Infertility is often the result of a variety of factors affecting both partners, and the causes must be identified through a thorough examination of both partners, which is the key to treating infertility.
First of all, the general medical history, physical examination and various assessments of the infertile couple should be taken.
Secondly, routine semen analysis of the male partner is the primary examination for infertility, which is performed at the hospital within 3-7 days of abstinence. The test will be performed according to the WHO 5th edition standards, and for abnormal results, 2-3 retests will be performed to confirm. Secondary infertility also needs to be examined.
III. Related examinations: including general physical examination, gynecological examination, vaginal ultrasound and special examination for infertility.
(I) General examination
The doctor will pay attention to the mental state, general development and nutritional status of the friends who come to the clinic, the development of secondary sexual characteristics including breast development, the presence or absence of breast overflow, fat distribution, hair growth, the presence or absence of masculinization; physical variation or skin pigmentation abnormalities caused by endocrine disorders of the pituitary, adrenal and thyroid glands, etc.
1.Body mass index (BMI)
It is a world-recognized grading method to assess the degree of obesity. The formula is BMI=weight (kg)/(height)2(m), and the normal range is 18.5-25kg/m2. Because of the error, BMI can only be used as one of the many standards to assess the weight and health status of individuals.
2.Waist-to-hip ratio (WHR)
That is, the ratio of waist circumference/hip circumference, the normal range should be < 0.85, which is an important indicator to determine < span="">central obesity.
As excessive waist fat can destroy insulin system and lead to diabetes, hypertension, hyperlipidemia and other diseases, and also lead to liver hypertrophy and affect liver function, thus patients should be encouraged to lose weight before treatment, and treatment after 15% weight loss can improve the treatment effect.
3.History of tuberculosis
Most patients lack clear symptoms and positive signs, so when there is primary infertility, scanty menstruation or amenorrhea; when unmarried women have low fever, night sweats, pelvic inflammatory disease or ascites; when there is a history of previous contact with tuberculosis or when I have had pulmonary tuberculosis, pleurisy or intestinal tuberculosis, the possibility of reproductive tuberculosis should be considered and the following tests should be routinely performed.
①PPD test: It is a highly sensitive and specific test. A positive test reaction is of great value in the diagnosis of tuberculosis infection, but it cannot diagnose the presence or absence of tuberculosis in the lungs or determine the nature of the lesion.
②Serum-interferon: It is used for the diagnosis of latent infection of tuberculosis bacilli.
③Frontal and lateral chest films or CT plain scan.
④Pelvic X-ray or CT plain scan: finding isolated calcified spots suggesting a previous pelvic lymphatic tuberculosis lesion.
⑤ Blood sedimentation and anti-tuberculosis antibody: poor sensitivity and specificity, although widely used in clinical practice, but of little diagnostic significance.
4. Thyroid examination: to check for enlargement of the thyroid gland and to assess thyroid function, the main reason being that certain thyroid disorders interfere with normal ovarian function.
(ii) Gynecologic examination
A gynecologic examination is mandatory for the first visit to detect some obvious congenital genital anomalies, such as congenital absence of vagina, vaginal diaphragm, double cervix and double uterus, etc.
(C) Vaginal ultrasound
It is a common clinical examination method in reproductive medicine. It is especially clear for the observation of endometrium and ovaries, especially for endometrial cancer, uterine fibroids, pelvic masses, follicle monitoring, early ectopic pregnancy, etc. The images are more clearly displayed.
(IV) Special infertility tests
1.Serum sex hormone determination
Under normal circumstances, serum hormone levels can be measured on the 2nd-5th day of menstrual cycle in fasting to obtain information about the functional status of ovaries and its influence on the link, and to identify ovarian or pituitary ovulation disorders and amenorrhea.
2.Hysterosalpingography
As infertility caused by tubal disease accounts for 1/3 of female infertility, a normal structure and function of the fallopian tubes is necessary for a normal pregnancy, and accurate evaluation of the structure and function of the fallopian tubes is a key part of the diagnosis and treatment of female infertility. Hysterosalpingography is currently the most common test used to find out whether the fallopian tubes are patent and the degree of patency and the specific site of obstruction. It is usually performed within 3-7 days after menstruation and without acute inflammation of the reproductive system.
3.Clinical scraping of the endometrium
The purpose is to scrape the contents of the uterine cavity for pathological examination to assist in diagnosis.
4.Immunological examination
Some patients with primary infertility are found to have adverse immune reactions such as anti-sperm antibodies, anti-ovarian antibodies and anti-hyaline antibodies through testing. Such immune reactions can kill sperm or inhibit sperm-egg union, causing infertility, and can also be understood indirectly through post-coital test and in vitro sperm penetration test.
5.Hysteroscopy
Hysteroscopy can not only determine the location, size, appearance and scope of the lesion, but also make detailed observation of the tissue structure on the surface of the lesion, and take material or position the uterus for scraping under direct vision, which greatly improves the accuracy of diagnosis of diseases in the uterine cavity and updates, develops and makes up for the shortcomings of traditional treatment methods. It is usually performed within 3-7 days after menstrual cleansing.