EXAMINATION OF THE INFERTILE COUPLE

Comprehensive History: Age, height, weight, history of chronic illness, work, duration of infertility, frequency of sexual intercourse, past infectious diseases and operations, information and medical records of previous pregnancies, menstrual period, bleeding pattern, chronic pelvic pain, pain during intercourse, recent rapid weight gain or loss, unwanted hair growth, milk secretion from the nipples

Examination and Tests:

• Vaginal speculum examination,  appearance of the cervix, looking for signs of infection, pap smear

• Evaluation of uterus and ovaries by vaginal ultrasonography

• It is possible to recognize or suspect a significant portion of the congenital or acquired uterine abnormalities  by standard 2-D ultrasonography. Use of 3D vaginal ultrasonography increases the diagnostic accuracy. Special  X-ray examination of uterus and fallopian tubes (Hysterosalpingography-HSG) may provide additional information. Rarely  It may also be necessary to perform diagnostic hysteroscopy for abnormalities that  cannot be diagnosed by ultrasonography or HSG.

• The presence of space occupying mass that affects the inner membrane of the uterus (endometrium) such as fibroid and polyp. Sonohysterography (Saline Infusion Sonograghy) can give clearer images in the diagnosis of endometrial pathologies.

• Evaluation of ovarian reserve after menstrual period by transvaginal ultrasonography. The structures that contain potential egg candidates in the ovary are called Antral Follicles. In each menstrual cycle, one of them fully develops and result with ovlation. In women of childbearing age, the number of Antral Follicles (AFC) should be between 5-10 in each ovary.

• Hormonal Tests performed in 2nd-3rd days of menstruation: Depending on the history and findings of the woman, the most common ones ordered are; FSH, LH, PROLAKTIN, TSH, ESTRADIOL and AMH. Especially in patients with decreased or increased ovarian reserve, AMH is important in drug dose adjustment during IVF treatment and for outcome.

• HSG- Hysterosalpingography  (Special Examination of Uterine and FallopianTubes by X-Ray): An interventional examination performed at the radiology unit prior to the ovulation period after the end of menstruation. It is not performed in the presence of infection or active bleeding. After appropriate preparation, a special cannula or catheter is inserted into the uterine cavity through the cervix and a special radio-opaque contrast material dye is injected.  The internal shape of the uterus, the inner width, course, length and the passage of the contrast material through fallopian tubes  into the abdominal cavity are evaluated by fluoroscopic x-ray .

• Sperm Analysis

    - After 3-5 days of sexual abstinence, preferably done in an IVF center.

    - A new analysis should be performed after 2-3 months for abnormal results.
    - Slightly lower values ​​than normal should not be interpreted as abnormal immediately. It should be kept in mind that there may be significant deviations in the values ​​of men having  children
  
        - Limit Values:
        o Volume: 1.5 ml
        o Number: 15 million / ml
        o Mobility: Moving Forward 32%
        o Morphology: 4%
  
       - Terminology of abnormal values ​​in sperm analysis
       o Oligospermia: Less than 15 million / ml
       o Azospermia: No sperm in the sample
       o Asthenospermia: Less than expected number of motile sperm
       o Teratospermia: A higher number of morphologically abnormal sperm
   

• Hysteroscopy: Endoscopic examination and performing necessary operation of endometrial cavirty through vagina and cervix. It is a very important method for diagnosis and treatment of intrauterine mass or deformity.
   

• Laparoscopy: Endoscopic examination of uterus, fallopian tubes, ovaries and intraabdominal structures done by entering from umbilicus and various other points of abdominal Wall.   It can be performed according to the examination and clinical findings of the patient. If there is a cystic or solid mass in the ovaries, or if there are signs of enlargement, obstruction or stenosis of fallopian tubes in the HSG.  If there are signs of endometriosis, it is appropriate to perform laparoscopy before treatment.