The investigations and the medical history are
required to find out if there is any condition
which might affect fertility: such as
Hormonal disorders of hypothalamus/pituitary or
Medication affecting reproductive function
Surgery of the abdomen affecting the
Obesity or anorexia nervosa which may affect
Alcohol, nicotine, drugs
Life situation causes stress
Difficulty with sexual intercourse
A full gynecological examination is required to
evaluate the external and internal female
reproductive organs: vulva, vagina, cervix,
allows the identification of potential
abnormalities of the internal reproductive
organs (uterus, fallopian tubes and ovaries) and
monitoring of ovarian response to hormonal
stimulation defined by counting the number and
size of follicles which are contained of oocytes.
To evaluate the ability of uterus to produce
endometrial lining whether it’s thick enough for
Blood / hormone tests
also required to evaluate whether ovulation
occurs and the quality of ovulation, tests for
infectious and immunological causes of female
infertility. Included of Karyotype examination
which is one kind of tests for chromosome
abnormalities for example Turner’s syndrome is
an abnormality of gender chromosomes.
This is a radiological investigation where a dye
is injected into the uterine cavity, any
abnormality of the uterus and fallopian tubes
can be seen on the X-ray. It particularly
demonstrates any blockage of the tubes.
This test visualizes the cavity of the uterus
and demonstrates any abnormalities inside. A
viewing instrument (a very thin, cold light
fiber-optic tube) is inserted into the uterine
cavity to see any abnormalities. It allows, if
necessary, corrective surgery to be performed.
This is a surgical procedure under general
anesthesia whereas a viewing scope is inserted
into a small incision in the abdominal wall
about one centimeter from the navel. The
abdominal cavity is filled with gas allowing the
viewing of reproductive organs including pelvis,
ovaries, fallopian tubes and uterus. The passage
of dye through the tubes can be checked at the
same time. Scar tissue and endometriosis can be
identified and certain abnormalities corrected
Various diagnosis of female reproductive organ
abnormality causes infertility e.g. vagina,
cervix, uterus, fallopian tubes and ovaries.
These abnormal incidences may be present at
birth or be acquired later for example acidic
cervical mucus, absence or insufficient mucus,
cervical infection, cervical mucus with
anti-sperm antibody, ovulation disorders, lack
of ovulation, irregular or incomplete ovulation,
luteal insufficiency, obstructive fallopian
tubes, damage to fallopian tubes from any
infection or surgery following an ectopic
is a common medical condition characterized by
growth beyond or outside the uterus of tissue
tissue, the tissue that normally lines the
This condition can causes chronic inflammation
with a subsequent adhesion development then
obstruct pathway of egg and sperm to fertilize.
This is infertility with no apparent cause being
demonstrated after all the previous history
taking, physical examination and investigation.
included surgery of fallopian tubes,
removal of adhesions, surgery to the uterus to
rectify any abnormality or remove anatomical
abnormality e.g. fibroids, polyps, congenital
in order to re-establishing a normal ovulation
cycle with the help of hormones: clomiphene
citrate, gonadotropins (FSH, LH), progesterone
which can help oocytes growing, maintain luteal
phase and support during early pregnancy.
Assisted conceptions treatments
Natural conception following timed sexual
intercourse with or without ovarian stimulation,
ovulation can be predicted by the use of urine
or blood ovulation prediction tests or by
follicular ultrasound scanning to determine the
exact day of ovulation. This allows a couple to
have intercourse during their most fertile
IUI- intrauterine insemination
After sperm preparation from the semen sample in
laboratory to select the most motive and normal
sperm, the preparation is injected with the aid
of a catheter directly into the woman’s uterine
cavity. The insemination may be made during a
natural cycle or an ovarian stimulation cycle.
IVF- in-vitro fertilization
One or more eggs are retrieved from the ovaries
following ovarian stimulation and these are
mixed with the partner’s sperm collected by
masturbation. If fertilization occurs, then
development of embryos are expected and
transferred into the woman’s uterine cavity on
the 3-5 days after fertilization.
Counseling and psychological
The emotional impact of IVF can be enormous.
Counseling and psychological support are
extremely important in helping couples dealing
with their infertility and/or treatment.
Especially, when treatment is not possible or
the chance of success is poor. Other treatment
options may be offered e.g. oocytes donation,
when a woman is suffering from ovarian failure.
Treatment for the patient is very similar to IVF
except that oocytes are retrieved from the donor
who should be under age of 35 years.