Ovarian and Ovulation Factors
Diagnostics studies performed to determine if ovulation is regular and
whether the progestational endometrium is adequate for implantation may include
a serum progesterone level and an ovulation index. The ovulation index involves
a urine- stick tests to determine whether the surge in LH that precedes
follicular rupture occurred. Ovulatory dysfunction is complex, but many women
with ovulation disorders have prolycystic ovary syndrome, and may be treated
with clomiphene to induce ovulation or insulin sensitizing agents. Once insulin
levels are normalized, ovulation often occurs. Some women have high prolacting
levels, which inhibit ovulation, and they are treated with dopaminergic drugs
after a pituitary adenoma is ruled out by MRI. If a woman has premature ovarian
failure, oocyte donation may be considered.
Tubal
and Uterine Factors
HSG is
used to rule out uterine or tubal abnormalities. A contrast substance introduced into uterus via the cervix gives an identity of the shape of the uterine
cavity and the patency of the tubes. This process sometimes removes mucus or
tissue that is lodged in the tubes. Laparoscopy permits direct visualization of
the tubes and other pelvic structures and can assist in identifying conditions
that may interfere with fertility (e.g endometriosis).
Fibroids,
polyps, and congenital malformations are possible causative factors affecting
the uterus. Their presence may be determined by pelvic examination,
hysteroscopy, saline sonogram ( a variation of a sonogram), and HSG.
Endometriosis, even if mild, is associated with reduced fertility.
MALE
FACTORS
An
analysis of semen provides information about the number of percentage of moving forms, sperm (density), and morphology (shape and form) quality of forward movement (forward progression),. From 2 to 6 mL of watery alkaline semen is
normal. A normal count has 60 to 100 million sperm/mL. However, the incidence
of impregnation is lessened only when the count decreases to less than 20
million sperm/mL.
Men may
also be affected by varicoceles, which
decrease semen quality by increasing testicular temperature and varicose veins around the testicle,. Retrograde
ejaculation or ejaculation into the bladder is assessed by urinalysis after
ejaculation. In male partners testing of blood may include the measuring of testosterone; LH and FSH ( which are involved in maintaining testicular function);
and prolactin levels.
Post a Comment