Initial Evaluation of the Infertile Couple
Complete history and physical examination
VITALAB encourages patients to obtain all previous medical records for treatment related to infertility, hormonal or menstrual disturbances, anovulation, gynaecologic surgery, or pelvic infection. Appropriate medical information should also be gathered on the husband i.e. previous semen analysis and prior hormone tests and x-rays. Particular attention is directed toward a review of medications that may interfere with fertility (i.e. Calcium channel blockers and non-steroidal anti-inflammatory preparations in males) or those that might be teratogenic (harmful to the foetus).
Initial Medical Laboratory Evaluation
On the 2nd and 3rd day of the menses, a basic hormone profile is performed (FSH, LH, Thyroid function, Prolactin), together with a sexually transmitted disease profile (HIV, Hepatitis B, VDRL) and assessment of immunity to German Measles.
Individualised Laboratory Testing
Irregular Menses with/without Hirsutism, Acne or Obesity.
An androgen profile is performed. A fasting insulin and glucose may also be required. Some PCOS patients may benefit from Metformin (Glucophage) therapy. A simple glucose tolerance test without insulin levels is not adequate to predict who may benefit from treatment with insulin lowering medication.
Low risk for tubal disease.
In those patients without a history of pelvic pain, surgery, dysmenorrhoea (painful periods) or dyspareunia (pain with intercourse), a serum chlamydia IgG antibody is obtained. As tubal disease or peritubal adhesions are frequently a result of asymptomatic chlamydia infection, a more aggressive evaluation of the fallopian tubes and pelvis is required, if a raised chlamydia IgG is noted.
Testing should be obtained before any invasive procedure such as HSG, laparoscopy, or ovulation induction is considered. A semen analysis is considered current if it has been obtained within the last 12-18 months and performed by a reputable laboratory using acceptable criteria. Abnormal values should be rechecked no sooner than 4-8 weeks. If, on repeat testing, the total motile count per sample is greater than 5 million, ovulation induction and intrauterine
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