Diagnostic Procedures for Females

Diagnostic Procedures for Females

In order to ensure that females receive proper treatment and are not exposed to unnecessary risk, several investigations take place. The screening process often requires the individual to be tested for certain viruses, hormonal imbalances, and abnormalities along the reproductive tract. Specific examples of diagnostic tests/procedures for females include a full blood count, viral tests, tests for blood levels of certain hormones (FSH, LH, prolactin, TSH, T3, T4, and progesterone), tests that reveal information about ovarian reserve (AMH), post-coital tests (PCT) to assess sperm migration, immunological investigations to detect antisperm and antiphospholipid antibodies, HSG, ultrasonography, endoscopic procedures, cytogenetic analysis, and psychological assessment.

Full Blood Count

A full blood count is often used to help test for the presence of anemia (low hemoglobin count), bleeding tendencies (low platelet count), or infections (high white cell count). Therefore, information derived from the blood test helps doctors provide proper medical care for their patients.

Cytogenetic Analysis

Chromosomal analysis in a blood sample is necessary in the case of primary or secondary amenorrhoea (absence of menstruation) with elevated FSH, premature ovarian failure (early menopause), long-term unexplained infertility, and recurrent spontaneous abortions.

Laparoscopy and Hysteroscopy

Both of these are endoscopic (keyhole) procedures. Laparoscopy can reveal a great deal of information on the presence and extent of endometriosis and adhesions in the pelvic cavity. It also gives information regarding the patency and mobility of the fallopian tubes. Hysteroscopy helps derive information regarding congenital uterine abnormalities and the presence of polyps and fibroids. Both these procedures require anesthesia. 

Ultrasonography

This test is performed with either abdominal or vaginal probes. It is now an irreplaceable investigative tool in routine practice for anatomical and functional evaluations of the genital tract. It is mandatory for the monitoring of ovarian stimulation (induction of ovulation) where it can visualize follicular growth in the ovaries and the associated gradual thickness of the uterine endometrium (inner wall).

Hysterosalpingogram (HSG)

A HSG is an X-ray test that provides information on Fallopian tube occlusion and uterine abnormalities. During this procedure, the patient lies on an X-ray table. A speculum is then inserted into the vagina, and a catheter is moved through the cervix. The catheter is attached to a syringe containing HSG dye, and this dye is then injected into the uterus. The movement of the dye through the uterus and Fallopian tubes can be seen on the X-rays. Failure of the dye to move through the Fallopian tubes can be an indication of blockage. The HSG also shows if there are abnormalities in the shape of the uterus. Distortion of the uterine cavity can be caused by polyps, fibroids, and adhesions.

Immunological Investigations

  • Antisperm antibodies (ASA): These can be detected directly in genital secretions (cervical mucus and semen) or in a blood sample. Qualitative and quantitative determinations can be performed by checking sperm agglutination (stickiness). The presence of ASA can lead to infertility.
  • Antiphospholipid antibodies: These can be detected in a blood sample and have been shown to reduce implantation and pregnancy rates after IVF.

Post-Coital Test (PCT)

A cervical scrape is taken half an hour after sexual intercourse to examine the number and motility of available sperms. This test assesses the ability of sperm to penetrate the cervical mucus as well as the actual occurrence and efficiency of intercourse.

Thyroid Function Tests Prolactin

Improper thryoid function can result in the excess or scarcity of certain hormones, which may in turn affect the maturation and ovulation of the ovum. Problems with the levels of the hormone Prolactin can also impair ovulation.

Follicle Stimulating Hormone (FSH) Oestradiol (E2) Clomid Challenge Test (CCT)

Both FSH and E2 help provide information on the quality of eggs produced by the female. The levels of these hormones are measured extremely early during the menstrual cycle (days 2 and 3). It is also used as a prognostic marker for the failure or success of IVF cycles (high FSH > 12 IU/ml is associated with low success rates). The CCT is a test specifically designed to assess egg quality.

Progesterone

Progesterone is necessary for preparation of the uterine lining for implantation. By testing serum progesterone in the second half of the menstrual cycle, doctors can discover if the ovary is releasing enough of the hormone for proper endometrial formation. Therefore, it is used as a marker to measure adequate ovulation.

Luteinizing Hormone (LH)

LH is the hormone that triggers ovulation, and a surge in this hormone can often be detected in the urine or blood. Usually, ovulation occurs 24 hours after the increase in LH. Therefore, this test can help doctors determine when ovulation occurs, and is helpful in indicating normal ovarian function and the proper timing for intercourse, insemination, or other treatment protocols.

Hepatitis (B & C), HIV Antibody Status, Rubella Immune Status

These three viruses are tested for in women before the onset of treatment. Hepatitis B, Hepatitis C, and HIV have all shown vertical transmission, or the transmission of the disease from mother to child during the perinatal period (the period immediately before and after birth). If a mother contracts Rubella during her first trimester, the fetus can suffer from Congenital Rubella Syndrome (CRS). CRS results in the child possibly having numerous birth defects. Therefore, the presence of any of these viruses can prove harmful to a developing fetus. In addition, these viruses often prove detrimental to an individual’s health. In order to appropriately treat the patient and develop a proper protocol, a doctor has to be aware of the presence of such viruses.

Psychological Assessment

Psychological factors have been implicated in reproductive performance and infertility. Therefore, psychological assessment and counseling may be advised for some infertile couples, and psychological support for couples undergoing infertility treatments.