Regardless of the nature and type of infertility, infertility investigations are considered basic to infertility management because they can unfold the cause of infertility in 80-90% of causes. These include semen analysis test, test of tribal potency (HSG, LG and adulatory function test). Additional or secondary investigation could be performed there is as immediate explanation for the cause of infertility from these basic test or when one of these test is inconclusive /abnormal.
Also, conferee commencing these investigations, endocrinal beuch microscopy culture and sensitivity is adviced before proceeding to do HSG. Beselien pelne scan is also some an denesing an appropriately sensitive technique is advisable but not usually feasible in may done settings of Africa. Hence, prophylactic antibiotic may be considered and before interne institution has (including HSG) if seceding has not been carried out ancillary investigations like packed cell volume (PIV) analysis (protein, glucose, mizroscoy) and other general investigation as might be indicated by  the general health condition of the clients.

Basic Infertility Test                   
Seminal fluid Analgesic (SFA)
The semen sample for analysis is normally obtained from the male partner following 3-5days of sexual abstinence. The sample should be pregnable collected by the saturation in a clear wide bore container. Collection by coitus interrupticus or with a latex condom impregnated with a spermicidal agent is not recommended ideally collection should take place in the hospital where analysis can be done immediately or within 30 to 1hour of most for those bring their sample from outside the hospital. The sample is then analyzed for volume count, mollify, morphology cultured to exclude the presence of bacteria organisms the SFA result (see table 3 & 4)
            The standard semen analysis has a sensitivity of about 90% (i.e 9 out of 10men with a genuine problem are detected) It is not, however, particularly specific test and a single sample analysis will falsely identify 10% of men as abnormal. Repeating the test reduces this chance to 2%.
            Marked fluctuations of the various semen parameters have been observed in normal fertile men. It is therefore important to repeat the semen analysis once any abnormality (interact of 2-3 mouths apart) is found with the first SAF. Repeat confirmatory test should ideally be undertaken 2-3 months after the initial analysis to allow for the cycle of spermatozoa formation to be completed (72days). However, if a gross spermatozoa deficiency (Azosperma or severe digospermia) has been detected, the repeat test should be undertaken earlier (i.e 4-6 weeks apart).
Test of Ovulation
            Clinical indicators of ovulation include mid cycle ovulatory pain (mittelschmerz), menstrual cycles in the range of 26-35 days.
            Confirmatory ovulation test is an important part of the basic infertility investigation and should be done whether or not the woman is menstruating normally, since about 10% of women with regular menstrual cycles may be anoovulatory.
            Several tests of ovulation are currently available but only few can be of practical evaluation of the infertile woman these include:-
Producer (using kaman’s syrup) and has the additional benefit of being able to diagnose other abnormalities that may be associated with infertility such as lacteal please defect and tuberculous endometritis. Semen progesterou:- ovulation can be confirmed retrospectively by measurement of the semen progesterone in the in lacteal phase, on approximately day 21 of a 28-day cycle.
            Several tests of ovulation are currently available (all dependent on the secretion of progesterone by the corpus luteum) but only few appear to be practically utilized in the clinical evaluation of the infertile women. These include:-
Endometrial Biopsy: sampling the endometrium to access progesterone production by the corpus luteum gives indirect evidence of the presence or absence of ovulation. It consist of a histological assessment of endometrial biopsy taken (day 21 regualar 28 day cycle. Or late luteal phase preferable 1-3 days before menses) normal ovulatory menstrual cycle would demonstrate a secretary endometrium with maturity that is compatible with the day of endometrial sample which non-ovulatory cycles would reveal pholiferative endometum. Endometrial biopsy can also identify ovulatory abnormalities like luteal phase deficiency which is presumptively diagnosed when there is a 3-days or more discrepancy in the maturity of the sampled.
            Its however, major available is mainly from difficulty in interpreting the biopsy because precision and accuracy vary greatly among individuals woman should not be offered an endometrial biopsy to evaluate the luteal phase as part of the investigation of infertility problems because there is no evidence that medial treatment of luteal phase defect improves pregnancy rats moreover,               
            Endometrial biopsy (EB) is no longer done routinely as part of infertility investigations except when endometrial pathology (such as tuberculosis) is being considered, making it an indication of Ep developed countries of Africa where this condition may be commonly assisted with infertility.  

Serum progesterone Estimation
            Consist of the estimation of serum progesterone in the mid leteal phase of their cycle on approximately nay 21 of a 28 day cycle) or a progesterone index (mean value of samples taken on days 20, 21 ad 22) to confirm ovulation retrospectively. Available evidence suggest that even within the normal range, higher progesterone levels associated with higher conception rate whole lower progesterone levels have lower pregnancy levels have lower rates of conception.
            The level needs to be interpreted in the light of the date of the subsequent menses. For women with irregular cycle, this test may need to be performed later in the cycle (for example day 28 of a 35 day cycle) or repeated weekly until the next menstrual cycle starts.
·        A level < 16 nmol/L suggest an ovulation
·        Levels > 30nmol/L is suggestive of ovulation, although WHO threshold is 18mmel/L (as this represent the 2.5th centile in a large population study)
·        Levels between 16 and 30 nmol/L should be repeated further investigation of unovulation should take place n tertiary care or specialized fertility clinics
            However,  hormone assay are often of available or affordable to couples in many clinics in Africa as a tool for basic investigation.
Ultrasound scan (USS)  
Ussacn, by contrast, is now available in increasing number of centres in Africa for the assessment of ovulation. With a sector ultrasound scan and a vaginal probe, it is now possible to visvalise the ovaries and ovarian follicles quite easily. An ultrasound scan (baseline scan) done at the beginning of the menstrual cycle usually reveals the follicles (as echoluscent circular spots within the more echolgenic ovarian tissue) which are normally not more than 3-4 mn initially paragraph with serial scans between day 8 and day 14, the follicles would be seen to increase in size up to a maximum of 20-22 mm and ovulation is then deferinched by the disappearance of the follicle and appearance of a distinct corpus luteum.
            Hence, ultrasound folliculagrphy (follicular tracking) is very useful in monitoring ovulation during induction of labour in specialized futility clinics worldwide. In addition, the thickness and reflectively of the endometrial eaho can be assessed at the tune of ultrasound folliculogrphy. However, the uss of the method for the assessment of ovulation in Africa is limited by the high cost of ultrasound equipment.
            Other methods that can be used for assessment of ovulation include use of home ovulation test such as measurement of daily basil body temperature (BBT) or use of lateralizing hormone (LH) defection kits by the woman to track her ovulation at home. Basal body temperature (BBT) tracing is not generally recommended for ovulation assessment in Africa because the method stressful with is at fondant difficulties in obtaining reliable temperature.. readings from the patients in addition, neither method has been found useful in the practical management of the infertile patient with respect to improving their conception rate.    

Test of Tubal Potency                                  
            Test of tubal potency is an important investigation that need to be carried out as part of basic infertility investigation in our environment since tubal factor is a major infertility in Africa..
            Hysterosalpingophry (HSG) and laparoscopy with dye are the two most commonly used methods to test tubal pathology.

            laparoscopy toye

- done in follicular (day 10 or sule 1st days
Done in luteal phase profer phollizular phase to exclusive pregnancy. 
- radiological setting/procedure
- surgical/theatre procedure
Pain relievers and/or antispatmedics to relax the tubes. (we please dales results from corneal sperms) 
- general anaestheisa  allows better assessment laparouspy (some gynecologist sometimes profer to use local anaesteis with light sedation)   
-Dye/canola oil based day or preferenably  water based sodium amidozoale (hypaque) or urographin preferably) instilled us the cervix using either hilkohson’s or faco canula or foolery catuetor
- less invasive less expensive and eailsy accessible in Africa  
-Dye/canula usually water based dye such as methylene blue or indigo carmine) preferred by some because it does not stain) injected via a tightly fitted cauola (sparkman/ nebin) expensive invasive and hence more complication prone  
Intratubal and intrauterine factors such as asherman’s factors, such as asherman’s syndrome subnucous fibrord, congerit a ulterine abnormalities, tubal package       
Extriutnue and partitioned factors such as pelux peritubal. Adhesions, subserous fibroid) endonetrisis, ovarian cyst (which may be missed by HSG)    
i.e mainly useful to establishing actual potency of the tubes where tubal occlusion exist 
Clear view of the several surface fo the tubes can be obtained, tubal potency determined, peritoneal 
HSG is a reliable indicator of tubal potency but poor at identifying cases of tubal occlusion
The sensitivity, specificity and predictive value of laparoscopy for tubal diseases is substantially greater than that of HSG   
-normal HSG has compared to laparoscopy (with opening up of mocos plays and actuating tubal cities) 
Normial lap and dye is roles associated with a increased pregnancy rate/outcome but usually allow the treatment of pathology at the same time such as adherioslysis ablation of endometriosis or salping ostomy  
- used as screening procedure
Gold standard /confirmatory test for investigating the fallopian tube 
-low risk group with no history of co-morbidities (such as PID /STD pestabortal/ puerperal surgeries etc) 
High risk group with hx suggestive of reproduction pathology impairment  

- six (6) months after normal HSG without conception 
Hysteroscal pornography and laparoscopy are now regarded as being complementary in the investigation of infertility. None of the procedures ont heir own, can fully assess the extent of infertility. Women not known to have tubal disease should be offered HSG or Hycosy to screen for tubal occlusion because they are reliable tests for ruling out tubal occlusion, less invasive and make more efficient use of resources than laparoscopy especially in developing courtiers of Africa. However, if only one test can be done, the practical recommendation is that this should by laparoscopy (+dye test) with the hope that if this is normal it obviates the need for HSG in a large population of case.
Hysterocontiastsougrphy (Hycosy) is a modern ultrasound based investigation which uses a son reflective contrast media to outline the uterine country and fallopian tubes. It is a simple test well tolerated, avoids exposure to x-rays and may be a suitable alternative out patient procedure.
            Hycosy has been shown to be comparable to HSG demonstrated good concordance with lap and dye, but is yet to become part of standard care in most centres especially in developing countries of Africa.
            Other techniques such as fertiloscopy and  fallopsoscopy require further evaluation before incorporated into routine practice.
            It must be noted that endceivcal such should be done before any instrumentation of the literus to reduce the risk of pelvic infections. Alternative by, prophylactic antibiotics may be given.     

            Further/testing final infertility investigation
            These investigations become necessary when the basic infertility evaluation are abnormal they are usually carried in specialized secondary or tertiary centres and fertility clinics.
            Inconclusive in determining the cause or clinical evidence of hypogonaism or raricocele. Further investigation of semen abnormalities a conclusion of normality or otherwise should be based on at least 2-3 semen analysis 4 to 6 weeks apart. Three abnormal properly collected semen specimen are indication for additional test to determine  the achology of the deduced/ abnormal semen parameten. These additional test include
1.         Endocrine test                                                    
·        Hormonal assay                    (fsit, lit, frolactin, testisterou)
·        Chromosomal                       (karyotyping, cystic fibrosis gene screen, Y-                                          chromosome micro deflection, ya, deletion,                                           FISH)   
genital tract
Imaging of the male             (Vasography, usccan scrotalnad                                                                transurethral Doppler studies,                                                                   theremographod venography)
semen culture   
Microbiology test or            (M/C/s- usually requested in ou                                                                environment because lupection is a major                                              contributor 
·        Antisperm antibodies          (Mixed agglotrmin reaction (MAR), immune                                          bead test)     
2.         Testicular Biopsy     -           is no logner soul as routinely investigation                                                         in male fact infertility because of feat of                                                                         compromising future microsurgical                                                                        proaedures expect where testicular                                                                      carcinoma in situ (CIS) is suspected.       
Obstructure azosperm                     FSH/normal profile noral, testicular size –                                                          nonal             
Cystic Fibrosis                                  Congenital bilated aersense of vas                                                                        defereus (CBAVD) po vasogrphy 
Surgery to gran, scrotum, mettra, vas deferens youngs synodame
Non obstructive -FSH is increased, testicular volume/size small (<15mls)
Klinefelters (r7xxx)
Testicular atrphy
Hypogonadotrophiom                     -           FSIT 1) reduced/noral, testes small
Ejaculatory failure
Retrograde ejaculation                    -           No post ejaculatory analysis for                                                                                        spernatzoa 
Olispermia fault thermoregulation            -           dopplar studies, thermogrpahy                                                                               and venography for confirmation
-incomplete descent                                    -           scrotal ussca
-hyohoceele                                      -          
Occupation – baker
- chaandra                 -           morphological studies
- Tb.
- Mrinps
- gonorrhea
In azospermia or severe oligosperima (25million/ml), a hormonal assay and imaging can help distinguish type of azospermia while genital studies should also be included as any abnormality may have implications for resulting pregnancies.
b.         drugs
- Alcohol
-Caner chemotherapy
- sulpliasalazue
Sperm immobilization (antisperion) antibodies in both semizel plasma and semen when sperm mobility is persistently cow.
Prostatic function test (zince, phosphates, fructose estimation) are not performed routinely but only when there is abnormal semen specimen or clinical evidence of discords of these glads.     
Investigation of anavulation/irregular cycles

            If ovulation is confirmed, no further endocrine test is one required. However, women fund to have low levels of day 2, progesterone (i.e no ovulation) should have hormonal assoy/ students dove.

Investigation for anoilelation    

Baseline day
2-3 (FSH, LH, protection


Assessment of uterine factor 
                 Uterine abnormalities sufficient to cause infertility are uncommon but should be investigated even through a direct casual relationship between these abnormalities (fibroid, polyps, intrauterine adhexous, septate) and infertility has not been established.
                 Assessment of the utems and endometrial cavity is accomplished with ultrasound scan (transvegica/abdominal), hysterosalpingogran (HSG) or saline-infusion sonohysterogrphy (SHG0 hysteroscopy is not offered as part of the initial investigation, it is usually reserved for evolution and treatment of abnormalities identified by less invasive methods.

                 Assessment of cervical factor       
                 The proslcoital test (PCT) has been used to evaluate the adequacy of the cervical music and its interaction with sperm.
                 Thus test is normally performed at 1-2 piror to ovulation (on day 14 of a normal 28 day cycle) by obtaining a sample of the cervical mucus 2-12 hours after intercourse. In the standard criteria (or a normal postcortal test the cervical mucus is often profuse (volume) clear, presence of ferming, more than 5-20cm of stretchanlity (spunnbarkeit effect) and at least 5 mobile 2 perm per high powered filed. An abnormal postcoital test usually implies the absence of those parameters and may be due to wrong towel of the test, abnormal tenvral micus from chronic cervites and antisperm antibodies from the woman or her husband. The utility validity of the PCT have been questioned because of the poor reproducibility poor pregnancy outcome, difficulty a reading consensus or test technique and interpretation. Again, contemporary fertility treatment with intrauterine 1 ugeulation (FUT) or invitio fertilization (IVF) by passes any abnormality of the cervox or cervical mucus. Due to limited diagnostic value, the PCT is only usually mentioned to be condemned in practercal terms, but it may be of some advantage (via Africa where the husband may evidently refuse to submit himself to a formal semen analysis.                         
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