1.Basic sex hormone examination.
Serum FSH, LH, E2, T, PRL, P, A2 were examined on the 2nd to 3rd day of menstrual cycle. If necessary, thyroid, adrenocortical function and other endocrine functions should be measured to rule out abnormal ovarian function due to systemic endocrine abnormalities.
2.Fallopian tube examination.
According to the medical history and the male partner’s semen, decide whether to perform tubal iodography or hysteroscopy to understand the condition of the fallopian tubes and uterine cavity. Tubal examination is recommended except in cases such as bilateral tubal resection of the female partner, severe oligozoospermia or obstructive azoospermia of the male partner. Commonly used tubal examination methods include hysterosalpingogram and lumpectomy.
Screening for acute and chronic inflammation in the vagina, cervix or pelvis before the test. If there are trichomonas or mycobacteria in the vagina, heavy cervical erosion and purulent discharge, they should be treated first; acute pelvic inflammatory disease prohibits examination of the fallopian tubes; chronic pelvic inflammatory disease should understand the cause of pelvic inflammatory disease and whether the inflammation is in the resting phase, otherwise the operation increases the probability of recurrence of inflammation.
2. Hysterosalpingogram.
The imaging can see whether the wall of the tube is stiff in the cervical canal, in the uterine cavity and in the tubal lumen agent, but cannot understand the lesions around the fallopian tubes.
① Abnormal images of the cervix: round filling defects suggest submucosal myomas; multiple round filling defects may be polyps hyperplasia; stripe-like defects suggest uterine adhesions;
② imaging can assist in the diagnosis and management of various types of uterine developmental malformations, such as complete or incomplete longitudinal uterus, bicornuate uterus; irregular shrinkage or deformation of the uterine cavity with irregular margins should be considered as uterine tuberculosis.
(3) Abnormal images of fallopian tubes: non-developing suggestive of obstruction; dilated pot belly suggestive of hydrops; rigid and wire-like fallopian tubes, bead-like walls, multiple fistulas suggestive of tuberculosis.
3) Tubal lavage.
It is possible to observe whether the fallopian tubes are patent, but it is not possible to observe the tubal lumen or lesions in the wall of the fallopian tubes.
3) Ultrasound imaging.
Ultrasonography can detect organic lesions in the uterus, ovaries and fallopian tubes. Continuous ultrasound detects signs of follicular development, ovulation and corpus luteum formation, which can help diagnose the cause of the disease. It can also show the number of ovarian sinus follicles and determine ovarian reserve function.
1) Transabdominal ultrasound: advantages: easy and painless to perform; can be used in all patients, regardless of age or marriage; large scanning area; disadvantages: low resolution; long bladder filling preparation time; examination results are affected by bladder filling.
2) Transvaginal ultrasonography: advantages: clear images; preferred in patients who are obese or have difficulty filling the bladder; disadvantages: difficult to observe the whole picture; cannot be used in patients who are unmarried, menstruating, have vaginal bleeding or infection, or have vaginal stricture deformity.
3) Transrectal ultrasonography: mainly suitable for those who cannot use negative ultrasound; posterior uterus close to the rectal wall; ectopic pregnancy with atypical masses located in the pelvic floor and the rectal fossa of the uterus, etc.
4) Ultrasonography to diagnose the cause of infertility: uterine lesions including congenital or uterine developmental abnormalities, adenomyosis, uterine fibroids, intrauterine lesions such as submucosal fibroids, endometrial polyps, intrauterine calcified foci, etc.; tubal lesions: tubal effusion; ovarian lesions: ovarian endometriosis cysts, polycystic ovary syndrome, ovarian tumors, etc.
5) Ultrasonography in infertility treatment: monitoring follicular development; ultrasound-guided follicular aspiration; determining the degree of uterine and endometrial development and the timing of embryo implantation; ultrasound-guided embryo transfer.
4.Laparoscopy.
Laparoscopic observation of the pelvis under direct vision can reveal lesions of the uterus, ovaries, fallopian tubes and pelvic peritoneum. At the same time, it is possible to perform microscopic surgery if necessary.
5.Hysteroscopy.
It can be used to examine the uterine cavity under direct vision, and is effective for the diagnosis of endometrial polyps, endometrial hyperplasia, small submucosal fibroids, uterine adhesions, uterine scars, incomplete longitudinal cavity and endometrial calcification. If necessary, it is performed simultaneously with laparoscopy.
6.Karyotype examination of chromosomes.
Applicable to adverse pregnancy history: recurrent spontaneous miscarriage or embryonic abortion, history of staph, stillbirth, abnormal fetus, abnormal offspring development, etc.; and patients with primary amenorrhea or abnormal development of reproductive organs.
7. Immunological examination.
For unexplained infertility, immunological examinations such as anti-sperm antibodies and anti-cardiolipin antibodies should be performed on the female partner.
8. Pre-IVF examination.
Routine examination of cervical secretion (bacteria, gonococcus, mycobacteria), chlamydia, mycoplasma culture, TORCH, HIV, RPR, hepatitis B two-and-a-half screening (hepatitis B virus DNA for virus carriers), liver and kidney function, blood and urine routine, coagulation function, electrocardiogram, chest X-ray.