I. When do I need to see a doctor?
When a couple of childbearing age has lived together for more than 1 year, has a normal sex life and does not use any contraceptive measures, and the woman cannot conceive, or the woman can conceive but cannot carry a baby or give birth, they should seek medical consultation in time.
In addition, the conception rate of a normal couple without contraception and with a regular sexual life for 3 months is about 70%. If a newlywed couple has never undergone a marriage test or eugenics examination, and the woman has not conceived after 3 months without contraception and with regular sex, they should go to the hospital for examination.
II. How to see a doctor?
①Who should see the doctor first, the husband or the wife?
Our recommendation is for both spouses to see the doctor at the same time. Pregnancy is not a personal matter, and a simultaneous visit can be more efficient in finding the cause of infertility.
②Where should I go for infertility treatment?
Here we emphasize the importance of going to the gynecology or fertility department of a regular public hospital. The doctors here have undergone formal study and training, and the tests and diagnoses given to patients will be clearer, and the examination machines and equipment in large hospitals are more advanced and the results are more accurate and reliable.
Third, what are the tests for initial diagnosis
①Menstrual examination (the 2nd-4th days of menstruation)
Ultrasound: Yin ultrasound to understand the development of the basic follicle;
Endocrine 6: To understand the basic endocrine condition.
If there is prolonged menstruation or late menstruation or amenorrhea, blood can be drawn at any time on an empty stomach for endocrine examination.
②Non-menstrual examination: (for those with regular menstruation, the 10th-12th day of menstruation is recommended; do not have intercourse 24h before the examination)
Pelvic ultrasound to understand the uterus, endometrium and follicle development, gynecological examination, routine white belt, mycoplasma, chlamydia.
And eugenics four, female infertility immunological examination, chromosome, hepatitis B, hepatitis C, AIDS and syphilis these tests can be carried out during menstruation or non-menstrual period, but because they and endocrine examination are tested with blood as specimen, blood can be drawn at once during menstruation.
IV. Special examination
1.Checking the degree of tubal patency
If there is no special finding in the above examination, if pelvic inflammatory disease is considered in the pelvic examination, tubal patency examination is required after treatment; or if ovulation is detected and intercourse is performed for 3 cycles according to medical advice, but no pregnancy has occurred, it is also recommended to perform this examination. However, because of the invasive nature of the tubal test, it is recommended that the male partner should undergo a semen test to rule out azoospermia or severe oligospermia before the test. There are currently 4 types of tests for tubal patency: hysterosalpingography (HSG), tubal lysis, hysterosalpingography with ultrasound, and hysteroscopic lysis. The doctor will advise the patient on the choice, taking into account the different conditions of the patient. The examination should be performed 3-7 days after menstruation and no intercourse during this period. Before the examination, routine blood test, four infectious diseases, white belt routine and electrocardiogram should be performed to ensure the safety of the examination.
2.Hysteroscopy
Hysteroscopy is required for recurrent miscarriage considering uterine factors. In addition, hysteroscopy can be both an examination and a hysteroscopic surgery during the examination. For example, separation of longitudinal uterus, removal of endometrial polyps, separation of uterine adhesions, removal of submucosal fibroids, etc. The examination time and precautions are the same as those for tubal examination.
V. How to read the initial laboratory test
1.Endocrine
Progesterone P, testosterone T, estradiol E2, prolactin PRL, follicle stimulating hormone FSH, luteinizing hormone LH and thyroid hormone examination are included. Low post-ovulatory blood P values are most often seen in luteal insufficiency and ovulatory dysfunctional uterine bleeding. Elevated blood T values, called hypertestosteronism, can cause infertility; elevated blood T values can also occur in patients with polycystic ovary syndrome. Low values of E2 are common in patients with ovarian hypofunction and premature ovarian failure. increased PRL during non-lactation is called hyperprolactinemia. excessive PRL can inhibit the secretion of FSH and LH, suppress ovarian function and inhibit ovulation. low values of FSH can be seen during estrogen and progesterone therapy, and its elevation indicates premature ovarian failure, ovarian insensitivity syndrome and primary amenorrhea. When FSH is higher than 40mIU/ml, the patient will be ineffective to pro-ovulatory drugs like clomiphene; LH below 5mIU/ml indicates gonadotropin insufficiency; high FSH combined with high LH indicates ovarian failure.
2. Eugenics IV
The prevalence of toxoplasmosis is 4%-9%, and the rate of intrauterine fetal infection is 0.5%-1.0%. In early pregnancy (<3 months), it can mostly cause miscarriage, stillbirth or abnormal development. Rubella virus has the highest incidence of infection in the first to third trimester of pregnancy and can cause the congenital rubella syndrome triad in the prenatal fetus: cardiovascular malformations, congenital cataracts, and deafness. The first infection of cytomegalovirus in pregnant women can invade the fetal nervous system and cardiovascular system through the placenta, causing miscarriage and stillbirth. Herpes simplex virus infecting the fetus before 20 weeks of gestation has a miscarriage rate of about 34%, and the main cause of congenital infection in pregnant women is HSV-II.
3.Immunological examination for female infertility
It includes anti-sperm antibodies-IgG, IgM; anti-cardiolipin antibodies-IgG, IgM; anti-endometrial antibodies-IgG, IgM; anti-ovarian antibodies, anti-HCG antibodies; anti-hyaline antibody, which are mandatory for infertile women.