Pre-pregnancy diagnostic methods

Pre-pregnancy diagnostic methods

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The investigation of an infertile couple begins with a prediction that both men and women come together. In the meantime, previous examinations and films of the couple, if any, are evaluated. An internal and gynecological history of the woman is taken, and the man's problem, if any, is discussed. Gynecological examination and ultrasonography of the woman is performed in the same session or at a later session. The presence of any pathology is noted. If necessary, urological examination of the man is requested. Afterwards, one or more of the following examinations will be requested in accordance with the findings and findings that have occurred so far.

1. Evaluation of female reproductive organs

Evaluation of cervix

The test to determine whether the cervix is ​​permeable to sperm is called a postcoital test. Gynecological examination is performed within 2-8 hours of the relationship on the day that the woman's egg will crack and the mucus taken from the cervix is ​​examined for sperm (male cell) content. The motions and progression of sperm within the mucus are investigated. However, this method has lost its importance in modern infertility approach because the test does not give the same results when repeated and the pregnancy is seen even in women with abnormal test.

Evaluation of uterus
Hysterosalpingography (HSG: uterine film), hysteroscopy, hysterosonography and falloposcopy are among the methods used for uterine factor. HSG can be performed within 5-7 days after the end of menstrual period. HSG may cause uterine fibroids, polyps, and structural disorders (double uterus, etc.). Hysterosonography is an ultrasound method which is used for the same purpose by injecting fluid into the uterus. Because it is less painful and cheaper than HSG and does not require X-ray, its value increases day by day. Hysteroscopy is a technique where the inside of the uterus can be seen directly under general anesthesia with a telescope with videomonitor system. The detected fibroids, polyps, or a membrane that narrows the uterus can then be removed by electrocautery or laser. With the increasing popularity of this technique, hospitalization has become a thing of the past. It is possible to return to normal life in a few days.

Evaluation of tubes
Evaluating the permeability, anatomy, adhesions and function of the tubes is one of the most critical stages of infertility research. HSG is still the most widely used valuable test for this purpose. It is interpreted whether the contrast material given from the cervix is ​​poured into the abdomen from both tubes and whether this flow is normal or not. For this purpose, there are new research techniques such as color Doppler ultrasonography and radionuclide HSG. However, laparoscopy is the determining technique in this regard. The pathologies detected during this period are visually monitored and their value is undisputed.

Under general anesthesia, 1 cm. wide sheath is transmitted to the abdomen, the image of the telescope is reflected live on the monitor uterus, tubes and both ovaries, peritoneum (peritoneum) intestines, the status of the bladder is directly monitored and the relationship of organs with each other, adhesions between them, ovarian cysts can be detected. Moreover, problems that prevent pregnancy can be eliminated by means of thin instruments delivered to the abdomen via other thin sheaths at the time (knife-free, seamless surgery). Diseases and tubes called endometriosis are best known for laparoscopy. It is decided whether the blue dye given through the cervix passes through the tubes and reaches the abdomen. Again, the patient may be discharged on the same day and within a few days may reach the old pace.

Falloposcopy and tubal drainage
Vaginal or abdominal cannulae can be inserted into the tube with thin flexible cannulae and the health of the hairy surfaces that facilitate fertilization can be evaluated. They are not yet routinely used for infertility investigations and we believe that these techniques will be utilized more in the future.

2. Assessment of hormonal status of women

Follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, progesterone, dehydroepiandrosterone sulfate, testosterone, thyroid stimulating hormone (TSH), thyroid hormones (T3, T4) and other androgens that directly and indirectly affect female reproduction hormones. Decrease, increase or change in the ratio of these hormones may cause problems in the ovulation and consequently reproduction of the woman. It should be known that a patient with increased hair growth, milk coming from his chest or goiter may have problems with his hormones and this situation can be controlled with a simple drug treatment and the couple may have children.

3. Ovulation evaluation

In order for a couple to have children, the man must have enough sperm in the man, and the woman must develop a healthy egg (oocyte) that month and the uterine inner membrane (endometrium), where the egg fertilized by sperm becomes embryo, has to be in adequate health and nutrition. This situation; basal body temperature, progesterone level, endometrial biopsy, urine ready home tests.

Basal body temperature is based on the measurement of body temperature from the first day of menstruation until the day of menstruation. In the middle of the menstrual period, body temperature increases up to 0.3-0.5 degrees. Because of the healthy hormonal environment that becomes evident as a result of ovulation, this increase lasts until a new period. If pregnancy occurs, it continues in the same way. Progesterone hormone levels in the middle of the estimated period after ovulation (midluteal) is detected in the blood taken and required to increase as required. Also on certain days after the start of menstruation, there are ready-to-use home tests that allow the subjective monitoring of LH levels in the woman's urine. Thus, ovulation can be learned by the positive LH in the urine, and a double matching schedule can be given.

Endometrial biopsy
With the formation of the embryo after ovulation and the endometrium of the uterus, it is necessary to make the appropriate preparations, for the formation of a healthy pregnancy. Whether the tissue in the endometrium is of this maturity can be interpreted by a biopsy to be performed within 48 hours of the expected number.

4. Evaluation of the man

As everyone knows, the first thing that comes to mind in such a situation. In recent years, the science of andrology has gone beyond a rough sperm analysis, revealing many more detailed functional evaluation methods of sperm and telling us that we are still at the beginning of this field. These can be briefly referred to as sperm, biochemical, genetic tests, electron microscopic examination, fertilization with other animal eggs, or physicochemical structure (hypoosmotic swelling test) and so on.

Until recently, infertility was considered a woman's problem. This situation, which is a reflection of the fragile male ego, stems from the fact that manhood power and reproductive ability are kept parallel. However, today's studies show that 40 out of every 100 infertile couples have problems with men. Since there is no relationship with sexual power and ejaculation, male infertility can be noticed only if there is no anatomic disorder when he decides to have a child.

Sperm analysis
When investigating the causes of an infertile couple, it is the first man to be examined. The first and cheapest test at this stage is sperm analysis. Although the examination is simple, it is extremely complex and should only be performed in clinics experienced in this field. As the inexperience of the technician examining the sample can change the whole treatment approach, sperm analysis is a crucial step in infertility research.

There are some important points for an adequate sperm analysis. The sample should be fresh, ie no more than 30 minutes between ejaculation and examination. The male should not be discharged by any means during the 2-4 day period prior to giving the sample. The sample should be provided by masturbation and no lubricant or condoms should be used. For these reasons, the sperm sample should be given in the clinic, in special rooms designed for this purpose.

Evaluation of the sample
After ejaculate is taken, it is allowed to liquefy for 30 minutes and then the examination is started. The factors investigated in this review are:

Quantity: Most men may find their semen amount more or less, but the normal amount is between 2-6 mL. Very little of this volume is formed by the sperm, while the majority is the secretion of the prostate gland for carrying the sperm. If the amount is too small, it may be difficult for the sperm to reach the target. Similarly, if too much sperm concentration decreases, chances of pregnancy may decrease.

Fluidity: The semen is gel-like during ejaculation. It liquefies within about 30 minutes and gains fluidity. If there is no liquefaction, the chance of the sperm moving freely decreases and thus the probability of pregnancy decreases.

pH: Normally semen is a basic liquid. It protects the sperm from the acidic environment in the vagina. Impairments in pH balance reduce the chance of sperm survival.

fructose: This sugar provides energy for sperm movement. Its absence suggests a congestion in the male reproductive system.

Number: The number of sperm in the ejaculate is very important. Less than 20 million sperm per milliliter is called a low sperm count, and less than 10 million is called a very low sperm count. This is commonly referred to as oligospermia. In some cases, there is no sperm in the ejaculate. It's called azoospermia. Although semen appears completely normal, there is no sperm in it. In this case, sperm is searched by testicular biopsy (TESA)

Movement: More important than the number is the quality of sperm. In order for the sperm to reach the egg, it must swim. Normally 50% of the sperm should move forward.

Figure: One of the most important indicators of sperm quality is their shape. Fertilization ability of sperm with abnormal shape is low. In a normal sample, 30% of the sperm must be of normal shape.

Other factors such as clustering of sperms and the presence of inflammatory cells in the sample are also controlled. However, the fertilization ability of sperm is under the influence of many known and unknown factors. Therefore, no test can provide 100% accurate information about sperm fertilization ability.

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