Fertility Screening

Fertility Screening Programmes

As a woman ages and her biological clock winds down, so too does her chances of achieving pregnancy become more difficult. Some women may also have structural problems in her reproductive system, such as blocks in her fallopian tubes.

Initial Screening Tests

Blood Tests
Most often, blood tests are done on the woman. These may include full Blood Count, Blood Group And Rhesus Factor, Rubella IgG, FSH, LH, Estrogen, Prolactin Thyroid Function Test, HIV, Hepatitis B, Syphillis
Hormone Tests
This is done to check the levels of ovulatory hormones as well as thyroid and pituitary hormones.
Anti-Mullerian Hormone (AMH) Test
AMH is a substance produced in the ovarian follicles. By measuring the levels of AMH, the doctor will be able to know the size of the ovarian reserve or the number of egg supply. Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved.
Pelvic Ultrasound
This may be done to look for uterine or fallopian tube disease.
Hysteroscopy or HSG
This may be ordered to inspect the uterine cavity.
This procedure involves making a small incision beneath the navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus.The most common problems identified by laparoscopy are endometriosis and scarring, blockages or irregularities of the fallopian tubes and uterus.The procedure is performed under general anaesthesia and generally done on an outpatient basis.

Male Infertility

Infertility is not just a woman’s issue. Men contribute 50 per cent to the causes due to problems with the sperm. The most common test is the Semen Analysis which is used to determine whether a man has an infertility problem by measuring the number and quality of sperms.

Male Infertility Screening Tests

SA (Semen Analysis)
A Semen Analysis evaluates certain characteristics of a man’s semen and the sperm contained therein. The test is done as part of a couple’s infertility investigation or to verify the success of a vasectomy. It involves a combination of procedures to assess the semen quantitatively such as sperm concentration and qualitatively such as morphology, motility and vitality. Although this is a standard test, the diagnostic sensitivity is low and male factor infertility is frequently undetected. Approximately 15% of men with proven male factor infertility are found to have normal spermiograms. Accordingly, additional tests can be carried out to assess the functionality of the spermatozoa. Among them, the tests for the hyaluronan-binding ability (HBA), sperm DNA fragmentation (Halosperm), and sperm oxidative stress assay are simple and quick enough that the same semen sample tested can be used for the insemination of oocytes.
DNA Fragmentation Assay
Spontaneous miscarriage occurs in 10–15% of clinical pregnancies in the normal fertile population but the rate is known to be higher in subfertile couples. Sperm DNA integrity is one of the important determinants of normal fertilization and embryo development. The Sperm Chromatin Dispersion (SCD) test, which is a simple, fast, and reliable procedure, is used to determine the frequency of sperm cells with fragmented DNA. The frequency of sperm DNA fragmentation is expressed as DNA Fragmentation Index (DFI). A sample with DFI <10% has high fertilization potential while a DFI >30% denotes poor prognosis for IUI and IVF treatment and the man will require clinical treatment to improve his sperm quality.
Sperm Oxidative Stress Assay
The seminal plasma is well endowed with an array of antioxidants that act as free radical scavengers to protect the spermatozoa against oxidative stress. Sperm that have been exposed to oxidative stress have reduce motility, lower capacity to sperm-oocyte binding and fusion, and sperm DNA damage. It is possible that excessive reactive oxygen species (ROS) generation by the human spermatozoa contributes to the aetiology of the male infertility. The result of such an oxidative stress is the induction of lipid per oxidation in the sperm plasma membrane, suppression of the sperm functions, and the precipitation of the DNA damage to both the nuclear and the mitochondrial genomes. Sincere Andrology Laboratory can perform an assay that is reliable and sensitive to measure a possible excess of superoxide anions present in the ejaculate.
Hyaluronan Binding Assay (HBA)
The Sperm Hyaluronan Binding Assay is a qualitative assay for the maturity of sperm in a fresh semen sample. This additional information will help the attending physician to identify patients with poor reproductive prognosis in Intra-Uterine Insemination (IUI) and In- vitro Fertilization (IVF). It is not intended to be a single diagnostic indicator of potential fertility.
Survival Test
Sperm after washing and removal of seminal plasma are cultured for extended period of time. The motility of spermatozoa is then checked after 24 hours. The specimen is considered normal if more than 70% of the sperms are alive and moving at 24 hours.
Retrograde Semen Analysis
A Retrograde Semen Analysis is indicated for patients with a low volume and a diminished sperm count in the initial semen analysis. Retrograde ejaculation is the ejaculation of sperm into the bladder. Urine released following sexual activity will contain sperm in men who undergo retrograde ejaculation. Many retrograde ejaculation patients will have had prior surgery or a medical condition that predisposes them to retrograde ejaculation, such as testicular cancer surgery (RPLND), transurethral surgery of the prostate, or childhood bladder surgery etc. Medical conditions such as diabetes, MS, or spinal cord injury may also predispose an individual to retrograde ejaculation.
Other Tests
Trial Wash and Freezability