Examination of infertility

In the early stages of couples should be checked out together, then the examination conducted separate husband and wife. Stages of inspection are:
I. Interview stage The initial phase of an interview for collecting data about the patient's identity, medical history, history of previous marriage and now, history of infertility, history of sexual relationships, and reproductive history.
II. Stage of physical examination Physical examination of both husband and wife include:
General physical condition, such as height, weight, hair distribution, etc.. State of reproductive organs, such as testis, vagina, clitoris, uterus, etc.. III.Tahap laboratory examination Man Analysis of sperm to determine the quality of semen and spermatozoanya, including the number of sperm / ml, shape, motion, number and percentage of live and thawing semen.
Woman Monitoring of ovulation, to determine whether the ovary produces a mature egg cell. Monitoring of ovulation can be done in several ways:
History of the menstrual cycle: menstrual cycles are regular and normal, mid-cycle pain, bleeding or increased sickness or vaginal fluids (vaginal discharge), Mastalgia PMS indicates ovulation has occurred. Fern test: examination on days 23-28 of the menstrual cycle, the wife asked to come for cervical lymph retrieval of endocervical canal and then dried on object glass and examined the influence of estrogen. If there is no pattern of fern leaves and cervical lymph crystal means ovulation has occurred. Basal Body Temperature (SBB): SBB is checked every morning wake up before doing any activity. The value marked on the graph paper. If a woman ovulates, the graph will show the biphasic pattern with a dive in mid-cycle. Endocervical or vaginal cytology cytology: monitor changes in cells that tereksfoliasi during the luteal phase (progesterone effect). Endometrial biopsy (mikrokuretase): can be done poliklinis with mild anesthesia or without anesthesia. By using a small curette. Performed on 5-7 days before the next menstruation. Diagnostic laparoscopy: see firsthand the spots Ovu-Outcome or corpus luteum as a result of ovulation. Hormone calibration: determining hormone levels in blood, urine nor saliva (saliva). Normal levels in one cycle:
Type
hormone
Phase of the menstrual cycle
Unit
Preovulatory
Ovulation
Post-ovulation
FSH
MUI / ml
5-20
15-45
5-12
LH
MUI / ml
5-15
30-40
5-15
PRL
ng / ml
-
5-25
-
E2
pg / ml
25-75
200-600
100-300
P
ng / ml
<5
5-8
10-30
Hysteroscopy: a painting of the endometrium may show a clear yellow, which correspond to the luteal phase. Ultrasonography: can monitor the follicular development and determine when ovulation. Examinations performed serially. Assessment of the uterus and fallopian tubes can be done in several ways:
Endometrial biopsy: in addition to assessment of ovulation, can also be for other histological examination, such as culture against tuberculosis, assess the presence of endometrial hyperplasia. Sometimes found the existence of focal hyperplasia despite ovulating cycle based on the calibration P plasma hormones in mid-luteal phase.It is therefore necessary to examine the ratio P/E2 and PRL/E2 along with endometrial biopsy. Insufflation test / pertubasi: CO2 is bubbled through the cervical canal and made recordings kymograf against uterine pressure, pressure changes mean tuba Falloppii patent. This gas can also be heard with stesto-spade or seen with X-rays Hydrotubation: pertubasi principle the same as just that is used is a liquid containing the antibiotic kanamycin 1 g, dexamethasone 5 mg and antipasmodik liquid. Hysterosalpingogram: half-done on the first menstrual cycle, laru-tan radioopak injected through the cervical canal into the uterus and fallopian tubes. Travel solution was monitored on the screen with the image amplifier. Hysteroscopy: see firsthand the surface state of endome-trump. Laparoscopy: direct view and test patensinya injected with a solution of methylene blue or indigokarmin, and with a view pelimpahannya into the peritoneal cavity.Laparoscopy can also show pelvic adhesions, endometriosis, and ovarian pathology, but can not describe the state of the uterine cavity. Ultrasound or endosonografi: assessing the shape, size, and uterine pathology or thick endometrium. Analysis-KM TORSH infection (toxoplasmosis, rubella, sitomegalus, herpes sim-complex, chlamydia, mycoplasma). Post-coital test (UPS) to see if the semen was flashed at either the top of the vagina during intercourse. UPS is done 2-3 days before the estimated ovulation.Patients were asked to come 2-8 hours after the prop-ma normal. Cervical sap sucked from the endocervical canal and examined with a microscope, if there are 20 spermatozoa per field of view (LPB = X400) then the chances of getting pregnant is quite large, between 10-20 spermatozoa per LPB has been satisfactory. Hysteroscopy or uterine cavity binoculars Laparoscopic or abdominal cavity binoculars Tuboskopi / Falloposkopi or binoculars cavity egg coating Hidrolaparoskopi or binoculars pelvic cavity with fluid flooding IV. Examination
Endoscopic examination is the examination by using a telescope (binoculars) that is inserted into the body cavity through a natural channel (cervical canal: at hysteroscopy; cervical canal, uterine cavity, the mouth of the oviduct: the tuboskopi / Falloposkopi), a minor surgery (in the navel area or umbilicus: at laparoscopy; at the top of the hollow rear or posterior fornix of the vagina: the hidrolaparoskopi). There are 4 (four) types in the field of gynecologic endoscopy:
Hysteroscopy is used to see the state line the cervix, uterine cavity, the mouth of the oviduct, uterine cavity size, color or clarity of the lining of the uterus, endometrial polyps and to distinguish leiomiom submukosum; to ensure adherence of in utero and congenital abnormalities in the uterus; for to recognize abnormalities on histerogram; as well as for management operations on the septum of the uterus that cause recurrent miscarriages. Laparoscopy is used to view a variety of abnormalities in the pelvic cavity (pelvis) or abdominal cavity (abdomen) such as cysts (tumors) ovaries (ovary), tumors of the uterus (uterine myoma), adhesions in the pelvis due to infection or endometriosis, nodule- nodule (lesions) endometriosis is not seen with ultrasound, swelling of the oviduct (hidrosalpinks), as well as some congenital uterine abnormalities such as two-horn of the uterus (uterine bikornis) or absence of ovaries (ovary agenesis).
Tuboskopi or Falloposkopi used to see the inside of the oviduct, either surface or sockets, for example, are there adhesions from infection, congenital narrowing, and loss of feathers vibrating (cilia) mucous membranes (mu-vocabulary) oviduct.
Hidrolaparoskopi is an advanced technique to see an impaired function and anatomic end of the fallopian tubes or hollow behind the uterus (Douglas pouch), such as attachment end of the oviduct (fimbria), endometriosis, uterine myoma subserum in the back of the uterus or ovarian cyst.
Endoscopic examination was not done just like that in all women, but rather should be the basis of clear, for example, infertile women who have been doing the basic infertility investigation before the cause is unknown but infertilnya, and in women suspected of endometriosis, myoma, or uterine cancer tumors .