Female Infertility Diagnostics

Hormonal tests are selected individually. FSH and estradiol are usually measured at the beginning of the menstrual cycle, while AMH can be tested on any day and provides information about ovarian reserve, but not egg quality.

In cases of ovulatory disorders, irregular menstrual cycles, or suspected polycystic ovary syndrome (PCOS), tests may include LH, prolactin, testosterone, and other androgens. TSH and FT4 are used to assess thyroid function, while progesterone may help confirm that ovulation has occurred.

Results are interpreted in the context of age, the day of the menstrual cycle, symptoms, and ultrasound findings.

Polycystic ovary syndrome is a common cause of irregular or absent ovulation. It may be associated with irregular menstrual cycles, acne, increased body or facial hair, weight gain, insulin resistance, or elevated androgen levels.

The diagnosis is not based on the ultrasound appearance of the ovaries alone. The menstrual cycle, clinical symptoms, hormone levels, and ultrasound findings all need to be assessed. Other conditions with similar symptoms should also be excluded before a diagnosis is made.

Ovarian reserve reflects the approximate number of remaining eggs. It does not directly indicate their quality. Age remains the most important factor associated with egg quality and the likelihood of conception.

Anti-Müllerian hormone (AMH) and the antral follicle count provide information about the quantity of the ovarian reserve and the expected ovarian response to stimulation. A low AMH level does not mean that natural pregnancy is impossible. The result should be interpreted together with age, ultrasound findings, and the overall reproductive history.

Endometriosis is a chronic, oestrogen-dependent inflammatory condition in which tissue similar to the lining of the uterus grows outside the uterus. It may affect the ovaries, fallopian tubes, and tissues within the pelvis.

Inflammation, adhesions, and endometriomas can alter normal pelvic anatomy and make it more difficult for the egg and sperm to meet. Some forms of endometriosis can be identified by ultrasound, while others may not be visible during a standard ultrasound examination.

Laparoscopy is not routinely recommended for every woman with suspected endometriosis. It may be considered when there is severe pain, characteristic imaging findings, or another medical reason for surgical evaluation.

The fallopian tubes may be damaged following pelvic infections, surgery, ectopic pregnancy, endometriosis, or the formation of adhesions. In some cases, fluid can accumulate within a blocked tube. This condition is called hydrosalpinx and may negatively affect implantation.

If both fallopian tubes are blocked, the egg and sperm cannot meet naturally. When one tube remains open and functional, natural conception may still be possible. The assessment also takes into account the woman’s age, ovulation, ovarian reserve, and semen analysis results.

Polyps, intrauterine adhesions, a uterine septum, and certain types of fibroids can alter the shape of the uterine cavity and may affect implantation.

Not every fibroid or other finding requires treatment. Its size, location, and proximity to the endometrium are important. Submucosal fibroids that extend into the uterine cavity generally have a greater impact on fertility than small fibroids located on the outer surface of the uterus.

Genetic and autoimmune causes are investigated when there are specific medical indications. In cases of recurrent pregnancy loss, evaluation for antiphospholipid syndrome or genetic testing of both partners may be considered.

Unexplained infertility is diagnosed when ovulation is present, the uterine cavity is suitable, at least one fallopian tube is open, and the semen analysis does not show abnormalities that would explain the absence of pregnancy.

In these cases, the treatment plan is based on the woman’s age, how long the couple has been trying to conceive, previous pregnancies, and the individual prognosis.