Infertility Tests in South Africa

Who needs an infertility test?

It is important that you and your partner both have infertility tests, so that the exact cause or combination of contributing causes of your fertility challenge as a couple can be determined.

This is because in about one-third of infertility cases, the fertility challenge is due to the female partner, while in another one-third of infertility cases, the fertility challenge is due to the male partner. For the remaining one-third of cases, the fertility challenge is a combination of male and female factor issues. Furthermore, in 25% of couples, there is also more than one factor contributing to infertility. It is necessary to determine whether the infertility is of male or female cause and of what duration.

Infertility testing is particularly important if a woman is over 35 years old or if either partner has known risk factors for infertility. An analysis of the man’s semen should be performed before the female partner undergoes any invasive testing.

Infertility testing starts with an initial fertility consultation. During this consultation, you and your partner will spend between 30 minutes and 1 hour with one of our fertility specialists.

You can expect an extensive review of your medical history, a comprehensive infertility physical exam (called a fertility work-up), blood tests, additional testing, and in-depth explanations and answers to all your questions.

To help determine which infertility tests will be appropriate, your fertility specialist will ask about your history of sexual activity, especially frequency and timing of intercourse, as well as lifestyle issues such as smoking, drug and alcohol use, and caffeine consumption, any medications being taken, and your general medical and emotional health. Your fertility specialist will also need to know your menstrual history, the history of previous pregnancies and their outcomes; pregnancy intervals; and detailed information about pregnancy loss, pregnancy duration, human chorionic gonadotropin (hCG) level, ultrasonographic data, and presence/absence of foetal heartbeat. It is also important to know the family history, including family members with infertility, birth defects, genetic mutations, or mental retardation.

In addition to all these factors, there is also a long list of possible medical causes of infertility in both men and women, making accurate, reliable infertility tests for the female partner and for the male partner crucial.

Infertility tests for women

Some of the most common medical causes of female infertility include abnormal thyroid; advanced maternal age; anovulation; blocked fallopian tubes; cervical factor; diminished ovarian reserve; endometriosis; hyperprolactinaemia; polycystic ovarian syndrome (PCOS); stress; and uterine factor.

Consequently, a number of infertility tests can be done to pinpoint a possible female factor. These include:

* Cycle day 2 or 3 FSH, LH, E2
* Insulin – Fasting
* Glucose – Fasting
* TSH
* FT4
* Thyroid Antibodies
* Prolactin
* Growth Hormone
* Rub IGG + IGM
* Cardiolipin Antibodies
* AMH
* HIV
* Hep B – Surface Antigen
* Hep C – Antibodies
* Chlamydia Swab

Several laboratory tests may be used to detect the cause of infertility and monitor treatments.

Evaluation of ovulation and hormonal assessment of egg quality: This is conducted by a blood test which allows us to maximise a woman’s ovulation and quality of eggs.

Evaluation of uterine health: This evaluation allows for successful implantation of an embryo, and the continued growth and delivery of a healthy baby. Pelvic ultrasounds are a routine part of the quality care rendered at Medfem Fertility Clinic and, when combined with other diagnostic procedures, provide insight into optimal embryo implantation and pregnancy.

Blood and urine tests to measure hormone levels: FSH, for example, will provide an indication of ovarian function, while the measurement of Anti-Mullerian Hormone (AMH) will provide an evaluation of ovarian reserve. Hormonal tests for ovarian reserve – the number of follicles and quality of the eggs – are especially important for older women.

Blood tests for prolactin levels and thyroid function are also measured. These are hormones that may indirectly affect fertility.

These blood tests may need to be run at a certain time period during your cycle and may necessitate you attending the clinic on another day.

If an initial fertility work-up does not reveal abnormalities, more extensive tests may help reveal abnormal tubal or uterine findings. There are four major approaches for examining the uterus and fallopian tubes. These are discussed below.

Ultrasound: Ultrasound is the standard imaging technique for evaluating the uterus and ovaries. It is also used for detecting fibroids, ovarian cysts and tumours, and obstructions in the urinary tract.

Hysteroscopy: Hysteroscopy is a procedure that may be used to detect the presence of endometriosis, fibroids, polyps, pelvic scar tissue, and blockage at the ends of the fallopian tubes. Some of these conditions can be corrected during the procedure by cutting away any scar tissue that may be binding organs together or by destroying endometrial implants.

Laparoscopy: A laparoscopy is a surgical procedure that involves looking directly into the abdomen and pelvis using a small camera that is placed through an incision in the umbilicus. This allows gynaecological problems such as scar tissue (adhesions), endometriosis, and ovarian cysts that may affect fertility to be evaluated and potentially treated.

Hysterosalpingogram (HSG): This is the best and least invasive method of evaluating the inside of uterine cavity and patency of the fallopian tubes. An X-ray test looks at the inside of the uterus and fallopian tubes to uncover uterine abnormalities such as intracavitary adhesions, fibroids or polyps, and tubal abnormalities. The HSG test can also show blockages preventing the egg from moving through a fallopian tube to the uterus; blockages preventing the sperm from moving into a fallopian tube and fertilising the egg; and problems on the inside of the uterus preventing a fertilised egg from attaching to the uterine wall.

Infertility tests for men

Male infertility is directly or indirectly responsible for roughly 50% of cases involving reproductive-age couples with fertility-related issues. Male infertility may be caused by the sperm, the testes themselves, the ducts that lead out from the testes, a functional problem in relation to sexual activity, hormonal issues or genetic problems.

Male infertility can also be as a result of congenital or acquired urogenital abnormalities; urogenital tract infections; increased scrotal temperature, for example as a consequence of varicocele; endocrine disturbances; genetic abnormalities and immunological factors.

However, most causes of male infertility are usually related to sperm disorders – in fact, damage to sperm production affects two thirds of men who are experiencing fertility challenges.
A medical history and physical examination are standard assessments in all men, as well as several tests including:

* Insulin – Fasting
* Glucose – Fasting
* TSH
* Prolactin
* Growth Hormone
* HIV – Screening Test
* Hep B – Antibodies
* Hep C – Antibodies
* Semen Analysis

A detailed medical history is obtained for any factor that may impact fertility potential. Information regarding the following areas are collected: prior fertility, previous diseases during childhood and puberty, surgeries performed (especially those involving the pelvic regions and genitalia), genital traumas, infections, physical and sexual development, social and sexual habits, exposure to radiotherapy or chemotherapy, current or recent medications and a family history of birth defects, mental retardation, reproductive failure or cystic fibrosis.

A semen analysis measures the amount of semen a man produces and determines the number and quality of sperm in the semen sample. A semen analysis is usually one of the first tests done to help determine whether a man has infertility problems.

A semen analysis assesses sperm quality and all sperm parameters including the sperm concentration, motility, forward progression, morphology (shape), and the absence or presence of antisperm antibodies.

Tests that may be done during a semen analysis include:

* Volume – a measure of how much semen is present in one ejaculation.
* Liquefaction time – how long it takes for the semen to liquefy from a thick gel at the time of ejaculation, normally 20 minutes.
* Sperm count – the number of sperm present per millilitre of semen in one ejaculation.
* Sperm morphology – a measure of the percentage of sperm that have a normal shape.
* Sperm motility and motile density – the percentage of sperm that can move forward normally and the number of sperm that show normal forward movement in a certain amount of semen.
* pH – the acidity (low pH) or alkalinity (high pH) of the semen.
* White blood cell count – white blood cells are not normally present in semen.
* Fructose level – the amount of a sugar called fructose in the semen that provides energy for the sperm.
* Hormonal determinations – endocrine evaluations.

In men with testicular deficiency, hypergonadotrophic hypogonadism is usually present, with high levels of follicle stimulating hormone [FSH] and luteinising hormone [LH], and sometimes low levels of testosterone.

Generally, the levels of FSH correlate with the number of spermatogonia; when spermatogonia are absent or markedly diminished, FSH values are usually elevated. It is important to assess if the male patient is suffering from hormonal problems. A routine part of the initial evaluation is testing of specific serum hormone levels, which usually includes FSH, LH, testosterone, and prolactin.

If the results of semen analysis are normal, one test should be sufficient. If the results are abnormal in at least two tests, further andrological investigation is indicated.

How to get the right infertility tests

An accurate diagnosis made after thorough infertility testing during consultation with a fertility specialist with extensive expertise and experience, and backed up by advanced techniques, state-of-the-art equipment and custom-designed facilities is invaluable – and this is exactly what you get during an initial consultation with a fertility specialist at Medfem Fertility Clinic.

Many of the fertility tests described above are done at Medfem Fertility Clinic during an initial fertility consultation with one of our fertility specialists, which is perhaps the single most important step on your fertility journey, and should also be the first step.

Setting up your fertility consultation and tests is as simple as clicking here or contacting us on +27 (11) 463 2244.

We look forward to meeting you!