Diagnostics in assisted human reproduction

Abstract

The World Health Organization (WHO) estimates that 50-80 x 10(6) couples in the world are infertile, i.e. 7-15% of all couples of reproductive age (15-45 years old). The term infertility refers to couples who have been unable to conceive children for at least 1 year of regular unprotected intercourse. Although the frequency and origin of infertility varies, approximately 40-60% of the aetiology of infertility in the population studied is due to female causes. The introduction of assisted reproduction techniques, which offer couples the best opportunities for pregnancy, has opened a vast field of knowledge in reproductive biology. The medical history must be taken meticulously, with enough time to obtain the largest possible amount of relevant information. It is recommended that both partners be included in the initial work-up. In recent decades, technological progress has been favoured with the development of a great variety of diagnostic tests. Moreover, a very valuable tool helping to solve this problem has gained strength and is available to everybody - so-called 'evidence-based medicine'. There are three categories in infertility diagnostic tests. The first category includes tests showing a well-established correlation with pregnancy, e.g. semen analysis, tubal patency with hysterosalpingography or laparoscopy, and ovulation detection. The second category includes patients whose results are not consistently related to pregnancy. Here, these tests include sperm penetration assay in the zona-free hamster oocyte, post-coital tests, sperm penetration into cervical mucus, and tests to detect anti-sperm antibodies. The third group includes patients whose tests are not correlated with pregnancy. The relevant tests include endometrial biopsy, the presence of varicocele, and Chlamydia detection tests. Tests for infertility are often expensive. Since these patients are usually anxious and eager and will do almost anything to have a child, care must be taken to avoid exploitation of their hopes with unnecessary procedures. This text now reviews and updates the procedures used to investigate infertility.

T helper cell subsets and related cytokines in infertile women undergoing in vitro fertilization before and after seminal plasma exposure

“…Infertility has been defined as the failure to conceive successfully after 1 year of unprotected intercourse. This condition affects approximately 7%–15% of couples of reproductive age [ 1 ]. Many factors, such as endocrine and immunological factors, might predispose a couple to infertility.…”

Human Papillomavirus Infection and Fertility Alteration: A Systematic Review

“…This definition seems insufficient because it does not take into consideration all the cases. In effect, for many couples, this inability can be overcome by a treatment or a medically assisted procreation procedure after diagnosis [ 1 ]. Infertility is a complex human health situation which particularly alters the quality of life in couples that face it.…”

Orthodox medical tests and investigations

“…15,18 Values of >12 mIU/mL on the third day of the menstrual cycle (especially levels >20 mIU/mL) suggest very poor prognosis of pregnancy. Reference values for FSH vary, but most laboratories use a cut-off point for FSH at <10 mIU/mL.…”

“…Reference values for FSH vary, but most laboratories use a cut-off point for FSH at <10 mIU/mL. 15,16 However, E2 levels on their own should not be used to measure ovarian reserve. 15 Care should be taken to check E2 concentrations at the same time as those of FSH because high E2 levels can have a negative feedback on FSH values (by artificially suppressing FSH, thus giving false normal FSH values).…”