Examination methods of the woman
The basic question for the physician is whether the woman is able to release a ripe egg and whether this egg can merge with the sperm in the woman’s fallopian tube.
The basic examination of the woman begins with transvaginal ultrasound of the uterus and ovaries with respect to the phase of menstrual cycle and following gynaecological examination. Ultrasound examination enables the determination of the size and shape of the uterus, presence of muscular nodules (myoms), thickness and quality of the uterine mucosa. It also provides information about the condition of the ovaries, growth of follicles and presence of cysts or endometriosis.
Examination of hormone levels (blood tests)
This examination provides information about the condition of the ovaries and their ability to produce ripe eggs.
Blood testing between the 1st - 3rd day of menstruation informs about the condition of the ovaries, their ability to produce ripe eggs and possible response to stimulating medicaments. The levels of follicle-stimulating hormone (FSH) are examined as well as of the luteinising hormone (LH). Anti-Müllerian (AMH) hormone levels can be assessed as well - it provides information about the ovarian reserve. Standard part of hormonal examination is also determination of the levels of prolactin (PRL) and hormone stimulating the thyroid gland (TSH).
Normal hormone levels in the blood
FSH 1,9 – 12 IU/ml
LH 0.9 – 12 IU/ml
PRL less than 25 ng/ml
TSH 1,0 – 4,0 IU/ml
AMH 0,5 – 30 IU/ml
Examination of the uterus and fallopian tubes - hysterosalpingography (HSG)
This examination determines the passability or occlusion of the fallopian tubes and shows the shape of the uterine cavity.
The examination can be performed either under ultrasound control (sono HSG - the modern way) or under X-ray (RTG HSG - the old way).
We are currently preferring sono HSG because it is painless and does not represent X-ray load for the patient. The method is widely available.
HSG examination can show the shape of the uterine cavity and passability of fallopian tubes (that means we can actually see that a contrast stain passes through the fallopian tubes into the abdominal cavity).
Surgical examination of the reproductive system - hysteroscopy and laparoscopy
These examinations allow for a direct view of the abdominal and uterine cavities.
Surgical methods in treatment and diagnostics of sterility include a direct view into the uterine cavity - hysteroscopy and view into the abdominal cavity to examine uterus, ovaries and fallopian tubes- laparoscopy.
It is used to detect and treat problems inside the uterus (polyps, myomas, adhesions, septa).
It is used in the diagnostics and treatment of endometriosis and also to detect passability of the fallopian tubes. Diagnostics of post-inflammatory conditions and post-operation adhesions following earlier operations is performed through laparoscopy.
Both methods, laparoscopy and hysteroscopy can be successfully combined under one anaesthesia.
Genetic examination of female infertility
This examination is recommended after repeated spontaneous miscarriages or repeated unsuccessful IVF cycles.
Karyotype determination (number of chromosomes) is performed in women after repeated spontaneous miscarriages or in case of repeated failures of the IVF treatment. Couples, whose embryos develop in a non-standard way should also undergo this examination.
This specialised examination is designated for patients after repeated failures of the IUI and IVF methods.
Immunological examination does not belong among the basic examinations of female fertility. This specialised examination is recommended to patients with repeated failures of IUI treatment, when her partner’s sperm count test is repeatedly assessed as normal. Patients after repeated embryotransfer of quality embryos under IVF programme with repeated failures to become pregnant despite very good conditions may also benefit from the immunological examination. The examination focuses on antibodies against sperm, against trophoblast (placenta) and against the embryonic sheet (zona pellucida). Modern laboratories detect also problems in celluar immunity and propose a treatment.