Welcome to Mayflower Women's Hospital - Infertility Department

Detailed history (counseling) & examination.
Routine blood investigations (CBC, Blood Sugar, ESR, VDRL, HbSAg, HIV, Urine examination, Bleeding & Clotting time).
BMI (body mass index).
Hormonal assay Serum FSH, LH, Prolactine, TSH, DHES and Insulin.

Serum FSH, LH, Estradiol on Day 3 of cycle
FSH > 10 mIU/ml & E2 > 60 pg/ml indicates poor ovarian reserve.
LH/FSH >2/1 indicates PCOS.
FSH more than 17 mIU/ml on Day 9 after CC indicates poor prognosis.
Low LH, FSH, E2 indicates hypogonadotrophic hypogonadism.

In case of patients suspected to be poor responders, two additional tests

Serum inhibin – B test which is < 45 pg/ml in poor responders.
Clomiphene challenge test.
CC 100mg per day from Day 5 to Day 9 & FSH on Day 10. A high FSH indicates poor response & poor prognosis.

Serum Prolactin & T3, T4, TSH.
In case of patients with PCOS diagnosed by USG or symptomatology or having feature of androgenisation one can do the following tests:

             1. Fasting Serum Insulin level (>10MIu/ml is significant).
             2. Fasting & Post prandial blood sugar.
             3. DHEAS, Androstenedione & testosterone.
             4. In obese patients a follicle phase 17 – OHP level (to rule out congenital adrenal              hyperplasia) & dexamethasone suppression test (to rule out Cushing’s syndrome)
             should be carried out.

Pelvic sonography (Trans-abdominal, Trans-vaginal & Colour Doppler study) of female partner which helps in diagnosis of various pelvic pathologies.
Live 3D (4D) sonography gives more accurate & precise diagnosis.

Hysterosalpingography (HSG):

Examination of the uterine cavity & patency of the tubes under X-ray guidance after instillation of radio-opaque dye in to the uterine cavity.
It provides only photographic images of the uterine cavity & tubes.
Only for diagnostic purpose & not therapeutic.

Role of Endoscopy:

Diagnosis & treatment simultaneously.
No scar / stitches on abdomen & cosmetically superior.
Short hospital stay & faster recovery.
Early resumption of daily activity.

A. Hsteroscopy:

Endoscopic visualization of the uterine cavity.
Diagnostic & therapeutic for uterine septum, polyps, sub-mucus fibroids,asherman’s syndrome, foreign body etc.

B. Laparoscopy:

It is endoscopic visualization of abdominal cavity through small hole.
Diagnostic & therapeutic for uterine fibroids, tubal pathologies, ovarian pathologies, PCOD, endometriosis, adhesions, etc.

C. Salpingoscopy:

Endoscopic visualization of the inner part of the fallopian tube up to the ampullary portion of the tube.
It shows the functional capacity of the tube so that, we can decide whether to offer IUI & IVF-ET.

Investigations & Diagnosis for Male Partner:

Detailed history (counseling) & examination.
Routine blood & urine investigations.
Semen analysis after 4 days of abstinence.
Hormonal assay: FSH, LH, TSH, Testosterone, Prolactine
Optional tests : semen culture
Kruger sperm morphology
Sonography & Colour Doppler study of scrotum.
Testicular biopsy.
Sperm antibodies: Immunobead & MAR test
Scrotal Doppler to rule out varicocele