to the routine analysis of our morphology, motility, and concentration, some of the additional testing we perform on the semen includes:
Semen culture to detect infection
Testing of anti-sperm antibodies
Additional diagnostic testing in patients with severe abnormalities e.g., HOS test
Abnormal semen analysis
An abnormal sperm analysis is repeated first for verification. Sometimes there is no sperm present in the semen. This condition is termed as Azoospermia. Typically, the male partner is referred to a urologist for evaluation. If the urologic evaluation is normal, results of the sperm count determine further treatment.
Sperm antibodies
Anti-sperm- antibodies are substances that attach to the surface of the sperm and may interfere with the ability of the sperm to move & penetrate the cervical mucus, or to fertilize an egg. They must be meet out when infertility is either unexplained, following an abnormal postcoital test, or when significant sperm coagulation is noted in the initial semen analysis. Our laboratory uses the immunobead technique to detect sperm antibodies. If they are detected, sperm washing in conjunction with IUI is considered. ICSI may also be advised.
This condition refers to the absence of sperms in the ejaculate. The reason for lack of sperms may be a blockage in the man’s reproductive system (obstructive azoospermia) or failure of the testes to produce sperm (testicular failure). In order to confirm azoospermia, sperm test needs to be repeated. In order to assess the cause, physical examination as well as blood tests is required. Testicular biopsy may also be required to prove presence of sperms. Our andrologist should be able to advise you with respect to your condition as well as the options for achieving pregnancy.
Obstructive Azoospermia
3-10% of infertile men are born with without the tubes that carry sperm from the testes to the penis. Blockage due to infection (such as gonorrhoea, tuberculosis, testicular mumps, heat exposure, athletics, hypogonadotropic hypogonadism etc.,) or a previous operation, such as a vasectomy, hernia repair can also result in this condition.
Men with obstructive azoospermia have good chances of achieving pregnancy through assisted reproductive techniques (ART). Sperms are extracted surgically from the testicle or the epididymis (depending on site of obstruction) and used to fertilise eggs from the wife/female partner. The embryo thus formed can be transferred into the uterus and the couple thus have realistic chances of achieving pregnancies.
Testicular Failure
Azoospermia may be due to the testicles not functioning well. Failure may occur gradually such that the number may progressively decrease and eventually complete absence of sperm cells may result. Sometimes it is possible to identify a reason, such as previous treatment with chemotherapy drugs, radiation treatment, sertoli cell syndrome etc., but often no cause is found. Depending on the severity of the failure, it may or may not be possible to achieve pregnancies using the husband/male partner’s sperm. In the most severe cases, donor sperm may be the only option.
FISH – Fluorescent In - Situ Hybridisation (Semen Analysis)
The use of chromosome specific DNA probes labelled with fluorochromes and especially the combination of several probes has been used to indirectly study the chromosome constitution in condensed sperm nuclei by fluorescence in-situ hybridization (FISH), and has allowed to include this test in the protocol of study of infertile males. Sperm DNA fragmentation can also be studied using FISH. Sperm DNA damage can be detected by SCSA (Sperm Chromatin Structure Assay) and TUNEL assay. Sperm DNA damage and fragmentation studies are important as increase in DFI (DNA fragmentation Index) is correlated with less chance to father a child. Nowadays, the predictive powers of these tests, and in particular SCSA, seem to be reduced as more rigorous technologies are used to treat infertility. SCSA definitely remains predictive of natural conception and IUI, but once IVF or ICSI treatment is adopted then SCSA loses its predictive power.
 Female factors
Many conditions in the female partner create a barrier to pregnancy. This may be a mechanical obstruction to the sperms ascending up, or those preventing release of egg or implantation of embryo formed by the union of the egg and the sperm. Sometimes conception occurs but the pregnancy occurs in a miscarriage.
Common causes of female infertility
Problems with
Ovulation: irregular or no ovulation may be the cause for infertility. The reasons may be many, including very high or very low body mass index (BMI), Polycystic ovaries, premature failure of ovaries, thyroid problems etc.
Tubes: Infection caused by gonorrhoea, Chlamydia etc cause inflammation of the tubes resulting in blockage thereby causing infertility. Past surgery for sterilisation through tubal clipping also impacts conception by preventing the sperms from meeting the egg.
Uterus: Surgery for abortion or miscarriage can result in an abnormal lining of the uterus thereby impacting on conception. Abnormalities such as fibroids (harmless growths of the muscle of the uterus) especially those growing into the cavity of the uterus are thought to have a detrimental effect on the chances of pregnancy.
Peritoneum such as endometriosis through several mechanisms including ovulation, tubal blockage and adverse effect on the lining of the uterus.
Are you at risk of female infertility?
Different risk factors put you at a higher chance of female infertility, including:
From around the age of 25 the chances of getting pregnant start to decline. By the age of 35 most women are half as fertile as they were at 25. As more and more women are choosing to postpone starting a family until later in life to suit modern careers and lifestyles, this introduces a risk that some women may ignore: trying to have a baby later in life can significantly affect your chance of becoming pregnant.
Extreme dieting or poor diet
Being overweight or underweight
Cigarette smoking, drugs, and alcohol
High caffeine intake
Health problems and medications
Environmental toxins
Genetic conditions
Sexually transmitted diseases
In most cases of female infertility, your doctor can do a fertility workup. Through a physical examination and tests, doctors may determine the problem. Then, treatment with medications and/or surgery or high-tech procedures may help you get pregnant.
Facing the diagnosis of infertility (the reason for which may or may not be known) is a difficult and complex task. A lack of awareness compounds the anxiety caused from the inability to conceive and the uncertainty about the future.
Do not despair. There are always answers to every problem. Let us help you understand the cause of infertility. Once this is done we can discuss the options that you have in order to conceive. We will plan your treatment based on your choice and convenience.
No matter what is causing infertility, there are answers. Talk with your fertility specialist. In many cases, planning ahead and preventing female fertility problems early on can help set the stage for a healthy pregnancy.
Recurrent Miscarriage
When a woman suffers three or more miscarriages in a row, these are termed as recurrent miscarriages. Around one in every 100 women has recurrent miscarriages and can be due to various reasons. Investigations should be done to find answers on why the miscarriages occurred so that treatment options can be determined to improve likelihood of a successful pregnancy.
To help determine the cause of miscarriages, your doctor may run the following tests:
Anatomical Evaluation: Your physician will conduct a thorough examination to determine if there are any acquired or congenital defects in the uterus. The various methods employed are:
Hormonal Tests: Through blood testing doctors can evaluate your hormone levels to determine if a hormonal disorder is the cause of your pregnancy losses.
Genetic Tests: Your doctor may run genetic testing on you and your partner. More than half of miscarriages that occur within the first 13 weeks of pregnancy are caused by problems with the chromosomes of the foetus. There can be problems with the number or structure of the chromosomes or with the genes they carry. Extra or missing chromosomes or genes will prohibit the foetus from developing properly. Quatriple test is performed at 15 weeks of gestation to know the status of the feotus and mentally retarded child.
Autoimmune Tests: Your doctor may request blood tests to screen for an autoimmune syndrome which affects blood clotting and may increase your risk of miscarriage.
What can be done?
Supportive antenatal care
  Women who have supportive care from the beginning of a pregnancy have a better chance of a successful birth.
Screening for abnormalities in the structure of your womb
  An ultrasound scan and/or hysteroscopy may be used to detect uterine abnormalities. In case there is a uterine septum, this may be correctable by surgery.
Screening for abnormalities in the embryo
  Checking the embryo chromosomes in case of recurrent miscarriages linked to a certain abnormality can be done using Pre-Genetic Screening or at a later stage of the pregnancy via Chorionic Villous sampling or amniocentesis.
Treatment for APL antibodies
  A combination of Heparin and Aspirin started early in the pregnancy

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Shivdikar Human Reproduction & Fertility Centre
Shivdikar Human Reproduction & Fertility Centre
Shivdikar Human Reproduction & Fertility Centre
Shivdikar Human Reproduction & Fertility Centre
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Dr. Ashok H. Shivdikar
Shivdikar Hospital & Fertility clinic
Shivdikar building No. 28-A, J.B. Road,
Opp. Shirodkar Market, Parel (East), Mumbai- 400 012

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