Dr. Kemi Ailoje
Last week, we discussed fertility profiling and the importance of knowing your fertility status. In this week, we will continue on female fertility as well as evaluations done to assess fertility status in men.
• Prolactin: Produced by the pituitary gland and causes milk production. In women this test is done to find out why they are not menstruating, or why they are having infertility problems or abnormal nipple discharge. Raised levels in a woman who is not pregnant or breastfeeding can be a signal for fertility problems as well as irregular periods
• Estradiol Test: Estradiol is an important form of estrogen. It is used to measure a woman’s ovarian function and to evaluate the quality of the eggs. Like FSH, it is done on the third day of a woman’s menstrual cycle.
• Other Tests Include: Thyroid Stimulating Hormone (TSH), FreeT3, T4, Anti-Mullarian Hormone (AMH), etc.
Tests to evaluate the uterus and fallopian tubes
Uterine abnormalities that can contribute to infertility include congenital structural abnormalities, such as a uterine septum (a band of tissue that makes the uterine cavity small) fibroids; polyps; and other structural abnormalities.
• Pelvic ultrasound scan: In a trans-vaginal ultrasound, a small ultrasound probe is inserted into the vagina; this provides a clearer image of the uterus and ovaries than ultrasound that is performed through the abdomen. It does not require that the patient to be sedated or anesthetized, and no risks. It is used to measure the size and shape of the uterus and ovaries and to determine if there are structural abnormalities (such as fibroids or ovarian cysts). If abnormalities are seen, further testing may be needed. It can also be used for Antral Follicular Count (AFC)
• Hystenosonogram (HSN): Infusion of sterile saline into the uterine cavity via a small catheter placed through the cervical opening enhances the visualization of the inside of the uterus (womb) during transvaginal ultrasound.
• Hysterosalpingogram: Hysterosalpingogram(HSG) is used to help identify structural abnormalities of the uterus and fallopian tubes. It involves inserting a small catheter through the cervix and into the uterus. A liquid that can be seen on x-ray is injected through the catheter, which fills the uterus and fallopian tubes. An x-ray is taken after the liquid is injected, which shows the outline of the uterus and tubes. An abnormally shaped uterus or blocked fallopian tube would be visible on the x-ray. The test is done while the woman is awake and lying on an x-ray table. Most women experience moderate to severe pelvic cramps when the liquid is injected, but this usually improves after 5 to 10 minutes. The test is usually performed 6 to 10 days after first day of the menstrual period (before ovulation has occurred).
• Laparoscopy: This is not routinely done, but may be necessitated by reports of previous investigations. During laparoscopy, a thin, lighted tube is inserted through a small incision in the abdomen, allowing the physician to view the uterus, ovaries, and fallopian tubes. Laparoscopy is performed as a day surgery procedure and requires that the patient receive general anesthesia. Laparoscopy can detect damage and obstruction of the fallopian tubes, endometriosis, and other abnormalities of the pelvic structures that may affect infertility.
• Hysteroscopy: a small tube containing a light source is inserted through the cervix and into the uterus (womb) to directly visualize the lining of the uterus and the sites where the fallopian tubes enter the uterus. Air or fluid is injected to expand the uterus and to allow the physician to see inside the uterus.
EVALUATIONS DONE TO ASSESS FERTILITY STATUS IN MEN
Blood tests: To determine blood levels of:
• Follicle Stimulating Hormone: Follicle Stimulating Hormone is produced in the pituitary gland for men and important in the production of sperm. Levels of FSH in men rise with age, but can also indicate testicular damage and reduced sperm production. Low levels of FSH are detected when men are not producing sperm.
• Luteinizing Hormone: Luteinising Hormone (LH) is produced by the pituitary gland and is important for male and female fertility. In women it governs the menstrual cycle, peaking before ovulation. In men it stimulates the production of testosterone. Raised LH in men can signal that the testes are not producing enough testosterone.
• Prolactin: The test is done in men when there is a lack of sexual desire, difficulty getting an erection, or if there might be a problem with the pituitary gland. Raised levels in men can cause reduced sex drive, lack of energy, erectile dysfunction and fertility problems. These hormones therefore examine the pituitary function.
• Testosterone (Free and Total) Hormonal test: Testosterone is a male sex hormone which is produced in the testicles of men .It is responsible for bone and muscle strength, as well as mood, energy and sexual function. Levels decline with age and it is usual to find naturally elevatedlevels in men. Low testosterone is more common than raised testosterone in the absence of supplementation.
• Sex Hormone Binding Globulin (SHBG): Most of the sex hormones – testosterone, oestrogen and dihydrotestosterone (DHT) – found in the blood is bound to Sex Hormone Binding Globulin (SHBG) which means that they are unavailable to the cells. Measuring the level of SHBG in your blood gives important information about your levels of “free” or unbound hormones which are biologically active and available for use. Elevated SHBG indicates that there is less testosterone or oestrogen available whereas low levels can mean an excess of available hormones in the male.
• Genetic Screening Counselling: This is an important aspect of profiling often recommended to educate males and females about the possibility of parent-to-child transmission, possible impact of the abnormality, prevention and treatments available to prevent parent-to-child transmission e.g. Pre Genetic implantation Diagnosis (PGD) or Polymerase Chain Reaction(PCR) Counselling to prevent transfer of embryos with sickle cell diseases to a female.