Investigations for infertile couple before IVF treatment

1. INVESTIGATIONS FOR INFERTILE COUPLE – FLOWCHART
 The patient name, patient ID, occupation, age, how many years since marriage are enrolled before
sample collection and investigation.
 History investigation is done in both the partners.
FEMALE INVESTIGATION:
-
1. HISTORY
2. PRIMARY INVESTIGATION
2.1. BLOOD INVESTIGATION
GENERAL BLOOD
INVESTIGATION
 Total blood count (TC)
 Hemoglobin (Hb)
 Random blood sugar
(RBS)
 Serum plasma
 Lipid test
HORMONAL
INVESTIGATION
 T3, T4, TSH
 AMH
 FSH, LH
 Serum Prolactin
 Estrogen
 Mid-lutel serum P4
SEROLOGICAL
INVESTIGATION
 HIV
 HbSAg
 VDRL
 HCV
3. SECONDARY INVESTIGATION
 CERVICAL FACTOR : Chronic cervicitis, Cervical
cancer
 UTERINE FACTOR : Fibroids, septate uterus
 TUBAL FACTOR : Blockage of both Fallopian
tubes
 OVARIAN FACTOR : PCOS, Ovarian tumors
 PERITONEAL FACTOR : Endometriosis
 GENITAL TUBERCULOSIS
 ULTRASONOGRAPHY / TRANSVAGINAL
SCANNING
 HYSTEROSALPINGOGRAPHY
 HISTEROSCOPY
 MRI
 LAPROSCOPY
1. HISTORY
OTHER INVESTIGATION
 Ovarian reserve test
 Antral follicular count
 CC challenge test
SEXUAL HISTORY
 Sexual
dysfunction
 Frequency of
coitus
MEDICAL
HISTORY
 PID/CKD/DM
 Hirsutism
 Surgery in
pelvic region
 Chemo/radio
therpy
 PCT
DRUG HISTORY
 Immunosup-
presants
 NASID
 Phenothizine,
metacloprami
de
FAMILY HISTORY
 Birth defect
 Genetic
mutation or
mental
retardation
 Premature
ovarian failure
MENSTRUAL
HISTORY
 Oligo-
amenorrhea
 Amenorrhea
GENERERAL
HEALTH HISTORY
 BMI
 Smoking
 Alcohol
 Age
 Occupation
 Stress
1. HISTORY

2. MALE INVESTIGATION:
1. GENERERAL HEALTH
HISTORY
 BMI
 Smoking
 Alcohol
 Age
 Occupation
 Stress
 Exposure to
environment toxins
6. SEXUAL HISTORY
 Erectile dysfunction
 Frequency of coitus
 Years since marriage
 Ejaculation failure
4. FAMILY HISTORY
 Birth defect
 Genetic mutation or
mental retardation
 History of Infertility
problems
5. DRUG HISTORY
 Immunosuppresants
 NASID
 Phenothizine,
 metaclopramide
2. MEDICAL HISTORY
 Hypertension
 DM
 Surgery in pelvic
region
 Chemotherapy
 radiotherapy
 Hyperprolactinemia
 Cystic fibrosis
 Thyroid disorder
1. HISTORY
3. HISTORY OF INFECTIONS
 Pelvic Inflammatory
Disease
 UTI
 STI
 Mumps
 Tuberculosis
 Leprosy
 Cystic fibrosis
 Thyroid disorder
2. PHYSICAL
EXAMINATION
 Secondary sexual characteristics
 Scrotum
 Penis
 Abdomen
 Gynaecomastia
 Epididymis
3.1. BLOOD INVESTIGATION
 Complete blood count
 Hb
 Tests for STD
 PCR for TB in serum
 Antisperm antibodies
3. PRIMARY INVESTIGATION
3.2. HORMONAL ASSAYS
 FSH
 LH
 T3, T4, TSH
 Testosterone
 Serum prolactin
3.4. SEMEN ANALYSIS
 Volume
 pH
 Sperm density
 Percent motility
 Sperm morphology
 Viscosity
 Sperm agglutination
3.3. GENETIC TESTS
 Karyotyping
 Y chromosome microdeletion
 Cystic fibrosis conductance
regulator (CFTR) gene mutation
ABNORMAL
 Varicocele
 Leukocytospermia
NORMAL
 Repeat semen analysis
 Female factor investigation
4. SECONDARY INVESTIGATION
 Sperm DNA fragmentation
 Post-ejaculatory urinalysis
 Ultrasonography / MRI
 Testicular biopsy
 Specialized semen and sperm analysis