Disorders of ovulation are a common cause of infertility occurring in 15% of couples. Ovulation requires a coordinated sequence of events between the hypothalamus, pituitary and the ovary. Disruption of this sequence results in abnormal ovulation and irregular menstrual cycles. There are a number of causes of abnormal ovulation. In some cases it associated with androgen excess in a common disorder known as polycystic ovarian syndrome (PCOs). The abnormal intra-ovarian androgens appears to disrupt normal ovulation. In other cases it is associated with inactivity of the hypothalamus as in the case patients with very thin body habitus. In some cases the ovaries will prematurely fail to produce eggs in what is known as premature ovarian failure.
Damaged Fallopian Tubes
Fallopian tubes are the conduit where the sperm joins with the ovulated egg. Abnormalities of the fallopian tubes account for 40% of female infertility. Causes of abnormalities of the fallopian tube include infection and endometriosis. Blockage of the fallopian tubes can be detected by a number of procedures including the hysterosalpingogram and sonohysterogram and this is discussed later.
Endometriosis is a common cause of infertility and results from tissue from the lining of the uterus becoming displaced to the organs of the abdomen and pelvis. A common theory is that during menstruation when the lining of the uterus sheds off during the process of menstruation a portion of it back-flows and covers the surface of internal organs such as the ovaries, bowel and uterus itself where it will remain in susceptible individuals.
The cervix and cervical mucosa play an important role in fertility. The cervical mucous filters out the sperm from other components in the semen ejaculate. Removal of these components from the ejaculate is important in sperm ability to fertilize an oocyte. Abnormal cervical mucous can impede.
Male factor components are a cause of infertility in approximately 40% of couples. The semen analysis is a major component of an initial infertility evaluation and is one of the first test ordered. The semen analysis measures more than than the actual number of sperm but also examines components such components as sperm motility and morphology. When the sperm parameters are abnormal additional studies are often required and these can be done through our center.
The semen analysis is an important aspect of the evaluation of the infertile couple and is covered by most insurances. Fertility Florida has a CAP inspected CLIA certified Andrology Laboratory.
These two procedure are a vital part of the infertility evaluation and will be done early on in the process. They both can be used to evaluate the endometrial cavity and the fallopian tubes and in general either one or the other will be used. The hysterosalpingogram is a hospital procedure while the sonohysterogram can be performed as an in office procedure..
Ovarian Reserve Testing
There are a number of methods to perform ovarian reserve testing. In most cases this is a simple blood test done on a specific day of the menstrual cycle. In some cases an ultrasound examination can be used to assess the functioning of the ovaries. These test are the standard part of your evaluation.
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